Use of acetazolamide to decrease cerebrospinal fluid production in chronically ventilated patients with ventriculopleural shunts
E Carriona, J H Hertzoga, M D Medlockb, G J Hausera, H J Daltona
a Department of
Pediatrics, Division of Pediatric Critical Care and Pulmonary Medicine,
Georgetown University Medical Center, Washington, DC, USA, b Department of Neurosurgery, Georgetown
University Medical Center
Correspondence to: Dr E Carrion, Children's National Medical Center, Department of Critical Care Medicine, 111 Michigan Avenue, NW Washington, DC 20010-2970, USA kikecarrion{at}pol.net
Accepted 13 July 2000
Acetazolamide (ACTZ), a carbonic anhydrase inhibitor, has been
shown to decrease cerebrospinal fluid (CSF) production in both in vivo
and in vitro animal models. We report two children with hydrocephalus
who experienced multiple shunt failures, and who had externalised
ventriculostomy drains (EVD) prior to ventriculopleural shunt
placement. The effects of increasing doses of ACTZ on CSF production
and subsequent tolerance to ventriculopleural shunts were evaluated.
The patients had a 48% and a 39% decrease in their EVD CSF output
when compared to baseline with maximum ACTZ dose of 75 mg/kg/day and 50 mg/kg/day, respectively (p < 0.05). This is the first report of
change in CSF volume in children after extended treatment with ACTZ.
ACTZ treatment in mechanically ventilated paediatric patients with
hydrocephalus may improve tolerance of ventriculopleural shunts and
minimise respiratory compromise. Potassium and bicarbonate supplements
are required to correct metabolic disturbances.
Keywords: acetazolamide; cerebrospinal fluid; hydrocephalus; ventriculopleural shunts
© 2001 by Archives of Disease in Childhood
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