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Safety and effectiveness of the combination acetazolamide and bicarbonates to induce alkaline diuresis in patients with rhabdomyolysis
  1. Konstantinos Ioannidis1,
  2. Apostolos Papachristos1,
  3. Zoe Athanassa2,
  4. Emmanouela Katsouda2,
  5. Ioannis Skarlatinis1,
  6. Haris Paskalis2
  1. 1Department of Pharmacy, Hygeia Hospital Athens, Athens, Greece
  2. 2Intensive Care Unit, Hygeia Hospital Athens, Athens, Greece
  1. Correspondence to Dr Konstantinos Ioannidis, Department of Pharmacy, Hygeia Hospital Athens, Erythrou Stavrou 4 & Kifisias, Marousi, Athens 15123, Greece; kioannidis{at}


Objectives The therapeutic goal in rhabdomyolysis includes treatment of the causative factor and symptoms, and prevention of complications. Administration of intravenous fluids and forced alkaline diuresis are essential. Both intravenous bicarbonates and acetazolamide are used to increase urine pH but have limitations and are associated with an increased risk of metabolic abnormalities. The purpose of this study is to evaluate the effectiveness and safety of the concurrent use of acetazolamide and bicarbonates in order to achieve urine alkalisation and avoid metabolic abnormalities.

Methods We conducted a retrospective study of the medical records of patients with rhabdomyolysis who received intravenous acetazolamide and sodium bicarbonate.

Results 12 patients (9 males and 3 females) with median age of 47.5 years were analysed. All had creatinine clearance >10 mL/min. The median maximum creatine phosphokinase (CPK) was 14 280 IU/L, and the median duration of treatment in order to achieve CPK levels <5000 IU/L was 3 days. Median urine and blood pH levels were within normal ranges at 7.75 and 7.4, respectively. Median electrolyte values were: potassium 3.6 mmol/L, ionised calcium in plasma 1.1 mmol/L, and bicarbonates 25.6 meq/L. The median creatinine clearance was 43.5 mL/min. No patient required chronic haemodialysis.

Conclusions In the present study, the combined use of acetazolamide and bicarbonates was effective and safe as we achieved alkaline urines on the first day and CPK levels were reduced to <5000 IU/L within 3 days, no patient needed chronic haemodialysis, and no electrolyte or metabolic abnormalities were observed.

  • GENERAL MEDICINE (see Internal Medicine)

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