Overview Snapshot A 32-year-old previously healthy man develops headache, fatigue, vomiting, and shortness of breath about 12 hours after arriving to Mt. Everest Base Camp. Over the next day, he develops mild difficulty walking, and confusion. He is seen by a physician who administers a medication and advises him to rest. His symptoms improve over the next 24-48 hours. (Acetazolamide) Mannitol Mechanism osmotic diuretic increases osmotic pressure of the glomerular filtrate this in turn impairs tubular reabsorption of water and electrolytes Clinical use oliguria which can result from shock and trauma drug overdose promotes urinary excretion of toxic substances glaucoma ↓ intraocular pressure increased intracranial pressure especially in the setting of cerebral edema Toxicity pulmonary edema congestive heart failure (CHF) exacerbation hypovolemia Contraindications anuria CHF Acetazolamide Mechanism carbonic anhydrase inhibitor blocks reabsorption of bicarbonate dissociation of carbonic acid into water and carbon dioxide in the proximal tubule prevented bicarbonate in the lumen then binds to sodium to form sodium bicarbonate which is excreted results in sodium bicarbonate diuresis and ↓ total body bicarbonate loss of bicarbonate results in metabolic acidosis loss of bicarbonate results in metabolic acidosis loss of bicarbonate results in metabolic acidosis loss of bicarbonate results in metabolic acidosis Clinical use glaucoma urinary alkalinization metabolic alkalosis altitude sickness increased intracranial pressure especially for idiopathic intracranial hypertension Toxicity hyperchloremic metabolic acidosis (non-anion gap) type 2 renal tubular acidosis hypokalemia neuropathy/parasthesias ↑ renal stone production calcium phosphate stones ammonia toxicity sulfa allergy