Does acetazolamide improve decongestive response across different baseline bicarbonate levels?
Acetazolamide is effective for decongestion across all bicarbonate levels, but provides magnified benefits in patients with elevated bicarbonate by counteracting proximal nephron NaHCO3 retention.
Acetazolamide improves decongestive response over the entire range of HCO3- levels; however, the treatment response is magnified in patients with baseline or loop diuretic-induced elevated HCO3 (marker of proximal nephron NaHCO3 retention) by specifically counteracting this component of diuretic resistance.
Martens et al. (Thu,) studied this question.