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Acetazolamide (ACZ) inhibits the carbonic anhydrase (CA) present in the tubular lumen preventing the conversion of H2CO3 to CO2 and H2O. H2CO3 dissociates to H+ and HCO3−. Bicarbonate is lost in the tubular lumen producing a metabolic acidosis. Within the proximal tubular cell itself ACZ blocks CA preventing the conversion of CO2 and H2O to H+ and HCO3−. The reduction in protons reduces the re-absorption of sodium ions which are excreted in the urine.
