Abstract
Background
Acetazolamide has been studied extensively in post-hypercapnic alkalosis as a tool
to facilitate ventilator weaning in chronic obstructive pulmonary disease (COPD).
It has also been utilized to facilitate respiratory drive in nonmechanically ventilated
patients with COPD. Although this is generally a forgiving intervention, providers
must carefully select patients for this medication, as it can cause severe acidosis
and deterioration of clinical status in severe COPD cases. The present report describes
two cases of patients who developed worsening acidosis and hypercapnia after receiving
acetazolamide in acute respiratory failure.
Case Report
Case 1 was a 72-year-old obese male with COPD who was dependent on supplemental oxygen
and presented to the emergency department (ED) with acute on chronic hypercapnic respiratory
failure. He was given a one-time dose of acetazolamide in the ED for “respiratory
failure made worse by severe metabolic alkalosis.” His arterial blood gas (ABG) worsened
overnight, accompanied by decreased mental status: pH 7.32, paCO2 82 mm Hg, paO2 50 mm Hg, HCO3 41.7 mmol/L, FiO2 32% to pH 7.21, paCO2 91.7 mm Hg, paO2 59 mm Hg, HCO3 36.6 mmol/L, and FiO2 32%. Case 2 was a 62-year-old male with COPD who was dependent on supplemental oxygen
and presented to the ED with acute on chronic hypercapnic respiratory failure. He
was given acetazolamide in the ED with similar results: ABG on presentation pH 7.37,
paCO2 79.3 mm Hg, paO2 77.6 mm Hg, HCO3 45.5 mmol/L, and FiO2 32%. The next morning, ABG was pH 7.29, paCO2 79 mm Hg, paO2 77 mm Hg, HCO3 45.5 mmol/L, and FiO2 32%.
Why Should an Emergency Physician Be Aware of This?
Acetazolamide given early in the uncompensated setting can worsen acidosis and potentiate
clinical deterioration.
Keywords
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Article info
Publication history
Published online: March 30, 2020
Accepted:
January 20,
2020
Received in revised form:
November 25,
2019
Received:
May 6,
2019
Identification
Copyright
© 2020 Elsevier Inc. All rights reserved.
