Management of Diamox (Acetazolamide)-Induced Metabolic Acidosis

Pathophysiology and Assessment

• Acetazolamide causes metabolic acidosis by inhibiting carbonic anhydrase, which increases renal bicarbonate excretion 1
• Obtain arterial blood gas to quantify the degree of acidosis (pH, pCO2, bicarbonate, anion gap) 2

Supportive Treatment

• Dosing of sodium bicarbonate for symptomatic or severe acidosis (pH <7.2) is 1-2 mEq/kg given slowly intravenously 2
• Check electrolytes every 2-4 hours initially until stable 2
• Maintain potassium levels between 4-5 mEq/L 3