Combined action of diamox and potassium bicarbonate in the treatment of of chronic glaucoma.

IT has been well established that Diamox causes excretion of cations, especially sodium and potassium, and that in conditions of sodium depletion potassium may be excreted in place of sodium (Milne, 1956). In fact the administration of potassium bicarbonate will increase the systemic effects of Diamox. We have already drawn attention to the correlation between cation excretion and fall in intra-ocular pressure after Diamox (Campbell, Jones, and Tonks, 1956), and were therefore interested to discover whether potassium bicarbonate would have a potentiating effect on the action of Diamox in cases of chronic glaucorha. In common with other observers (Becker and Middleton, 1955; Kupfer, Lawrence, and Linner, 1955), we have noticed that patients under treatment with Diamox often complain of paraesthesia and that this symptom is sometimes associated with a relatively low level of blood potassium. It is interesting to note in this respect that Becker and Middleton have reported the relief of paraesthesia and other side-effects by the addition of potassium chloride given by mouth. On a pharmacological basis, the continued use of Diamox could not be expected to be beneficial in the treatment of chronic glaucoma, since a single dose engenders a state of acidosis from which the body may take 2 to 3 days to recover (Maren and Wadsworth, 1955; Hanley and Platts, 1956). In fact, Arruga (1955) pointed out that, whenever Diamox has been used over long periods with success, it has always been employed in combination with miotics. It is highly probable that the latter masked the diminishing effect of Diamox. Our experiments were designed to elucidate this point as well as to investigate the effects of the addition of a potassium salt.