RESUMEN
BACKGROUND: Metabolic alkalosis usually complicates the evolution of patients with hypercapnia under diuretic or steroid therapy. The objective of this study was to analyze the efficiency of therapy with acetazolamide, a reversible carbonic anhydrase inhibitor, in this condition. PATIENTS AND METHODS: Prospective study conducted at our hospital from June 1994 to March 1996, with 45 patients who had chronic respiratory acidosis and metabolic alkalosis. After a previous stabilization of the patient and eventually the discontinuation of diuretic or corticosteroid drugs fro 24-48 hours, 500 or 750 mg of acetazolamide were administered daily for 48 hours. Later, variations both in arterial gasometry and venous electrolytes were analyzed by comparing two means of paired data. RESULTS: After therapy with acetazolamide a clinical improvement was observed in patients, a decrease in PaCO2, pH and CO3H (p < 0.001) and an increase in PaO2 (p < 0.001). Hypochloremia (82.2%) and hypopotassemia (33.3%) were the most common electrolytic abnormalities before therapy. Both abnormalities improved significantly after the administration of acetazolamide. In five patients (11.1%) acetazolamide was discontinued when metabolic acidosis appeared, which only in three cases was associated with acidemia. No secondary effects were observed. CONCLUSIONS: Acetazolamide is an efficient alternative for treatment of patients with respiratory acidosis and metabolic alkalosis, particularly when other more common measures in this condition (discontinuation of diuretics and/or volemic replacement) have failed or are contraindicated. On the other hand, the emergence of relevant secondary effects is unlikely.
Asunto(s)
Acetazolamida/uso terapéutico , Alcalosis/tratamiento farmacológico , Inhibidores de Anhidrasa Carbónica/uso terapéutico , Hipercapnia/tratamiento farmacológico , Acetazolamida/administración & dosificación , Equilibrio Ácido-Base , Acidosis Respiratoria/tratamiento farmacológico , Corticoesteroides/efectos adversos , Anciano , Anciano de 80 o más Años , Alcalosis/inducido químicamente , Inhibidores de Anhidrasa Carbónica/administración & dosificación , Cloruros/sangre , Diuréticos/efectos adversos , Femenino , Humanos , Hipercapnia/diagnóstico , Masculino , Persona de Mediana Edad , Potasio/sangre , Estudios Prospectivos , Pruebas de Función Respiratoria , Sodio/sangre , Factores de TiempoRESUMEN
Hepatic lesions induced by non-steroid antiinflammatory drugs are a common cause of disease, particularly among elderly patients. Although its clinical expression is polymorphous, occasional increases in serum transaminase values predominate. Sixteen cases of liver involvement by bendazac were studied. This NSAID is used in Spain for the treatment of cataracts, from a total of 112 patients observing such therapy. The clinical spectrum of liver disease induced by bendazac is discussed and emphasis is placed on the necessity to judiciously select the indications for NSAIDs.