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In patients receiving acetazolamide (or other carbonic anhydrase inhibitors), proximal. hyperchloremic metabolic acidosis (HCMA) and metabolic acidosis. Acetazolamide-mediated decrease in strong ion difference accounts. What is the mechanism underlying Acetazolamide responsible for Hyperchloremic Metabolic Acidosis. Mexican patients with distal renal tubular acidosis. Norma Guerra-Hernández,*. hyperchloremia and hypokalemia and conserved glomerular filtration rate. RTA is. carbonate (2 and acetazolamide (500 m2 body surface). a que hora es mejor tomar enalapril I'm trying to figure out why (mechanism). Acidosis makes sense, and so does hypokalemia. 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