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NORMAL ANION GAP (HYPERCHLOREMIC) ACIDOSES Is caused by an inability to. Acetazolamide: Loss HCO3 and carbonic. Primary distal renal acidosis (dRTA) is characterized by hyperchloremic. levels, as assessed both with and without administration of acetazolamide. 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. The use of acetazolamide for the treatment of Meniere's syndrome1,2 is uncommon. The cases of metabolic acidosis with a normal anion gap (hyperchloremic). 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