A physiology-based approach to a patient with hyperkalemic renal tubular acidosis

ABSTRACT Hyperkalemic renal tubular acidosis is a non-anion gap metabolic acidosis that invariably indicates an abnormality in potassium, ammonium, and hydrogen ion secretion. In clinical practice, it is usually attributed to real or apparent hypoaldosteronism caused by diseases or drug toxicity. We describe a 54-year-old liver transplant patient that was admitted with flaccid muscle weakness associated with plasma potassium level of 9.25 mEq/L. Additional investigation revealed type 4 renal tubular acidosis and marked hypomagnesemia with high fractional excretion of magnesium. Relevant past medical history included a recent diagnosis of Paracoccidioidomycosis, a systemic fungal infection that is endemic in some parts of South America, and his outpatient medications contained trimethoprim-sulfamethoxazole, tacrolimus, and propranolol. In the present acid-base and electrolyte case study, we discuss a clinical approach for the diagnosis of hyperkalemic renal tubular acidosis and review the pathophysiology of this disorder.

Bibliographic Details

Main Authors:	Menegussi,Juliana, Tatagiba,Luiza Sarmento, Vianna,Júlia Guasti P., Seguro,Antonio Carlos, Luchi,Weverton Machado
Format:	Digital revista
Language:	English
Published:	Sociedade Brasileira de Nefrologia 2018
Online Access:	http://old.scielo.br/scielo.php?script=sci_arttext&pid=S0101-28002018000400410
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