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Abstract: FR-PO487

Flaccid Paralysis in Peritoneal Dialysis Patient After Using Acetazolamide

Session Information

Category: Dialysis

  • 702 Dialysis: Home Dialysis and Peritoneal Dialysis


  • Sbaih, Ahmed S.H., Tulane University School of Medicine, New Orleans, Louisiana, United States
  • Baudy, Adrian J., Tulane University School of Medicine, New Orleans, Louisiana, United States
  • Harasis, Farah, Tulane University School of Medicine, New Orleans, Louisiana, United States

Neurotoxicity is a serious life threatening and rare side effect of Acetazolamide (ACTZ). There are only several studies found in literature about ACTZ toxicity and pharmacokinetics in dialysis patients. Here, we describe an unusual case of a patient with end stage renal disease (ESRD) on peritoneal dialysis (PD) with normal cognitive function that presented with progressive confusion, lethargy and paralysis. We diagnosed him with ACTZ toxicity and he had a complete recovery after treatment.

Case Description

A 58-year-old male with ESRD due to diabetes (DM) on PD was admitted for 3 days of confusion and progressive weakness that presented with flaccid paralysis. Complete workup for cognitive impairment including blood test and images were done without identify a cause. Detailed history was taken and we determined that his symptoms started after treated with high dose of ACTZ 250 mg thrice a day as prescribed by his ophthalmologist after cataract surgery. Symptoms started after 500mg taken over 16 hours and he became paralyzed and confused after 2250 mg over 3 days. ACTZ was stopped on the day of admission, and we did daily PD. He started to improve after 3 days and completely recovered after 8 days of last dose and daily PD with total 93 hours.


ACTZ is a carbonic anhydrase inhibitor commonly used to reduce intraocular pressure. Since it is entirely excreted in the urine, accumulation and severe side effects may occur with renal impairment. Toxicity is more common in advance age, diabetes, concurrent salicylates use and in renal impairment or ESRD as it depends on renal clearance. Symptoms included lethargy, drowsiness, confusion, and coma which are potentially reversible with early diagnosis and treatment. Early diagnosis is important to avoid life threatening conditions and should be considered in any patient with CKD or ESRD receiving high dose of ACTZ came with neurological symptoms or metabolic acidosis, as it blocks absorption of bicarbonate. Levels should be measured to help in the diagnosis. The drug should be stopped as soon as the diagnosis is made and started on dialysis immediately. The time of recovery vary according to patient condition and risk factors and half-life of ACTZ in PD patient according to one study is prolong to 28.5 hours with continuous PD compared to patient with normal renal function, in which the half-life is 5-10 hours.