Great debate: in patients with decompensated heart failure, acetazolamide in addition to loop diuretics is the first choice.

high-dose loop diuretics in HF patients, thiazides, not high-dose loop diuretics, were independent predictors of the occurrence of hyponatraemia and hypokalaemia with a strong trend towards a higher risk for all-cause mortality. 26 This adverse effect of thiazides on potassium levels was further corroborated by the CLOROTIC trial, where a very high prevalence of hypokalaemia defined as potassium ≤3.0 mmol/L was noted within 5 days of 25 mg daily of HCTZ administration (40.6% v

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Absolute diuretic effects were clinically of marginal significance with an increase of only 0.5 L at 48 h after the randomization day (Day 3 of the study protocol) in the acetazolamide group compared with placebo.

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