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Western Regional Meeting Abstracts

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WAFMR, WSCI, WAP and WSPR Joint Plenary Session II 1:45 PM Thursday, January 29, 2009

1 SHORT-TERM EXPOSURE OF ACETAZOLAMIDE IN THE PHARMACOLOGIC TREATMENT OF CHRONIC METABOLIC ALKALOSIS IN NEONATES AND INFANTS

B. Tam, A. Chhay, L. Yen, L. Tesoriero, I. Seri, P. Friedlich Childrens Hospital Los Angeles, USC Keck School of Medicine, Los Angeles, CA.

Purpose of Study

To evaluate the effects on electrolyte homeostasis and acid-base balance of acetazolamide administered to ameliorate the metabolic alkalosis associated primarily with diuretic therapy in neonates and infants with chronic respiratory insufficiency.

Methods Used

Infants and neonates who received acetazolamide (3-5 mg/kg/dose intravenously every 6 hours up to 4 doses) in the NICU of Childrens Hospital Los Angeles between January 2006 and October 2007 were identified. A retrospective chart review was conducted to obtain patient demographics, concurrent diuretics, electrolyte supplements, parenteral nutrition, number of acetazolamide doses, results of serum metabolic panel(s) and blood gas analyses, and urine output during the 24 hours of the study.

Summary of Results

Eighty-nine patients receiving 129 courses of acetazolamide were identified and included. Fifty, 42, 17 and 20 patients received 1, 2, 3, and 4 doses of acetazolamide, respectively. Calculated serum bicarbonate (36.9 ± 4.1 vs. 31.5 ± 4.3 mEq/L, P < 0.001) and BE (10.0 ± 3.4 vs. 4.8 ± 4.0 mEq/L, P < 0.001) were significantly reduced following 24 hours of acetazolamide administration. During the same time interval, a statistically significant decrease in serum pH (7.41 ± 0.06 vs. 7.37 ± 0.06, P < 0.001) and creatinine (0.38 ± 0.19 vs. 0.43 ± 0.19, P < 0.001) and an increase in serum chloride concentration (98.9 ± 5.3 vs. 101.3 ± 5.5 mEq/L, P < 0.001) from baseline were noted. There were no significant differences in serum sodium, potassium, blood urea nitrogen, and urine output. After acetazolamide administration, 4 patients developed uncompensated respiratory acidosis (pH < 7.25) with pCO2 >55 mm Hg.

Conclusions

Short-term exposure to acetazolamide for the pharmacologic treatment of chronic metabolic alkalosis associated with diuretic therapy in neonates and infants with chronic respiratory …

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