Purpose: Furosemide is the most commonly used diuretic in intensive care units (ICU). We aimed to evaluate the physiological effects of adjunctive acetazolamide with furosemide on diuresis and the prevention of potential furosemide-induced metabolic alkalosis.
Materials And Methods: We performed a two-center, pilot, open-label, randomized trial. Where the treating physicians planned intravenous diuretic therapy, we randomized ICU patients to a bolus of furosemide (40 mg) plus acetazolamide (500 mg) (n = 15) or furosemide alone (40 mg) (n = 15). Urine output, additional furosemide use, acid-base parameters, and electrolytes were compared following a Bayesian framework.
Results: Adjunctive acetazolamide didn't increase urine output in the first six hours (mean difference: -112 ml, credible interval: [-742, 514]). However, compared with furosemide alone, it maintained a greater urine output response to furosemide over 24 h, with 100 % probability. Acetazolamide also acidified plasma (pH difference: -0.045, [-0.081, -0.008]) while alkalinizing urine (1.10, [0.04, 2.11]) at six hours, compared to furosemide alone with >95 % probability. Finally, we didn't observe severe acidosis or electrolyte disturbances over 24 h.
Conclusions: Adjunctive acetazolamide may increase diuretic efficacy and counterbalance furosemide-induced metabolic alkalosis without safety concerns. Larger trials are warranted to verify these findings and assess their impacts on clinical outcomes.
Registration Number: ACTRN12623000624684.
Registration Title: A pilot trial of single versus dual diuretic therapy in the intensive care unit.
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http://dx.doi.org/10.1016/j.jcrc.2024.155002 | DOI Listing |
J Crit Care
December 2024
Department of Intensive Care, Austin Hospital, Melbourne, Australia; Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Australia; Department of Critical Care Medicine, Hospital Israelita Albert Einstein, São Paulo, Brazil.
Purpose: Furosemide is the most commonly used diuretic in intensive care units (ICU). We aimed to evaluate the physiological effects of adjunctive acetazolamide with furosemide on diuresis and the prevention of potential furosemide-induced metabolic alkalosis.
Materials And Methods: We performed a two-center, pilot, open-label, randomized trial.
Eye (Lond)
October 2024
Department of Ophthalmology & Visual Neurosciences, University of Minnesota, Minneapolis, MN, USA.
Purpose: This retrospective case-control study from 2008 to 2022 aimed to determine the effect of adjunctive sodium bicarbonate (NaHCO) on treatment outcomes of and side effects of acetazolamide (ACZ) for the treatment of idiopathic intracranial hypertension (IIH).
Subjects/methods: Retrospective data was collected via chart review. 288 eyes of 144 patients with IIH, including those taking ACZ alone (control group, n = 89) vs.
J Neurol Surg B Skull Base
October 2024
Department of Neurosurgery, Penn Medicine, Philadelphia, Pennsylvania, United States.
Spontaneous temporal encephaloceles (STEs) are increasingly recognized as sequelae of idiopathic intracranial hypertension (IIH), which in turn may further complicate their management. We endeavored to review the University of Pennsylvania institutional experience on operative management of STEs, with a focus on factors which may influence surgical outcomes, particularly IIH. Retrospective chart review over 9 years from 2013 to 2022.
View Article and Find Full Text PDFAm J Cardiovasc Drugs
March 2024
Division of Cardiology, Duke University School of Medicine, Duke University Medical Center, 2301 Erwin Rd., Durham, NC, 27705, USA.
Background: Recent evidence suggests that acetazolamide may be beneficial as an adjunctive diuretic therapy in patients with acute decompensated heart failure (HF). We aim to pool all the studies conducted until now and provide updated evidence regarding the role of acetazolamide as adjunctive diuretic in patients with acute decompensated HF.
Methods: PubMed/Medline, Cochrane Library, and Scopus were searched from inception until July 2023, for randomized and nonrandomized studies evaluating acetazolamide as add-on diuretic in patients with acute decompensated HF.
Curr Opin Cardiol
May 2024
Centre for Cardiovascular Diseases, University Hospital Brussels.
Purpose Of Review: To summarize the contemporary evidence on decongestion strategies in patients with acute heart failure (AHF).
Recent Findings: While loop diuretic therapy has remained the backbone of decongestive treatment in AHF, multiple randomized clinical trials suggest that early combination with other diuretic classes or molecules with diuretic properties should be considered. Mineralocorticoid receptor antagonists and sodium-glucose co-transporter-2 inhibitors are disease-modifying drugs in heart failure that favourably influence prognosis early on, advocating their start as soon as possible in the absence of any compelling contraindications.
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