Specimen Name Result Units Range
Plasma Sodium 138 mmol/L (135-145)
Potassium 6.8 mmol/L (3.5-5.5)
Chloride 115 mmol/L (100-109)
Bicarbonate 16 mmol/L (22-32)
Anion Gap 14 mmol/L (7-17)
Glucose 5.7 mmol/L (3.8-5.5)
Urea 17.5 mmol/L (2.7-7.2)
Creatinine 210 μmol/L (60-110)
Osmolality 291 mmol/kg (275-295)
Urate 0.41 mmol/L (0.20-0.40)
Phosphate 1.20 mmol/L (0.80-1.45)
Total Calcium 2.45 mmol/L (2.10-2.55)
Albumin 53 g/L (34-48)
Globulins 36 g/L (22-35)
Total Bilirubin 9 μmol/L (6-24)
Conj. Bilirubin 3 μmol/L (1-4)
GGT 11 U/L (< 60)
ALP 71 U/L (30-110)
AST 19 U/L (< 45)
LDH 198 U/L (110-230)
Cholesterol 5.5 mmol/L (3.5-5.5)

91yo female RAH patient.
Renal Tubular Acidosis

Type 4 - Hyperkalaemic:

  • hyperchloraemic-hyperkalaemic metabolic acidosis
  • moderate AKI
  • ** hyperkalaemia is marked and higher than would be expected from RTA alone
    → likely additional pathology

Hyperchloraemia:

  1. any hypernatraemic state
  2. respiratory alkalosis
  3. normal AG metabolic acidosis:
    • renal - RTA, CA inhibitors, early uraemia
    • non-renal - hypoadrenalism, diarrhoea, ureterosigmoidoscopy, treated DKA

 

Renal Tubular Acidosis

Type 1 Type 2 Type 4
Location DT & CT
α-intercalated cells		 PT Adrenal
Acidaemia Yes → Severe Yes ≈ mild Mild
Potassium Hypokalaemia Hypokalaemia Hyperkalaemia
Pathology Failure of
H+↔K+ exchange		 Failure of
HCO3- reabsorption		 ↓ Aldosterone
(hypo-/pseudo-)
Indicence Congenital (AD)
50:million		 Congenital (AD)
Acquired*
NB : *type 2
  • acquired most common → recovery phase ATN!
  • AutoD : deToni-Fanconi-Debris synd → aminoaciduria / phosphaturia