Acetazolamide in Idiopathic Intracranial Hypertension

• Main Authors: Andrew G. Lee, MD, Daniel Rodricks
• Format: Moving Image (Video)
• Language: English
• Published: North American Neuro-Ophthalmology Society 2019
• Subjects: Intracranial Hypertension; Acetazolamide; Meningitis; Carbonic acid
• Online Access: https://collections.lib.utah.edu/ark:/87278/s63r5jdx

Summary: Idiopathic Intracranial Hypertension (IIH) • Increased intracranial pressure of an idiopathic nature • Treated with acetazolamide/weight loss + surgery as deemed necessary o Acetazolamide (Diamox) is an effective first-line therapy according to IIH Treatment Trial (IIHTT) -Lowers intracranial pressure -Treats vision loss and papilledema stemming from IIH IIH Patients and Treatment • Tend to be young, overweight females o Weight loss is preferred treatment • Acetazolamide is effective medical therapy o Normal dosage is 500 mg a day -IIHTT allows for dosage of up to 2-4 grams/day o Dosage limited by side effects -Paresthesias -Tingling in hands/feet -Metallic taste in mouth following consumption of carbonated beverages -Fatigue -Frequent urination is a known side effect, but a rare complaint from IIH patients treated with acetazolamide Metabolic Acidosis due to Acetazolamide Treatment • Acetazolamide is a carbonic anhydrase inhibitor o Removes water from carbonic acid o Generates water and carbon dioxide -Water and carbon dioxide are easily removed from body -good byproducts • Carbonic anhydrase inhibition prevents build of these good byproducts o Carbonic acid will subsequently dissociate into hydrogen and bicarbonate ions -Kidney pushes bicarb into urine -alkylurea + metabolic acidosis • Na+/H+ exchangers and Na+/K+ pumps result in potassium being pushed into urine HYPOkalemia (life threatening) • Chloride/bicarbonate exchanger impacted due to dumping of bicarbonate into urine HYPERchloremia (life threatening and causes patient discomfort) •Hypokalemic hyperchloremic metabolic acidosis o Acetazolamide contraindicated for patients without IIH or with metabolic acidosis due to potentially life-threatening electrolyte imbalances Cryptococcal Meningitis • Cryptococcal meningitis results in non-idiopathic intracranial hypertension o Acetazolamide administration during clinical trials for cryptococcal meningitis patients resulted in adverse outcomes (death) • Serial lumbar puncture or lumbar drain used to ...