Renal tubular acidosis
Etiology
- Type I (distal H+ secretion defect): low serum K+, urine pH >5.5, associated with autoimmune disease, hypercalcemia
- Type II (proximal HCO3- reabosrbtion defect): low serum K+, urine pH < 5.5, associated with multiple myeloma, drugs (eg, sulfa)
- Type III (rare): normal serum K+, urine pH < 5.5, associated with renal insufficiency
- Type IV (hyporeninemic hypoaldosteronism): high serum K+, urine pH < 5.5, associated with diabetes mellitus, drugs (eg, NSAIDs)
DDx
Other causes of normal gap metabolic acidosis
- Gastrointestinal loss of HCO3-, eg, diarrhea, pancreatic ileostomy or ileal loop bladder
- Renal tubular acidosis
- Recovery from diabetic ketoacidosis
- Dilutional acidosis from rapid administration of 0.9% NaCl
- Carbonic anhydrase inhibitors
- Chloride retention or administration of HCl equivalent or NH4Cl
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