Case studies using Acetazolamide and Bicarbonate Simultaneously

[tankasnowgod]

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.

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.

 

[YourUniverse]

Nice.

 

[Amazoniac]

These two mention the combination:
- Safety of carbonic anhydrase inhibitors
- Side effects of acetazolamide: A systematic review and meta-analysis assessing overall risk and dose dependence

 

[Ignoramus]

I don't know, but combining them made my feet so tingly I thought they would fall off

 

[tankasnowgod]

I don't know, but combining them made my feet so tingly I thought they would fall off

The "tingly" feeling is a side effect of Acetazolamide. I have gotten this feeling from it alone, without any supplemental baking soda. Have you tried a similar dose without the baking soda?

I sometimes get the feeling that my blood is carbonated, like soda or selzter water. This feeling I like, but the tingly feeling in hands and feet (usually with a bit of numbness), I don't like so much.

 

[Nokoni]

The "tingly" feeling is a side effect of Acetazolamide. I have gotten this feeling from it alone, without any supplemental baking soda. Have you tried a similar dose without the baking soda?

I sometimes get the feeling that my blood is carbonated, like soda or selzter water. This feeling I like, but the tingly feeling in hands and feet (usually with a bit of numbness), I don't like so much.

What do you attribute the tingling to? Might it be a case of CO2 relaxing arteries and thereby enhancing the oxygenation of hands and feet (and therefore also other tissues), similar to the flushing effect of niacin? In which case the tingling might be neutral or even an indicator of improvement.

 

[tankasnowgod]

What do you attribute the tingling to? Might it be a case of CO2 relaxing arteries and thereby enhancing the oxygenation of hands and feet (and therefore also other tissues), similar to the flushing effect of niacin? In which case the tingling might be neutral or even an indicator of improvement.

I don't know, but I think some of it might be due to better carbon dioxide in the cell and better oxygenation, and some of it might be due to lowered electrolytes, especially bicarbonate. I wouldn't think the numbness that goes along with the tingly feeling in fingers and feet is due to better oxygenation.

 

[Nokoni]

I wouldn't think the numbness that goes along with the tingly feeling in fingers and feet is due to better oxygenation.

Right. Good point.

 

[InChristAlone]

Tingling in extremities can be low thiamine. Check your resting to standing BP and pulse, if BP doesn't rise or goes lower and pulse goes up 30 or more then it is definitely beri beri type condition.

 

[tankasnowgod]

Tingling in extremities can be low thiamine. Check your resting to standing BP and pulse, if BP doesn't rise or goes lower and pulse goes up 30 or more then it is definitely beri beri type condition.

Thiamine is, itself, a CA inhibitor. It can also allow you to use less Acetazolamide, which is another way to reduce side effects.