Related Experiment Video
Updated: Mar 13, 2026
A Novel Approach for the Administration of Medications and Fluids in Emergency Scenarios and Settings
Published on: November 9, 2016
Acetazolamide Therapy for Metabolic Alkalosis in Pediatric Intensive Care Patients
Carolina López1, Andrés José Alcaraz, Blanca Toledo
11Division of Neonatal Critical Care, Gregorio Marañón General University Hospital, Madrid, Spain.2Department of Pediatrics, Getafe University Hospital, Universidad Europea de Madrid, Research Network on Maternal and Child Health and Development, Getafe, Madrid, Spain.3Red SAMID, Spain.4Division of Pediatric Critical Care, Gregorio Marañon General University Hospital, Madrid, Spain.5Hospital Pharmacy Service, Gregorio Marañón General University Hospital, Madrid, Spain.
Insights
Acetazolamide effectively treats metabolic alkalosis in pediatric intensive care unit (PICU) patients, particularly those recovering from cardiac surgery. This therapy reduced serum bicarbonate and PCO2 levels and increased urine output in these patients.
Area of Science:
- Pediatric critical care medicine
- Pharmacology
- Nephrology
Background:
- Patients in pediatric intensive care units (PICUs) often develop hypochloremic metabolic alkalosis due to loop diuretic use.
- This condition is particularly common in children following cardiac surgery.
Purpose of the Study:
- To evaluate the efficacy of acetazolamide in treating metabolic alkalosis in PICU patients.
- To assess the impact of acetazolamide on acid-base balance and renal function in this population.
Main Methods:
- A retrospective observational study was conducted in a tertiary care children's hospital PICU.
- Data from 58 patients (78 episodes) receiving enteral acetazolamide for at least two days were analyzed.
- Patient groups included postoperative cardiac surgery, decompensated heart failure, and respiratory disease, all of whom received loop diuretics.
Main Results:
- Acetazolamide administration led to a significant decrease in serum bicarbonate (HCO3) and partial pressure of carbon dioxide (PCO2) within 72 hours.
- Cardiac postoperative patients showed a significant increase in urine output.
- No significant changes were observed in serum electrolytes, blood urea, or creatinine levels.
- Acetazolamide treatment was well-tolerated by all patients.
Conclusions:
- Acetazolamide is effective in reducing serum HCO3 and PCO2 in PICU patients with diuretic-induced metabolic alkalosis.
- Cardiac surgery patients experienced improved urine output with acetazolamide therapy.
- Acetazolamide represents a safe and effective treatment option for metabolic alkalosis in critically ill children.
Objective:
Patients in PICUs frequently present hypochloremic metabolic alkalosis secondary to loop diuretic treatment, especially those undergoing cardiac surgery. This study evaluates the effectiveness of acetazolamide therapy for metabolic alkalosis in PICU patients.
Design:
Retrospective, observational study.
Setting:
A tertiary care children's hospital PICU.
Patients:
Children receiving at least a 2-day course of enteral acetazolamide.
Interventions:
None.
Measurements And Main Results:
Demographic variables, diuretic treatment and doses of acetazolamide, urine output, serum electrolytes, urea and creatinine, acid-base excess, pH, and use of mechanical ventilation during treatment were collected. Patients were studied according to their pathology (postoperative cardiac surgery, decompensated heart failure, or respiratory disease). A total of 78 episodes in 58 patients were identified: 48 were carried out in cardiac postoperative patients, 22 in decompensated heart failure, and eight in respiratory patients. All patients received loop diuretics. A decrease in pH and PCO2 in the first 72 hours, a decrease in serum HCO3 (mean, 4.65 ± 4.83; p < 0.001), and an increase in anion gap values were observed. Urine output increased in cardiac postoperative patients (4.5 ± 2.2 vs 5.1 ± 2.0; p = 0.020), whereas diuretic treatment was reduced in cardiac patients. There was no significant difference in serum electrolytes, blood urea, creatinine, nor chloride after the administration of acetazolamide from baseline. Acetazolamide treatment was well tolerated in all patients.
Conclusions:
Acetazolamide decreases serum HCO3 and PCO2 in PICU cardiac patients with metabolic alkalosis secondary to diuretic therapy. Cardiac postoperative patients present a significant increase in urine output after acetazolamide treatment.
More Related Videos
08:47Microdialysis of Excitatory Amino Acids During EEG Recordings in Freely Moving Rats
Published on: November 8, 2018
10:22Interictal High Frequency Oscillations Detected with Simultaneous Magnetoencephalography and Electroencephalography as Biomarker of Pediatric Epilepsy
Published on: December 6, 2016
Related Concept Videos
01:29Disorders of Acid-Base Balance
Respiratory Acidosis and Alkalosis
Respiratory acidosis occurs due to an increase in the partial pressure of carbon dioxide PCO2 in the blood. It often arises from shallow breathing or impaired gas exchange caused by...
01:20Acute Kidney Injury V: Interprofessional Care
01:24Diagnosing Acidosis and Alkalosis
First, the pH level is assessed to determine whether the blood pH is normal (7.35–7.45), low (acidosis), or high (alkalosis).
Next, the PCO2 and...
01:26Pharmacokinetics in Pediatric Patients: Drug Excretion
01:24Pharmacokinetics in Pediatric Patients: Drug Metabolism
01:29Renal Regulation of Acid-Base Balance
In the kidneys, cells within the proximal convoluted tubules (PCT) and the collecting ducts secrete hydrogen ions (H+) into the tubular fluid. Specifically, in the PCT, Na+/H+ antiporters secrete H+ while reabsorbing Na+.
However, the intercalated cells in...