Table 3.

Summary of notable key points

1. Systemic Absorption Matters: Topical ophthalmic medications, such as brinzolamide and dorzolamide, can be absorbed systemically and reach systemically relevant concentrations sufficient to cause systemic toxicity, including severe metabolic acidosis.

2. CKD is a Major Risk Factor: Patients with chronic kidney disease are at high risk for CAI-induced acidosis due to impaired drug excretion and reduced capacity for acid-base compensation.

3. Diagnostic Rigor: In complex acid-base disorders, calculating the Delta-Delta ratio is essential. It helps identify mixed disorders (e.g., concomitant RTA) that might be masked by a high anion gap metabolic acidosis associated with AKI.

4. Dietary Management: In addition to pharmacological alkali therapy, increasing fruit and vegetable intake is an evidence-based strategy to manage metabolic acidosis in CKD patients, helping to preserve renal function and improve outcomes.