Acid-Base

Question 1

What are the features of renal tubular acidosis type I?

Answer 1

• Normal anion gap metabolic acidosis
• Alkaline urine (pH > 5.5)
• Low urine NH4Cl
• High serum chloride level (hyperchloremic non-gap metabolic acidosis)
• Distal tubule not excreting H+
• Hypokalemia

Question 2

What are the features of renal tubular acidosis type II?

Answer 2

• Normal anion gap metabolic acidosis
• Proximal tubules losing too much HCO3
• Urine pH < 5.5
• Hypokalemia

Question 3

What causes chloride responsive metabolic alkalosis?

Answer 3

Vomiting
Dehydration
Diuretics
- Loop: hyponatremia hypokalemia hypochloremia, except LASIX: hypernatremia hypercalciuria hypomagnesemia
- Thiazides: hyponatremia hypokalemia hypochloremia

Question 4

What causes chloride unresponsive metabolic alkalosis?

Answer 4

• Cushing’s syndrome
• Hyper aldosteronism
• Bartter Syndrome: low/normal BP, hypokalemia, hypochloremia, high urine K and Cl
• Gitleman Syndrome: normal BP, hypokalemia, hypochloremia, high urine K and Cl
• Liddle Syndrome: high BP because of an over active renin-angiotensin-aldosterone system, hypokalemia, hypochloremia, high urine K and Cl