Do you use acetazolamide to aid diuresis in patients with acute on chronic respiratory acidosis with significantly elevated serum bicarbonate levels?  

Yes, acetazolamide can be used in aiding diuresis in patients with chronic respiratory acidosis where the metabolic compensation results in an alkalemic pH which then sets up a vicious cycle of increasing CO2 as a compensation for the metabolic alkalosis. Use of acetazolamide results in a metabolic ...

The real question is do you use acetazolamide when there is a simultaneous primary metabolic alkalosis with a respiratory acidosis so that the pH is not low enough to give you a respiratory drive. It is usually from diuretics that create the metabolic alkalosis so using acetazolamide may reverse the...

I do on occasion, the problem is that acetazolamide is actually a pretty weak diuretic when you are using it for primary metabolic alkalosis (even if on top of resp acidosis) which by definition has to have a strong maintenance mechanism to stay elevated, and then the mechanisms behind the maintenan...