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Why Does Acetazolamide Cause Hyperchloremic Metabolic Acidosis

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This parody of Hugh Martin and Ralph Blane's "Have Yourself a Merry Little Christmas" describes the pharmacology of the carbonic anhydrase inhibitor acetazolamide. Lyrics are below. Note that all element abbreviations refer to ions, met. acidosis refers to metabolic acidosis, and pee stones refers to nephrolithiasis. Lyrics: Have yourself some acetazolamide. Stop carb. anhydrase. In the prox. tubule block bicarb. reuptake. Swallow some good acetazolamide. Treat mountain sickness, Glaucoma, and swelling from alkalosis. Watch out for met. acidosis, Pee stones, drowsiness, low K, Bad hyperuricemia, And paresthesias all day. Get rid of more bicarb., Na, and K. More H+ allow, Along with NH4+. Do it somehow. And have yourself some acetazolamide now. Watch out for met. acidosis, Pee stones, drowsiness, low K, Bad hyperuricemia, And paresthesias all day. Get rid of more bicarb., Na, and K. More H+ allow, Along with NH4+. Do it somehow. And have yourself some acetazolamide now. And have yourself some acetazolamide now.

Acetazolamide [tusom | Pharmwiki]

Trade Names: generic, Diamox, Diamox Sequels Drug Class: diuretic (carbonic anhydrase inhibitor) The diuretic effect of acetazolamide is due to its action in the kidney on the reversible reaction involving hydration of carbon dioxide and dehydration of carbonic acid. The result is renal loss of bicarbonate (HCO3 ion), which carries out sodium, water, and potassium. Alkalinization of the urine and promotion of diuresis are the end result. Alteration in ammonia metabolism occurs due to increased reabsorption of ammonia by the renal tubules as a result of urinary alkalinization. Carbonic anhydrase inhibitors were the forerunners of modern diuretics. Legend. Mechanism of action of carbonic anhydrase inhibitor diuretics. Bicarbonate absorption by the proximal tubule is dependent on the activity of carbonic anhydrase (CA) which converts bicarbonate (HCO3-) to CO2 and H2O. CO2 rapidly diffuses across the cell membrane of proximal tubule cells where it is rehydrated back to H2CO3 by carbonic anhydrase. H2CO3 dissociates to HCO3- and H+ which are transported out of the cell on the basolateral side by different transporters. Bicarbonate absorption is therefore dependent on the activity of c Continue reading >>

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  1. Knicks

    In DKA, the patient is acidotic, right? So why would the body decrease bicarbonate (a base)? Wouldn't you want to keep the bicarbonate high so as to neutralize the acid?
    Too tired to think straight at the moment.

  2. generic

    The HCO3 derangement is not a compensation--it is the primary problem.
    DKA patients have a metabolic acidosis, I think it's mostly caused by the formation of tons and tons of ketone bodies (acidic). These are formed because despite high circulating levels of glucose, the cells can't use the glucose without insulin-->turn to ketone formation instead.
    The metabolic acidosis may cause respiratory compensation, which would give Kussmaul breathing, for example.

  3. treva

    Knicks said: ↑
    In DKA, the patient is acidotic, right? So why would the body decrease bicarbonate (a base)? Wouldn't you want to keep the bicarbonate high so as to neutralize the acid?
    Too tired to think straight at the moment. Remember the kidney takes days to compensate for acidodic state by producing more bicarb. Acutely, the bicarb is used to buffer the extra acid, so it drops.
    This also explains why DKA pts have increased RR:
    CO2 + H20 <--> H2CO3 <--> HCO3- + H+
    If you blow off extra CO2 (ie by upping RR) you shift the above equation to the left, and promote the formation of H2CO3 via CA, helping to mop up the H+.

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This video is about Acetazolamide Mechanism

Can Acetazolamide Cause Hyperchloraemia?

Lamisil vs Lotrimin Mucinex vs Sudafed Lactogen 1 Side Effects Evekeo vs Adderall Dexilant and Alcohol Treato does not review third-party posts for accuracy of any kind, including for medical diagnosis or treatments, or events in general. Treato does not provide medical advice, diagnosis or treatment. Usage of the website does not substitute professional medical advice. The side effects featured here are based on those most frequently appearing in user posts on the Internet. The manufacturer's product labeling should always be consulted for a list of side effects most frequently appearing in patients during clinical studies. Talk to your doctor about which medications may be most appropriate for you. The information reflected here is dependent upon the correct functioning of our algorithm. From time-to-time, our system might experience bugs or glitches that affect the accuracy or correct application of mathematical algorithms. We will do our best to update the site if we are made aware of any malfunctioning or misapplication of these algorithms. We cannot guarantee results and occasional interruptions in updating may occur. Please continue to check the site for updated information Continue reading >>

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  1. steverocks83

    Why no ketosis in the morning?

    Hello!
    I have been on Ketogenic diet for bit over a month (with a few cheat days once in a while) and monitoring the ketosis level with Ketone strips. I am very happy with my progress so far, but one thing that always puzzled me is that I never get a ketosis in the morning (at least according to ketone strip) even after a high-fat breakfast with BP coffee. It's only around noon that it starts registering the trace/low amount of ketone, and it gets stronger in the afternoon, and usually at night the strongest. Perhaps because of that, I feel a bit inert & hungry early in the morning, but less so as it gets closer to noon. Is it just me or anyone with similar experience?

