Acetazolamide, alternate carbonic anhydrase inhibitors and hypoglycaemic agents: comparing enzymatic with diuresis induced metabolic acidosis following intraocular surgery in diabetes

We describe a case of acetazolamide induced acidosis associated with the precipitation of a hyperosmolar state in a diabetic patient 6 weeks after routine phacoemulsification. While renal tubular acidosis is well reported with acetazolamide, this case suggests that a direct diuresis induced acidosis can also have significant effects, producing serious complications when acetazolamide is prescribed to a diabetic patient, and those with renal impairment, with important implications for prescribing.