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Causes of Metabolic ACIDOSIS, Causes of Renal Tubular Acidosis(RTA),…
Causes of Metabolic ACIDOSIS
Metabolic Acidosis+Normal Anion Gap
RTA- Type1 & 2
Acid ingestion/Therapeutic NH4Cl infusion
Increased GI HCO3- loss(diarrhoea,small bowel fistula)
Metabolic Acidosis with Increased Anion Gap
Endogenous Acid load
Kidney disease(AKI,CKD)- accumulation of organic acids
Lactic Acidosis- caused by Shock, liver disease, drugs(metformin)
Starvation ketosis- accumulation of ketones without Hyperglycemia
DKA- accumulation of ketones with hyperglycemia
Alcoholic Ketoacidosis- accumulation of ketones without Hyperglycemia
Exogenous acid load
Aspirin poisoning(salicylate accumulation)
METHANOL poisoning(accumulation of formate)
Ethylene glycol poisoning(accumulation of Glycolate,Oxalate)
Causes of Renal Tubular Acidosis(RTA)
Type 1(Classical distal RTA)
:red_flag:impaired acid secretion in Late DCT or IC cells of CD
Autoimmune(SLE,Sjogren's syndrome) Drugs(Lithium, Amphotericin)
Hyperglobulinemia & Inherited causes
Type 2 RTA(Proximal RTA)
:red_flag: decreased HCO3 reabsorption in proximal tubules, so increased urinary HCO3 loss
Inherited: Fanconi's syndrome, Wilson's disease Paraproteinemia: Myeloma
Amyloidosis, Hyperparathyroidism,
Drugs: CA inhibitor, Ifosfamide, Heavy metal toxicity- Lead, mercury
Type 4 RTA(Hyperkalemic distal RTA)
:red_flag: decreased K & H excretion with impaired Na reabsorption in Late DCT/CD
Drugs: Spironolactone, Amiloride
Hypoaldosteronism(primary or secondary)
Obstructive Nephropathy
Kidney transplant rejection
causes
causes
(Urinary pH<5.5) means able to acidify urine
causes
Confirmatory Dx(Urinary pH>5.5)- unable to acidify urine
(Urinary pH<5.5) means able to acidify urine