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Oral acetazolamide in the assessment of (urine-blood)PCO2

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Abstract

Urine-blood (U-B)Pco2 difference in children is usually assessed following urine alkalinization with oral sodium bicarbonate (NaHCO3). Since oral NaHCO3 is often poorly tolerated by children, we compared oral acetazolamide with oral NaHCO3 in a study of (U-B)Pco2. In the first phase of the study 14 children and adolescents aged 11.1±3.7 years (mean±SD) were studied. Eight participants had normal kidney function and 6 had disturbed distal acidification capacity. Each child was studied twice, once with oral NaHCO3 (2.5 mEq/kg) and once with acetazolamide (17±2 mg/kg). All studies were performed according to the standard protocol. Acetazolamide administration resulted in a lower blood pH than NaHCO3 (7.30±0.03 vs 7.38±0.06,P<0.001) and a lower serum bicarbonate (HCO3 −) concentration (25.1±2.2 mEq/l vs 27.5±2.1 mEq/l,P<0.025). Acetazolamide also resulted in a higher urinePco2 (81.9±26.2 mm Hg vs 71.6±18.2 mm Hg) than NaHCO3 (P<0.025). No significant differences between acetazolamide and NaHCO3 were observed with respect to their effects on urinary pH and HCO3 − concentration, plasmaPco2 and (U-B)Pco2. Good linear correlations were found between the effects of acetazolamide and NaHCO3 on urinePco2 (r=0.878,P<0.001), and on (U-B)Pco2 (r=0.795,P<0.01). Using either method of urinary alkalization, children with normal kidney function had urinePco2 greater than or equal to 80 mm Hg and (U-B)Pco2 greater than or equal to 30 mm Hg, and those with disturbed acidification capacity had urinePco2 less than or equal to 70 mm Hg and (U-B)Pco2 less than or equal to 20 mm Hg. Patient satisfaction with the test, on a scale of 1 (worst) to 5 (best), was 2.6±0.8 for NaHCO3 and 3.9±0.3 for acetazolamide (P<0.001). Tests with NaHCO3 lasted 150.9±30.5 min versus 115.7±18.1 min for acetazolamide (P<0.01). In the second phase of the study 8 children, 5 with normal and 3 with abnormal acidification capacity were studied twice with oral acetazolamide. Studies were performed 3 weeks apart. The results showed very good reproducibility of (U-B)Pco2 in all of the subjects. Oral acetazolamide and NaHCO3 have similar effects on (U-B)Pco2 but the diuretic agent shortens the testing time and is easier to administer to children. We conclude that oral acetazolamide could be substituted for NaHCO3 under certain circumstances in the assessment of (U-B)Pco2.

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Authors and Affiliations

  1. Department of Pediatric Nephrology, The Children's Mercy Hospital, University of Missouri-Kansas City, 24th at Gillham Road, 64108, Kansas City, MO, USA

    Uri Alon, Stanley Hellerstein & Bradley A. Warady

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  1. Uri Alon
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  2. Stanley Hellerstein
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  3. Bradley A. Warady
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Alon, U., Hellerstein, S. & Warady, B.A. Oral acetazolamide in the assessment of (urine-blood)PCO2 . Pediatr Nephrol 5, 307–311 (1991). https://doi.org/10.1007/BF00867488

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  • DOI: https://doi.org/10.1007/BF00867488

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