Acetazolamide complications

Diuretic-induced metabolic alkalosis is another adverse effect that may further compromise cardiac function. This complication can be treated with replacement of K+ and restoration of intravascular volume with saline however, severe heart failure may preclude the use of saline even in patients who have received excessive diuretic therapy. In these cases, adjunctive use of acetazolamide helps to... 

Metabolic acidosis due to acetazolamide causes increased minute ventilation, which can cause increased intracranial pressure and result in neurological complications (38). 

Compared with acetazolamide, methazolamide generally causes less paresthesia but often causes more drowsiness. Although extremely rare, aplastic anemia and agranulocytosis have been reported as complications of methazolamide therapy. 

Volume resuscitation is the cornerstone of management of lithium toxicity (Table 3) [124, 125]. Patients with underlying lithium-induced diabetes insipidus may initially present with volume depletion. It must be borne in mind, however, that hypernatremia [125] is a potential complication, especially in those with underlying diabetes insipidus. Forced saline diuresis is expected to increase lithium clearance by decreasing proximal tubular reabsorption. With normal renal function, lithium can be cleared at a rate of 10-40 mL/min [125]. The excretion of lithium can be further increased acutely by using acetazolamide and/or loop diuretics [124,125]. 

Moldow B, Sander B, Larsoen M, et al. The effect of acetazolamide on passive and active transport of fluorescein across the blood-retina barrier in retinitis pigmentosa complicated by macular edema. Graefes Arch Clin Exp Ophthalmol 1998 236 881-889. 

Davis DW. Acetazolamide therapy with renal complications. Brit Med J 1959 1 214-215. 

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