Caution for Acetazolamide indicates avoidance in which patients?

• A. Sickle cell patients
• B. History of kidney stones
• C. Taking diuretics
• D. All of the above

Answer: (D)

Acetazolamide inhibits carbonic anhydrase in the proximal tubule, so more bicarbonate, sodium, and water are lost in the urine. This creates an alkaline urine and a mild metabolic acidosis. That combination raises specific risks: in people with a history of kidney stones, the alkaline urine can promote certain stone forms; in those with sickle cell disease, the acidosis and potential dehydration can worsen sickling episodes; and in patients already taking diuretics, the added diuretic effect plus electrolyte shifts (like potassium loss) can lead to dehydration and electrolyte disturbances. Because of these potential problems, caution or avoidance is advised in all these groups, making “all of the above” the best choice.