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Related Subjects: |Metabolic acidosis |Aspirin or Salicylates toxicity |Ethylene glycol toxicity |Renal Tubular Acidosis |Lactic acidosis
RTA 1,2 and 4
Lytes and gaps, we love it all
Kind request from kidney docs
Check pH before we talk
@DrCindyCooper
There is failure to excrete normally acidic urine so typical urinary pH is > 5.5 even with an acid load. Causes a normal Anion gap Metabolic acidosis as there is a basic failure to excrete an acid urine
Type | Defect | Details | Management |
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1 | Failure to excrete H⁺ ions Distal tubule, Low K | SLE, Sjogren's, sickle cell, Ehlers Danlos, Autoimmune diseases, nephrocalcinosis, Toluene, Lithium, Amphotericin | Renal stones due to hypercalciuria and low citrate in urine Treat with oral Bicarbonate to correct acidosis |
2 | Failure to absorb HCO₃- Proximal Tubule Rare | Fanconi syndrome, Cystinosis, Wilson's disease, Myeloma, Amyloid, HPTHM, Heavy meta poisoning, Carbonic anhydrase inhibitors | Treat with oral Bicarbonate to correct acidosis |
3 | This is Type 1 + 2 | Rare, Normal serum K+ < and Urine pH < 5.5, associated with renal insufficiency | |
4 | Hyperkalaemic | Abnormal excretion of acid and potassium in the collecting duct. Hyperkalaemia and low renin and low aldosterone. Seen with Diabetes, interstitial nephritis, Commonest. Others are Renal transplant rejection, Obstructive uropathy. May worsen with inter current illness | Treat with fludrocortisone, diuretics and Bicarbonate and ion exchange resins to lower K |