tankasnowgod
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I have been interested in Acetazolamide for a while now, and have used it off and on. It certainly has an instant diuretic effect when first using it, but that effect seems to wane pretty quickly. As such, it has seemed to only be useful occasional doses. One of the things I have always wondered about is if bicarbonate (like baking soda) should be used simultaneously. The main reason is that, from every "official" mechanism of action, it increases bicarbonate levels in urine. As such, I have always wondered if higher doses and/or more chronic use (like a few weeks) is counter productive, if the goal is to increase CO2 stores in the body, since bicarbonate is a storage form in the blood. I've seen some warnings about using Acetazolamide and Baking Soda together, but found a series of case studies where extra bicarbonate was supplied.
In the 4 case studies, multiple diuretics were used, but the other diuretics tended to cause alkalosis, which Acetazolamide balanced out. But it seems like a similar effects can happen just by adding bicarbonate or baking soda.
Actuality of the use of acetazolamide as a diuretic: usefulness in refractory edema and in aldosteroneantagonist- related hyperkalemia | Nefrología
This is the last article published in Nefrología by Dr. Carlos Caramelo Díaz. It
revistanefrologia.com
"Acetazolamide (ACZ), a sulphonamide derivative, is the oldest diuretic among those commercially available. Although uncommon nowadays, its use has survived due to its usefulness in glaucoma rather than for its diuretic properties.1
Its role in edema management has been limited because of two essential facts: the induction of metabolic acidosis because of renal bicarbonate loss and the compensating reabsorption effect at distal segments, which preclude its complete use, as shown in figure 1. These circumstances limit its use and imply a particular issue on its management."
She was treated by means of continuous infusion furosemide pump, with a poor diuretic response and persistent hyperkalemia of KP + 7 mEq/L, and severe Na+ retention -Na+ p/u ratio of 126/22 mEq/L. Given the bad clinical situation, a blockade of the different clinical segments with ACZ, furosemide, and hydrochlorotiazide was started. Pulsed doses of 1M bicarbonate were given to keep bicarbonate levels above 22 mmol/L. The clinical improvement and diuretic response were remarkable, with a negative balance of 30 liters in 20 days, normalization of potassium levels, and creatinine decrease to 1.3 mg/dL. This case is remarkable for the magnitude of the diuretic response that was only achieved with multi-segmentary tubular blockade.
Again, and as in case 1, the use of bicarbonate is the differential critical element since it provides ACZ its «working material» and allows perpetuating its effect. The interest of this case is centered in the use of ACZ as a promoting factor for K+ clearance, boosted by adding bicarbonate that counteracts its acidifying effect.
ACZ has not been considered as a first-line drug because of the above-mentioned limitations. The efficacy of ACZ linearly decreases when plasma bicarbonate levels lower than normal are reached. By contrast, its action is complete in the presence of high bicarbonate levels, so that it is a very interesting complementary drug when thiazides or furosemide are used, especially at high doses, rendering these patients particularly susceptible to alkalosis.
The main aspect to highlight is that although ACZ is naturally most effective under alkalosis conditions, its effect may be induced by keeping normal bicarbonate levels by infusing controlled amounts of i.v. bicarbonate, as shown in the cases presented.
In the 4 case studies, multiple diuretics were used, but the other diuretics tended to cause alkalosis, which Acetazolamide balanced out. But it seems like a similar effects can happen just by adding bicarbonate or baking soda.