A 63-year-old man with long-standing diabetes mellitus comes to the clinic because of fatigue. Medications include lisinopril and ibuprofen as needed for back pain. Laboratory studies show potassium 5.9 mEq/L, bicarbonate 18 mEq/L, and a normal anion gap. Which of the following is the most likely explanation for this patient's acid-base disorder?
- A)Lactic acid accumulation from tissue hypoperfusion
- B)Chronic vomiting with chloride depletion
- C)Proximal bicarbonate wasting from Fanconi syndrome
- D)Hyporeninemic hypoaldosteronismGABARITO
- E)Distal hydrogen ion secretion defect with nephrolithiasis
Explicação
Type 4 renal tubular acidosis is common in diabetic nephropathy and results from hyporeninemic hypoaldosteronism or aldosterone resistance. It causes hyperkalemia and a mild nonanion gap metabolic acidosis because reduced aldosterone decreases distal sodium re... Ver explicação completa e trilha adaptativa →