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The manifestations of metabolic acidosis during acetazolamide treatment in a cohort of pediatric idiopathic intracranial hypertension

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Abstract   

Background

Idiopathic intracranial hypertension is characterized by increased intracranial pressure with unidentified pathology. Despite its use as the first-line treatment, data on acetazolamide’s effectiveness and safety in pediatric idiopathic intracranial hypertension is sparse. This study's objective was to assess those issues and the need for routine blood gas monitoring during treatment.

Methods

Retrospective observational cohort study, based on multicenter computerized medical charts of pediatric patients with idiopathic intracranial hypertension diagnosed between 2007–2018 in three medical centers serving one metropolitan area (an estimated population of 400,000 children). Clinical and laboratory data of children up to 18 years old, fulfilling the Friedman criteria and taking acetazolamide, were collected and analyzed.

Results

Sixty-eight patients were included with a mean acetazolamide treatment duration of 8.5 months and a median maximal dose 18 mg/kg/d. Sixty-two children had mild (76%), moderate (13%), or severe (1.5%) metabolic acidosis. At least one adverse effect (neurologic, gastrointestinal, renal) was recorded among 27% of patients. No significant difference was found between the mean pH of children with or without clinical adverse effects (p = 0.35). No correlation was found between laboratory acidosis and adverse effect severity (p = 0.3), or between median acetazolamide dose and acidosis level (p = 0.57).

Conclusions

Although laboratory finding of metabolic acidosis is common among patients with idiopathic intracranial hypertension treated with acetazolamide, it is not correlated with clinics. Therefore, we recommend sending blood tests during acetazolamide treatment based on clinical judgment.

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Data availability

For additional information and access to the data, please reach out to the study’s corresponding author.

Abbreviations

IIH:

Idiopathic intracranial hypertension pressure

MA:

Metabolic acidosis

ICP:

Intracranial pressure

CT:

Computerized tomography

MRI:

Magnetic resonance imaging

LP:

Lumbar puncture

CSF:

Cerebrospinal fluid

CA:

Carbonic anhydrase

BMI:

Body mass index

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Acknowledgements

The graphical abstract for this work was created using the 'Noun project' application.

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Author notes

  1. Tal Gilboa and Oded Volovelsky contributed equally to this work.

Authors and Affiliations

  1. Faculty of Medicine, Hebrew University, Jerusalem, Israel

    Yarden Bulkowstein

  2. Pediatric Department, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Israel

    Adi Nitzan‑Luques, Aviad Schnapp & Shimon Reif

  3. Pediatric Neurology Unit, Shaare Zedek Medical Center, Jerusalem, Israel

    Noa Barnoy

  4. Pediatric Neurology Unit, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Israel

    Tal Gilboa

  5. Pediatric Nephrology Unit and Research Lab, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Israel

    Oded Volovesky

  6. Pediatric Hematology Oncology Department, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Israel

    Adi Nitzan‑Luques

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Correspondence to Oded Volovesky.

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Yarden Bulkowstein and Adi Nitzan-Luques contributed equally to this work.

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Bulkowstein, Y., Nitzan‑Luques, A., Schnapp, A. et al. The manifestations of metabolic acidosis during acetazolamide treatment in a cohort of pediatric idiopathic intracranial hypertension. Pediatr Nephrol 39, 185–191 (2024). https://doi.org/10.1007/s00467-023-06084-9

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