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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
RTA is characterized by the inability to excrete acidic urine, resulting in a typical urinary pH > 5.5 even with an acid load. It causes a normal anion gap metabolic acidosis due to the failure in acid urine excretion.
Type | Defect | Details | Management |
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1 | Failure to excrete H⁺ ions in distal tubule, low K | Conditions include SLE, Sjogren's, sickle cell, Ehlers-Danlos, autoimmune diseases, and exposure to substances like Toluene, Lithium, and Amphotericin. | Renal stones are common; treat with oral bicarbonate to correct acidosis. |
2 | Failure to absorb HCO₃⁻ in proximal tubule, rare | Associated with Fanconi syndrome, Wilson's disease, amyloidosis, and other causes. | Treat with oral bicarbonate. |
3 | Combination of Type 1 and Type 2 | Very rare; associated with renal insufficiency. | May not require specific treatment beyond managing underlying conditions. |
4 | Hyperkalemic | Caused by abnormal excretion of acid and potassium. Seen in diabetes, interstitial nephritis, and various medications. | Treat with fludrocortisone, diuretics, bicarbonate, and potassium binders. |