Pak WLW, Chan KL, Chan Z, et al. - Researchers here describe a case report of acetazolamide (a carbonic anhydrase inhibitor) toxicity as well as the findings of a literature review. An 80-year-old man suffering from end-stage renal failure, receiving intermittent haemodialysis (HD), and with previously normal cognitive function was admitted for 4 days of lethargy and confused speech. Two days before symptom onset, he underwent left cataract surgery. An in-depth drug review was performed which revealed that his ophthalmologist prescribed oral acetazolamide 250 mg twice per day for 2 days following cataract surgery, and thereafter he developed his presenting complaint. Full recovery happened 5 days after his last dose of the drug and 1 day following the receipt of his second session of postoperative HD. He received a diagnosis of acetazolamide toxicity. Case reports of neurotoxicity caused by acetazolamide in three HD patients and one peritoneal dialysis (PD) patient were identified via a literature review. After the receipt of oral doses ranging from 250 mg twice per day to 1250 mg over 2 days, the development of symptoms was noted. Following drug discontinuation for 3–5 days, complete recovery was seen in all HD patients, while the time to recovery for the PD patient was not documented. In patients undergoing intermittent HD or PD, no clear dosing guidance was afforded by common pharmacy references; many pharmacokinetic investigations had tried to provide recommendations. 62.5–125 mg daily per-oral seems a prudent choice since therapeutic drug monitoring may not be easily available.