Acetazolamide is the commonly prescribed oral and intravenous carbonic anhydrase inhibitor;over the years,its use in clinical practice has decreased in favor of more recent drugs.However,it is a rather handy drug,whic...Acetazolamide is the commonly prescribed oral and intravenous carbonic anhydrase inhibitor;over the years,its use in clinical practice has decreased in favor of more recent drugs.However,it is a rather handy drug,which can be useful in several clinical settings when managing critically ill patients.The objective of this review is the evaluation of the most recent evidence on the use of acetazolamide in emergency medicine and critical care medicine.Furthermore,the safety profile of this drug has been evaluated.This is a narrative review on the use of acetazolamide in the main contexts in which this drug can be useful in emergency situations for patients with potential critical issues.For the timeline 1999–2024,a search was conducted on the main scientific platforms;resources of greatest relevance for the use of acetazolamide in critical care and emergency medicine were selected.The most common emergency situations in which a critically ill patient could benefit from acetazolamide therapy are acute heart failure,acute mountain sickness,post hypercapnic metabolic alkalosis,idiopathic intracranial hypertension and acute angle-closure glaucoma.In a few cases,however,randomized controlled clinical trials have been conducted.There are also other less solid indications based mostly on experience or retrospective data.Acetazolamide seems to be an overall safe drug;serious side effects are rare and can be avoided by carefully selecting the patients to be treated.Acetazolamide represents a precious resource for emergency physicians and intensivists;critical patients with different conditions can in fact benefit from it;furthermore,acetazolamide is a safe drug if administered to correctly selected patients.展开更多
BACKGROUND:BRASH syndrome(Bradycardia,Renal failure,AV nodal blockade,Shock,and Hyperkalemia)is a recently described clinical entity characterized by synergistic interaction between AV nodal blocking medications and h...BACKGROUND:BRASH syndrome(Bradycardia,Renal failure,AV nodal blockade,Shock,and Hyperkalemia)is a recently described clinical entity characterized by synergistic interaction between AV nodal blocking medications and hyperkalemia.Despite increasing recognition,its clinical characteristics,risk factors,and outcomes remain poorly defined.The rationale of this review is to provide clinicians an upto-date overview of the most commonly encountered risk factors,triggers,clinical pictures,usual lab values,complications and outcomes,via the systemic analysis of currently published cases.METHODS:A systematic review was conducted using MEDLINE,Web of Science,and Cochrane Library databases through December 2024.Case reports,case series,and conference abstracts involving adult patients with BRASH syndrome were included.Data extraction focused on demographics,clinical presentations,laboratory findings,management strategies,and outcomes.RESULTS:Analysis included 131 patients from 111 published cases.Mean age was(71±13)years,with female predominance(58.1%).Hypertension(77.0%),chronic kidney disease(48.4%),and diabetes mellitus(46.7%)were the most common comorbidities.Beta-blockers were the predominant medication(76.5%).Most common presenting symptoms were syncope(17.9%),generalized weakness(16.2%),and altered mental status(11.9%).Mean potassium level was 6.6 mEq/L,with more than half of cases presenting with non-severe hyperkalemia(<6.5 mEq/L).Management often required multimodal therapy,with 50.8% of patients requiring vasopressors and 31.6% requiring hemodialysis.CONCLUSION:This systematic review provides the most comprehensive analysis of BRASH syndrome to date,demonstrating that while potentially serious,outcomes are generally favorable with appropriate recognition and management.The syndrome can develop even with modest hyperkalemia,particularly in elderly patients with multiple comorbidities.Early recognition and systematic management addressing all components of the syndrome appear crucial for optimal outcomes.展开更多
文摘Acetazolamide is the commonly prescribed oral and intravenous carbonic anhydrase inhibitor;over the years,its use in clinical practice has decreased in favor of more recent drugs.However,it is a rather handy drug,which can be useful in several clinical settings when managing critically ill patients.The objective of this review is the evaluation of the most recent evidence on the use of acetazolamide in emergency medicine and critical care medicine.Furthermore,the safety profile of this drug has been evaluated.This is a narrative review on the use of acetazolamide in the main contexts in which this drug can be useful in emergency situations for patients with potential critical issues.For the timeline 1999–2024,a search was conducted on the main scientific platforms;resources of greatest relevance for the use of acetazolamide in critical care and emergency medicine were selected.The most common emergency situations in which a critically ill patient could benefit from acetazolamide therapy are acute heart failure,acute mountain sickness,post hypercapnic metabolic alkalosis,idiopathic intracranial hypertension and acute angle-closure glaucoma.In a few cases,however,randomized controlled clinical trials have been conducted.There are also other less solid indications based mostly on experience or retrospective data.Acetazolamide seems to be an overall safe drug;serious side effects are rare and can be avoided by carefully selecting the patients to be treated.Acetazolamide represents a precious resource for emergency physicians and intensivists;critical patients with different conditions can in fact benefit from it;furthermore,acetazolamide is a safe drug if administered to correctly selected patients.
文摘BACKGROUND:BRASH syndrome(Bradycardia,Renal failure,AV nodal blockade,Shock,and Hyperkalemia)is a recently described clinical entity characterized by synergistic interaction between AV nodal blocking medications and hyperkalemia.Despite increasing recognition,its clinical characteristics,risk factors,and outcomes remain poorly defined.The rationale of this review is to provide clinicians an upto-date overview of the most commonly encountered risk factors,triggers,clinical pictures,usual lab values,complications and outcomes,via the systemic analysis of currently published cases.METHODS:A systematic review was conducted using MEDLINE,Web of Science,and Cochrane Library databases through December 2024.Case reports,case series,and conference abstracts involving adult patients with BRASH syndrome were included.Data extraction focused on demographics,clinical presentations,laboratory findings,management strategies,and outcomes.RESULTS:Analysis included 131 patients from 111 published cases.Mean age was(71±13)years,with female predominance(58.1%).Hypertension(77.0%),chronic kidney disease(48.4%),and diabetes mellitus(46.7%)were the most common comorbidities.Beta-blockers were the predominant medication(76.5%).Most common presenting symptoms were syncope(17.9%),generalized weakness(16.2%),and altered mental status(11.9%).Mean potassium level was 6.6 mEq/L,with more than half of cases presenting with non-severe hyperkalemia(<6.5 mEq/L).Management often required multimodal therapy,with 50.8% of patients requiring vasopressors and 31.6% requiring hemodialysis.CONCLUSION:This systematic review provides the most comprehensive analysis of BRASH syndrome to date,demonstrating that while potentially serious,outcomes are generally favorable with appropriate recognition and management.The syndrome can develop even with modest hyperkalemia,particularly in elderly patients with multiple comorbidities.Early recognition and systematic management addressing all components of the syndrome appear crucial for optimal outcomes.
