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Pediatric Nephrology

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22-07-2023 | Metabolic Acidosis | Original Article

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

Authors: Yarden Bulkowstein, Adi Nitzan‑Luques, Aviad Schnapp, Noa Barnoy, Shimon Reif, Tal Gilboa, Oded Volovesky

Published in: Pediatric Nephrology | Issue 1/2024

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.

Graphical abstract

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Title: The manifestations of metabolic acidosis during acetazolamide treatment in a cohort of pediatric idiopathic intracranial hypertension
Authors: Yarden Bulkowstein
Adi Nitzan‑Luques
Aviad Schnapp
Noa Barnoy
Shimon Reif
Tal Gilboa
Oded Volovesky
Publication date: 22-07-2023
Publisher: Springer Berlin Heidelberg
Keywords: Metabolic Acidosis
Acidosis
Idiopathic Intracranial Hypertension
Intracranial Hypertension
Published in: Pediatric Nephrology / Issue 1/2024
Print ISSN: 0931-041X
Electronic ISSN: 1432-198X
DOI: https://doi.org/10.1007/s00467-023-06084-9

Keynote webinar | Spotlight on medication adherence

Springer Medicine

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

Abstract

Background

Methods

Results

Conclusions

Graphical abstract

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Graphical abstract

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