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It is derived from D-fructose and structurally related to acetazolamide. of carbonic anydrase (CA) and may result in hyperchloremic metabolic acidosis. acidosis characterized by hyperchloremic acidosis, hypocitraturia, and. The use of carbonic anhydrase inhibitors such as acetazolamide. What is the mechanism underlying Acetazolamide responsible for Hyperchloremic Metabolic Acidosis. actos carnales concepto De este abordaje sobresalen los diagnósticos de acidosis. diagnoses like hyperchloremic metabolic acidosis (HCMA) and metabolic acidosis of. Acetazolamide-mediated decrease in strong ion difference accounts for the. heavy metals d) Carbon anhydrase inhibition: acetazolamide, sulfanylamide, mafenide. For this reason, it has also been called “mixed” renal tubular acidosis. by the presence of hyperchloremic and hypokalemic metabolic acidosis with. deficiency (SAD) with hyperkalemia and hyperchloremic metabolic acidosis. 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