Following administration of glucose and insulin to three patients with hypokalemic periodic paralysis, serum K fell 1.9 mM. After administration of acetazolamide, 250 mg four times daily, serum K fell 0.9 mM, a substantial difference. In normal persons glucose and insulin lowered serum K 0.5 mM, and this was not changed substantially by acetazolamide.
The metabolic acidosis induced by the drug appears to be responsible for the change in decrement of serum K and for the amelioration of symptoms in the patients. The findings agree with earlier reports that metabolic acidosis lowers the rate of entry of K± into muscle, thus opposing the heightened or pathological entry of K± into muscle cells during attacks of the disease.
Vroom FQ, Jarrell MA, Maren TH. Acetazolamide Treatment of Hypokalemic Periodic Paralysis: Probable Mechanism of Action. Arch Neurol. 1975;32(6):385–392. doi:10.1001/archneur.1975.00490480051006
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