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Combined Acid-Base Abnormalities During Noninvasive Ventilation and Place of Acetazolamide

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Pharmacology in Noninvasive Ventilation

Part of the book series: Noninvasive Ventilation. The Essentials ((NVE))

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Abstract

Mixed acid-base disturbances are common during noninvasive mechanical ventilation therapy in patients with respiratory failure. Studies have shown that the use of carbonic anhydrase inhibitors in patients receiving noninvasive ventilation therapy improves both clinical findings and PaCO2 and pH levels. Carbonic anhydrase inhibitors are considered part of the diuretic class of medications. The most often used carbonic anhydrase inhibitor is acetazolamide, which plays a crucial role in proximal bicarbonate, sodium, and chloride reabsorption and causes NaCl and NaHCO3 loss. The most common indication for its usage as a diuretic is in edematous individuals with metabolic alkalosis, in whom the elimination of excess bicarbonate in the urine tends to restore acid-base balance. Studies have shown that in patients receiving noninvasive ventilation therapy, 500 mg of acetazolamide once a day improves both the clinic and PaCO2, HCO3, serum, and urine pH. Of course, carbonic anhydrase inhibitors can have many adverse effects such as taste changes, fatigue, abdominal pain, diarrhea, nausea, vomiting, blurred vision, tinnitus, paresthesia, and headache. As a result, in patients with respiratory failure, mixed acid-base imbalance that may occur during NIV should be better investigated and treatment should be planned accordingly.

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References

  1. Derksen R, Scheffer G, Van Der Hoeven J. Quantitative acid–base physiology using the Stewart model. Does it improve our understanding of what is really wrong? Eur J Intern Med. 2006;17(5):330–3.

    Article  CAS  PubMed  Google Scholar 

  2. De Leeuw P, Dees A. Fluid homeostasis in chronic obstructive lung disease. Eur Respir J. 2003;22(46 suppl):33s–40s.

    Article  Google Scholar 

  3. Terzano C, Di Stefano F, Conti V, Di Nicola M, Paone G, Petroianni A, et al. Mixed acid-base disorders, hydroelectrolyte imbalance and lactate production in hypercapnic respiratory failure: the role of noninvasive ventilation. PLoS One. 2012;7(4):e35245.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  4. Navalesi P, Fanfulla F, Frigerio P, Gregoretti C, Nava S. Physiologic evaluation of noninvasive mechanical ventilation delivered with three types of masks in patients with chronic hypercapnic respiratory failure. Crit Care Med. 2000;28(6):1785–90.

    Article  CAS  PubMed  Google Scholar 

  5. Prinianakis G, Delmastro M, Carlucci A, Ceriana P, Nava S. Effect of varying the pressurisation rate during noninvasive pressure support ventilation. Eur Respir J. 2004;23(2):314–20.

    Article  CAS  PubMed  Google Scholar 

  6. Diaz O, Iglesia R, Ferrer M, Zavala E, Santos C, Wagner PD, et al. Effects of noninvasive ventilation on pulmonary gas exchange and hemodynamics during acute hypercapnic exacerbations of chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 1997;156(6):1840–5.

    Article  CAS  PubMed  Google Scholar 

  7. Dokwal C. Interpretation of arterial blood gases. Pulse. 2009;3(1):15–9.

    Article  Google Scholar 

  8. Tanios BY, Omran MO, Noujeim C, Lotfi T, Mallat SS, Bou-Khalil PK, et al. Carbonic anhydrase inhibitors in patients with respiratory failure and metabolic alkalosis: a systematic review and meta-analysis of randomized controlled trials. Crit Care. 2018;22(1):1–12.

    Article  Google Scholar 

  9. Khanna A, Kurtzman NA. Metabolic alkalosis. Respir Care. 2001;46(4):354–65.

    CAS  PubMed  Google Scholar 

  10. Hodgkin JE, Soeprono FF, Chan DM. Incidence of metabolic alkalemia in hospitalized patients. Crit Care Med. 1980;8(12):725–8.

    Article  CAS  PubMed  Google Scholar 

  11. Kavukçu S. Alkaloz ve Tedavisi. J Curr Pediatr 2007;(5):0–0

    Google Scholar 

  12. Grogono AW: Acid-base balance. International Anesthesiology Clinics, Problems and Advances in Respiratory Therapy, Spring 1986, Vol. 24, No. 1, 1986

    Google Scholar 

  13. Kassamali R, Sica DA. Acetazolamide: a forgotten diuretic agent. Cardiol Rev. 2011;19(6):276–8.

    Article  PubMed  Google Scholar 

  14. Farzam K, Abdullah M. Acetazolamide. In: StatPearls; 2021.

    Google Scholar 

  15. Van Berkel MA, Elefritz JL. Evaluating off-label uses of acetazolamide. Am J Health Syst Pharm. 2018;75(8):524–31.

    Article  PubMed  Google Scholar 

  16. Assadi F. Acetazolamide for prevention of contrast-induced nephropathy: a new use for an old drug. Pediatr Cardiol. 2006;27(2):238–42.

