Which agent is a carbonic anhydrase inhibitor that can contribute to hypokalemia?

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Multiple Choice

Which agent is a carbonic anhydrase inhibitor that can contribute to hypokalemia?

Carbonic anhydrase inhibitors promote loss of bicarbonate in the proximal tubule, which reduces reabsorption of NaHCO3 and water. Acetazolamide specifically blocks carbonic anhydrase in the proximal tubule, leading to bicarbonaturia and a mild metabolic acidosis. The increased delivery of sodium to the collecting duct drives more potassium secretion to maintain electroneutrality, making hypokalemia more likely. Other diuretics in the list have different actions and potassium effects—furosemide can cause hypokalemia but is not a carbonic anhydrase inhibitor; spironolactone is potassium-sparing; mannitol is an osmotic diuretic with no direct effect on bicarbonate handling. Thus, acetazolamide is the carbonic anhydrase inhibitor that can contribute to hypokalemia.

Carbonic anhydrase inhibitors promote loss of bicarbonate in the proximal tubule, which reduces reabsorption of NaHCO3 and water. Acetazolamide specifically blocks carbonic anhydrase in the proximal tubule, leading to bicarbonaturia and a mild metabolic acidosis. The increased delivery of sodium to the collecting duct drives more potassium secretion to maintain electroneutrality, making hypokalemia more likely.

Other diuretics in the list have different actions and potassium effects—furosemide can cause hypokalemia but is not a carbonic anhydrase inhibitor; spironolactone is potassium-sparing; mannitol is an osmotic diuretic with no direct effect on bicarbonate handling. Thus, acetazolamide is the carbonic anhydrase inhibitor that can contribute to hypokalemia.

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