  2. yoly2

    The most probable reason is that in the night the body uses most of the ketones produced since you have no food. So there is none to be spill so that the ketone strips can measure. Eating fatty acids doesn't produce ketones instanly it takes liver time to produce ketones in excess and then to arrive to the kidneys were the ketone strips can measure them.

  3. steverocks83

    Thanks yoly2, that makes sense.
    So this fat-rich breakfast I am eating doesn't really kick in until a few hours later. Are there kind of quicker acting fat food that I can eat for breakfast that would give me more energy earlier in the morning?

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Metformin, Diabetes Mellitus, Adverse effects of metformin, How does metformin work, Mechanism of action of metformin, Indications of metformin, Contraindications of metformin, Blood Glucose, Hypoglycemia, Side Effects of metformin Adverse effects of metformin, Oral hypoglycemic Drugs, Metformin and lactic Acidosis, Type II diabetes mellitus, NIDDM, Non insulin dependent diabetes mellitus, Uses of Metformin. About Me: Dr. Sumit Verma MD, DNB , with more than 15 years of experience in clinical medicine / clinical research / pharmacovigilance domain I have co-authored a book titled "Fundamentals of Pharmacovigilance" (http://www.amazon.in/Fundamentals-Pha...) https://www.linkedin.com/in/dr-sumit-... Disclaimer: Medicine is an ever-changing science. The information presented in the video or on this channel is of a general informational nature and should not be considered as specific to the needs of a particular individual or organisation or entity. Please consult your doctor, medical specialist or your health care professional for all matters related to health. The video does not contain all the information about any drug. Any information presented in the video or on this channel does

Acetazolamide For Injection (acetazolamide) Dose, Indications, Adverse Effects, Interactions... From Pdr.net

Acetazolamide/Acetazolamide Sodium/Diamox Intravenous Inj Pwd F/Sol: 500mg Acetazolamide/Diamox Oral Tab: 125mg, 250mg Acetazolamide/Diamox/Diamox Sequels Oral Cap ER: 500mg For the adjunctive treatment of open-angle glaucoma. 250 mg PO given 1 to 4 times daily. Maintenance dosage should be titrated to response. The maximum dosage is 1 g/day. Consider dosage reduction. An elderly patient is more likely to develop hyperchloremic metabolic acidosis in addition to an age-related renal impairment. 8 to 30 mg/kg/day PO or 300 to 900 mg/m2/day, given in divided doses every 8 hours. 5 to 10 mg/kg IV every 6 hours for acute glaucoma. Maximum dosage is 1 g/day. For use as an alternative agent in the treatment of absence seizures. NOTE: The extended release preparation is not recommended for use as an anticonvulsant. Oral dosage (regular-release tablets only) 8 to 30 mg/kg/day PO, given in up to 4 divided doses. The usual maintenance dosage is 375 to 1,000 mg/day. Consider dosage reduction. An elderly patient is more likely to develop hyperchloremic metabolic acidosis in addition to an age-related renal impairment. 8 to 30 mg/kg/day IV, given in up to 4 divided doses. The usual maintenance Continue reading >>

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  1. KinkingPump

    Hi
    A few weeks ago I was admitted to A&E- long story short my sugar was up around 35 as my pump had kinked, I was vomiting up everything. The sugar had been rising for about 12 hours, the first ketone reading I did practically turned the dip stick black, but within 4 hours it was coming back as no ketones (I know how to down water!) and my BS 7.
    I had an easy day the following day and just slept, drank loads of water and then started trying to do "normal" routine stuff the day after that. It took about a week before I was back to normal, I felt crampy and achey, couldn't concetrate on anything and just wanted to sleep! Is there any way of speeding this recovery up? How long does "recovery" take from an episode like this until you feel normal in yourself again? And how do people manage with work- I was getting tellings off for my lack of concentration, I didn't want to go on the sick per se as I didn't feel that I needed to be home in bed, but equally I wasn't capable of performing (I'm an engineer- not a physical labourer, someone who does calculations and lots of sums!)... What should I have done?
    Thanks for any responses, experiences and tips would be really appreciated- I've been diabetic since I was 9 (now 22) and this is the first time I've had real problems (was a teenager with HBAs in the teens on injections, and only been on a pump 9 months with a HBA of 8 now so guessing I'm a lot more sensitive to the highs that I was before!)

  2. SimonClifford

    I kinked mine last night. Was awoken by the pump's blocked-cannula alarm (Aviva Combo), thankfully & nothing untoward had happened.
    Sent from the Diabetes Forum App

  3. Lady_luce_x

    I had DKA just before I went on my pump, which was caused initially by a sickness bug. i was on placement for my university degree at the time. I was in hospital for about 24 hours, and then my mum took me home. I had 3 days off to recover, and like you said mainly just slept and drank water. The week following I felt very crampy and achey, and i think it took a week or so to feel "normal" again. Now if my pump ever messes up (on friday night it disconnected over night) and i ended up with ketones, i recovered without need of A&E but I felt rubbish yesterday (tired, crampy, irritable) and today I'm not feeling 100%. I think once youve had a high level of ketones it takes awhile for your body to recover, they are "poisonous toxins" afterall. Hope you feel better soon

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