What question did this study set out to answer?

To explore the effects of acetazolamide on respiratory function in a patient with heart failure and cardio-renal-pulmonary syndrome.

January 10, 2026

Improvement of respiratory function with acetazolamide in heart failure: a case of cardio-renal pulmonary syndrome

Key Result

Acetazolamide improved respiratory function in a heart failure patient, decreasing BNP from 348 to 158 pg/mL and PaCO2 from 59.7 to 37.8 mmHg.

Key Points

To explore the effects of acetazolamide on respiratory function in a patient with heart failure and cardio-renal-pulmonary syndrome.
Case report of a 93-year-old male heart failure patient
Administered 250 mg/day acetazolamide orally
Monitored changes in body weight, BNP levels, and arterial blood gases before and after treatment
Body weight decreased from 39.8 to 36.8 kg
BNP levels fell from 348 to 158 pg/mL
Blood pH improved from 7.41 to 7.37
PaCO2 decreased from 59.7 to 37.8 mmHg
HCO3 decreased from 36.7 to 21.3 mmol/L

Structured PICO

Does oral acetazolamide improve hypercapnia and metabolic alkalosis in a heart failure patient with cardio-renal pulmonary syndrome?

Population

93-year-old male heart failure patient taking diuretics, presenting with mild body fluid retention, elevated BNP, and hypercapnia (n=1).

Intervention

Oral acetazolamide 250 mg/day for 1 month.

Outcome

Changes in body weight, BNP, and arterial blood gas parameters (pH, PaO2, PaCO2, HCO3, base excess) after 1 month.surrogate

Acetazolamide may reduce cardiac burden and enhance pulmonary ventilation in heart failure patients with hypercapnia and metabolic alkalosis, highlighting a potential cardio-renal pulmonary syndrome.

Main Result

Absolute Event Rate: 0% vs 0%

Abstract

As renal handling of chloride (Cl) and bicarbonate (HCO3) under different cardiac states would affect the acid-base balance and subsequently influence respiratory function, cardio-renal-pulmonary interactions can be predicted in heart failure (HF) pathophysiology, but have not yet been confirmed. We report a 93-year-old male HF patient taking diuretics who presented with mild body fluid retention, elevated b-type natriuretic peptide (BNP), and hypercapnia during a hospital stay. To improve the hypercapnia and correct metabolic alkalosis, he was given oral acetazolamide (250 mg/day). Peripheral venous blood tests before and after 1 month on acetazolamide showed that his body weight (39.8 to 36.8 kg) and BNP level (348 to 158 pg/mL) decreased. Arterial blood gas analysis showed that his blood pH (7.41 to 7.37) and PaO2 (91 to 95 mmHg) increased, and PaCO2 (59.7 to 37.8 mmHg), HCO3 (36.7 to 21.3 mmol/L) and base excess (11.5 to -3.1 mmol/L) decreased. These observations indicated that acetazolamide treatment reduced the cardiac burden and enhanced pulmonary ventilation possibly by stimulating the brain's respiratory center. This case highlights a new clinical HF entity of pathophysiologic cardio-renal pulmonary syndrome as a pathologic spectrum defined by cardio-pulmonary interactions linked to kidney function through renal modulation of the acid-base balance.

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