    Article  PubMed  Google Scholar 

  17. Javaheri S. Acetazolamide improves central sleep apnea in heart failure: a double-blind, prospective study. Am J Respir Crit Care Med. 2006;173(2):234–7.

    Article  CAS  PubMed  Google Scholar 

  18. Jones P, Greenstone M. Carbonic anhydrase inhibitors for hypercapnic ventilatory failure in chronic obstructive pulmonary disease. Cochrane Database Syst Rev. 2001;2001:CD002881.

    PubMed  PubMed Central  Google Scholar 

  19. Cervera GR, Puigdevall JR, Chorro IM, Delgado MM, la Calle GH, Serra AM, et al. Effects of early administration of acetazolamide on the duration of mechanical ventilation in patients with chronic obstructive pulmonary disease or obesity-hypoventilation syndrome with metabolic alkalosis. A randomized trial. Pulm Pharmacol Ther. 2017;44:30–7.

    Article  Google Scholar 

  20. Raurich J-M, Rialp G, Ibáñez J, Llompart-Pou JA, Ayestarán I. Hypercapnic respiratory failure in obesity-hypoventilation syndrome: CO2 response and acetazolamide treatment effects. Respir Care. 2010;55(11):1442–8.

    PubMed  Google Scholar 

  21. Vos P, Folgering H, de Boo TM, Lemmens W, van Herwaarden C. Effects of chlormadinone acetate, acetazolamide and oxygen on awake and asleep gas exchange in patients with chronic obstructive pulmonary disease (COPD). Eur Respir J. 1994;7(5):850–5.

    Article  CAS  PubMed  Google Scholar 

  22. Faisy C, Meziani F, Planquette B, Clavel M, Gacouin A, Bornstain C, et al. Effect of acetazolamide vs placebo on duration of invasive mechanical ventilation among patients with chronic obstructive pulmonary disease: a randomized clinical trial. JAMA. 2016;315(5):480–8.

    Article  CAS  PubMed  Google Scholar 

  23. Bahloul M, Chaari A, Tounsi A, Turki O, Chtara K, Hamida CB, et al. Impact of acetazolamide use in severe exacerbation of chronic obstructive pulmonary disease requiring invasive mechanical ventilation. Int J Crit Illn Inj Sci. 2015;5(1):3.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Heming N, Faisy C, Urien S. Population pharmacodynamic model of bicarbonate response to acetazolamide in mechanically ventilated chronic obstructive pulmonary disease patients. Crit Care. 2011;15(5):1–9.

    Article  Google Scholar 

  25. Fontana V, Santinelli S, Internullo M, Marinelli P, Sardo L, Alessandrini G, et al. Effect of acetazolamide on post-NIV metabolic alkalosis in acute exacerbated COPD patients. Eur Rev Med Pharmacol Sci. 2016;20(1):37–43.

    CAS  PubMed  Google Scholar 

  26. Mullens W, Dauw J, Martens P, Verbrugge FH, Nijst P, Meekers E, et al. Acetazolamide in acute decompensated heart failure with volume overload. N Engl J Med. 2022;387:1185.

    Article  CAS  PubMed  Google Scholar 

  27. Leaf DE, Goldfarb DS. Mechanisms of action of acetazolamide in the prophylaxis and treatment of acute mountain sickness. J Appl Physiol. 2007;102(4):1313–22.

    Article  CAS  PubMed  Google Scholar 

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Author information

Authors and Affiliations

  1. Gazi University School of Medicine Department of Pulmonary Disease, Ankara, Turkey

    Burcu Öztürk Şahin

  2. Division of Critical Care, Gazi University School of Medicine Department of Pulmonary Disease, Ankara, Turkey

    Gül Gürsel

Authors
  1. Burcu Öztürk Şahin
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  2. Gül Gürsel
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Editor information

Editors and Affiliations

  1. Intensive Care Unit, Hospital General Universitario Morales M, Murcia, Murcia, Spain

    Antonio M. Esquinas

  2. Medicine, Pulmonary Critical Care Medicine, Northern Westchester Hospital, Mount Kisco, NY, USA

    Bushra Mina

  3. Translational Medicine, University of Ferrara, Ferrara, Italy

    Savino Spadaro

  4. Anesthesiology and Pediatric Intensive Care, Bambino Gesù Children’s Hospital, Roma, Italy

    Daniela Perrotta

  5. Anesthesiology and Pediatric Intensive Care, UOC ARCO Palidoro Bambino Gesù Children's Hospital, Roma, Italy

    Francesco De Sanctis

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Öztürk Şahin, B., Gürsel, G. (2023). Combined Acid-Base Abnormalities During Noninvasive Ventilation and Place of Acetazolamide. In: Esquinas, A.M., Mina, B., Spadaro, S., Perrotta, D., De Sanctis, F. (eds) Pharmacology in Noninvasive Ventilation. Noninvasive Ventilation. The Essentials. Springer, Cham. https://doi.org/10.1007/978-3-031-44626-9_10

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  • DOI: https://doi.org/10.1007/978-3-031-44626-9_10

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-031-44625-2

  • Online ISBN: 978-3-031-44626-9

  • eBook Packages: MedicineMedicine (R0)

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