interestingly, acetazolamide is also effective to treat mountain sickness and sleep apnea (
@TiredBill )
https://emedicine.medscape.com/article/304967-medication
it's important to know that acetazolamide can sometimes induce increased ammonemia.
"Acetazolamide may induce hyperammonaemia in two ways.
First, carbonic anhydrase activity is essential for hepatic urea synthesis from ammonium ions. Carbonic anhydrase inhibitors such as acetazolamide can inhibit this urea synthesis. This inhibition of urea synthesis occurs proximally in the urea cycle, at a step prior to citrulline formation, 8,9 thus causing hyperammonaemia.
Acetazolamide can also interfere with the normal production and excretion of ammonia from the kidney. Normal kidney cells produce free ammonium ions that are either excreted into the urine or released into the renal vein. The release of ammonia into the renal vein represents a major source of the normal ammonia concentration in blood. 10,11 Acetazolamide acts through changes in the acid-base balance and by a direct effect on the kidney. The total amount of ammonia produced by the kidney and its partition into the renal vein or the urine is modified in response to the acid–base balance, potassium status and kidney function. 12,13 Acidosis induces an increase in the total kidney ammonia production and a significant rise in the urinary excretion of ammonia. In contrast, metabolic alkalosis is associated with a marked reduction in urinary ammonium excretion and a rise in the ammonium released into the kidney’s venous blood. In the kidney, carboxic anhydrase is located on the brush border of the tubular cells, where it promotes hydrogen ion loss and reabsorption of bicarbonate. Acetazolamide mainly acts on the proximal tubule of the kidney and induces a metabolic acidosis by inhibiting bicarbonate re-uptake. Acetazolamide also reduces the urinary excretion of ammonium by shifting the ammonia from the urinary compartment to the renal vein, 14 thus further contributing to the hyperammonaemia – as seen in our patient. As acetazolamide is mainly excreted by the kidney, patients with renal failure are at risk for acetazolamide accumulation resulting in hyperammonaemia. 15"