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Discussion:
The Foundations response about Metabolic Acidosis
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Quoting "Earleen F. Kemmish-Johnson" :

>
> Hello Foundation.
> I am a registered member and was hoping you could clear something up
> for me and some other members of the IH community.
> Is Diamox supposed to cause mild metabolic acidosis to be effective ?
> Our Neurologists seem split on this subject.
> Some believe that a mild Hyperchloremic non anion gap acidosis is
> part of the mechanism which the drug uses to lower CSF production.
>
> For example:
> My labs are consistently as follows ( only showing the abnormalities
> on a BMP)
> Chloride 111Co2 18Sodium is sometimes very slightly low , as calcium
> is on occasion.
> My potassium is normal (3.7-3.9) , supplemented with 30 meq's of
> Potassium , as I am on Lasix 10mg as well as Diamox 750mg per day
> My co2 stabilized at 21-22 a year ago but since then it seems has
> stayed at 18-19 whether I am on 500mg, 750mg or 1000mg of Diamox per
> day.
>
> Some of the IH community have doctors who believe that the mild
> state of acidosis from the lowered co2 needs to be treated.
> Other physicians believe it is a necessary side effect or inconsequential.
> I experience mild shortness of breath which usually corrects itself
> in a short time , as many of us do who are in a similar state.
> Do you have any information that may help us ?
>
> On a related note, some of us who are overweight and have insulin
> resistance are being prescribed Metformin.
> There is concern that if we already have mild metabolic acidosis
> from the Diamox , we may develop Lactic acidosis easier from the
> Metformin. Any thoughts or information on this to share ?
> Thank you as always for your time and expertise, You are GREATLY
> appreciated in our lives.
> Earleen Faye Johnson
















Re: Metabolic Acidosis question‏

9:13 AM
Reply ▼
contact@ih​rfoundation​.org
To Earleen F. Kemmish-Johnson, ihreg@ohsu.edu
Hello Earleen,

First, please understand that we cannot recommend treatment or
diagnose or give specific advice, only your doctors who know you
medically can. The information that follows may or may not
actually apply to your medical situation. So these are general
comments and should not necessarily be considered correct or the
basis for making medical decisions or actions.

Your question concerns renal physiology and pharmacology for which we
would defer specifics to experts in those areas.So our comments are to
be considered general comments concerning practical clinical care
concepts.Also please note that generalizations about clinical
situations are not valid or necessarilly applicable to all patients

Acetazolamide is a carbonic anhydrase enzyme inhibitor. Carbonic
anhydrase permits a reversible action to take place in the formation
of carbonic acid (H2Co3) and its break dowm to H2O and CO2.When
carbonic anhydrase inhibition occurs HCO3 enters the urine causing
alkalinization and H+ ions remain in the blood producing metabolic
acidosis.Additionally there is a loss of sodium, potassium and
calcium.From a clinical perspective the mild acidosis ...low CO2 and
elevated CL seems in most cases tolerated with out addition management.

Since carbonic anhydrase is inhibited in the choroid plexus there is a
reduction in CSF and in the eye reduction in acqueous
production.Reduced production leads to lower pressures.

As far as metaformin and lactic acidosis...... which is a
rare but serious complication considered related to accumulation of
and elevated blood levels of metformin mostly due to renal impairment
. ....we are not able to comment on risks with simultaneous use of
Diamox. Each patient is unique and their clinical management is
dependent on the treating physicians who are the only individuals in
position to be advisors on health care decisions.

Hope this is helpful.

IHRF
Posted on 05/25/12, 12:43 pm
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Reply #1 - 05/25/12  6:16pm
" So they are saying the same thing as my NO. It's not a problem as long as you aren't showing additional signs of acidosis. Well at least I know my NO isn't trying to kill me now.

I wonder if they would consider doing a study on the affects of patients that are taking diamox and metformin? I tried to get my diabetes meds switched back to metformin and my PCP wouldn't do it. She said I was already at risk of acidosis with the diamox and the adding the metformin back would put me at a greater risk. I know there are a lot of people on this site who are on metformin as well and while I was on it, I didn't have any side effects from it. My labs were the same as they are now so I really don't see how the risk is greater. "
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Reply #2 - 07/02/12  6:57pm
" This was good to hear. I was going to ask about this since my Bloodwork just came back the first time out of whack in co2 (14) and chloride (113). My Dr didn't mention anything about it. I am also on metformin.

Hope "
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Reply #3 - 07/02/12  7:15pm
" Wish I had the nerve to go on Metformin. I am too concerned about the acidosis that I seem prone to and how it (to me) implies a connection to the Lactic Acidosis tendency. If a doctor would stop trying to be politically and liablity correct and talk to me REAL RISK about it, maybe I would. "
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Reply #4 - 07/03/12  10:07pm
" Metaformin gave me a big headache. I wonder why? "

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