Renal tubular acidosis differential diagnosis: Difference between revisions
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Aditya Ganti (talk | contribs) (Created page with "__NOTOC__ {{Renal tubular acidosis}} {{CMG}} ; {{AE}} {{ADG}} ==Overview== ==Differentiating Renal tubular acidosis from other diseases== ==References== {{reflist|2}}") |
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__NOTOC__ | __NOTOC__ | ||
[[Image:Home_logo1.png|right|250px|link=https://www.wikidoc.org/index.php/Renal_tubular_acidosis]] | |||
{{CMG}} ; {{AE}} {{ADG}} | {{CMG}} ; {{AE}} {{ADG}} | ||
==Overview== | ==Overview== | ||
Renal tubular acidosis must be differentiated form other diseases as most of them have a similar presentation of acidosis on [[Arterial blood gas|ABG]], [[dehydration]] ([[Nausea and vomiting|nausea]] and vomiting) and specific history pertaining to underlying etiology. | |||
==Differentiating Renal tubular acidosis from other diseases== | ==Differentiating Renal tubular acidosis from other diseases== | ||
Renal tubular acidosis must be differentiated form other diseases as most of them have a similar presentation of acidosis on [[Arterial blood gas|ABG]], [[dehydration]] ([[Nausea and vomiting|nausea]] and vomiting) and specific history pertaining to underlying etiology. | |||
<small> | |||
{| | |||
! rowspan="4" align="center" style="background:#4479BA; color: #FFFFFF;" + |Category | |||
! colspan="2" rowspan="4" align="center" style="background:#4479BA; color: #FFFFFF;" + |Disease | |||
! colspan="3" rowspan="3" align="center" style="background:#4479BA; color: #FFFFFF;" + |Mechanism | |||
! colspan="8" align="center" style="background:#4479BA; color: #FFFFFF;" + |Clinical | |||
! colspan="18" align="center" style="background:#4479BA; color: #FFFFFF;" + |Paraclinical | |||
! rowspan="4" align="center" style="background:#4479BA; color: #FFFFFF;" + |Gold standard diagnosis | |||
! rowspan="4" align="center" style="background:#4479BA; color: #FFFFFF;" + |Other findings | |||
|- | |||
! colspan="4" rowspan="2" align="center" style="background:#4479BA; color: #FFFFFF;" + |Symptoms | |||
! colspan="4" rowspan="2" align="center" style="background:#4479BA; color: #FFFFFF;" + |Signs | |||
! colspan="18" align="center" style="background:#4479BA; color: #FFFFFF;" + |Lab data | |||
|- | |||
! colspan="3" align="center" style="background:#4479BA; color: #FFFFFF;" + |ABG | |||
! colspan="2" align="center" style="background:#4479BA; color: #FFFFFF;" + |CBC | |||
! colspan="8" align="center" style="background:#4479BA; color: #FFFFFF;" + |Chemistry | |||
! colspan="2" align="center" style="background:#4479BA; color: #FFFFFF;" + |Renal | |||
! colspan="3" align="center" style="background:#4479BA; color: #FFFFFF;" + |U/A | |||
|- | |||
! align="center" style="background:#4479BA; color: #FFFFFF;" + |↑ acid | |||
production | |||
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Loss of | |||
bicarbonate | |||
! align="center" style="background:#4479BA; color: #FFFFFF;" + |↓ renal acid | |||
excretion | |||
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Fever | |||
! align="center" style="background:#4479BA; color: #FFFFFF;" + |N/V | |||
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Diarrhea | |||
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Dyspnea | |||
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Toxic/ill | |||
! align="center" style="background:#4479BA; color: #FFFFFF;" + |BP | |||
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Dehydration | |||
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Level of consciousness | |||
! align="center" style="background:#4479BA; color: #FFFFFF;" + |HCO<sub>3</sub><sup>−</sup> | |||
! align="center" style="background:#4479BA; color: #FFFFFF;" + |paCO<sub>2</sub> | |||
! align="center" style="background:#4479BA; color: #FFFFFF;" + |O<sub>2</sub> | |||
! align="center" style="background:#4479BA; color: #FFFFFF;" + |WBC | |||
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Hb | |||
! align="center" style="background:#4479BA; color: #FFFFFF;" + |BS | |||
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Cl<sup>−</sup> | |||
! align="center" style="background:#4479BA; color: #FFFFFF;" + |K<sup>+</sup> | |||
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Na<sup>+</sup> | |||
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Ketones | |||
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Lactic acid | |||
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Serum AG<ref>Brubaker RH, Meseeha M. High Anion Gap Metabolic Acidosis. [Updated 2017 Oct 9]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2018 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK448090/</ref> | |||
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Osmolar gap<ref name="pmid217949663">{{cite journal |vauthors=Kraut JA, Xing SX |title=Approach to the evaluation of a patient with an increased serum osmolal gap and high-anion-gap metabolic acidosis |journal=Am. J. Kidney Dis. |volume=58 |issue=3 |pages=480–4 |date=September 2011 |pmid=21794966 |doi=10.1053/j.ajkd.2011.05.018 |url=}}</ref> | |||
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Bun | |||
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Cr | |||
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Urine pH | |||
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Urine AG | |||
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Urine ketone | |||
|- | |||
| rowspan="3" align="center" style="background:#4479BA; color: #FFFFFF;" + |Ketoacidosis | |||
! colspan="2" align="center" style="background:#DCDCDC;" + |[[Diabetic ketoacidosis]]<ref name="WolfsdorfAllgrove2014">{{cite journal|last1=Wolfsdorf|first1=Joseph I|last2=Allgrove|first2=Jeremy|last3=Craig|first3=Maria E|last4=Edge|first4=Julie|last5=Glaser|first5=Nicole|last6=Jain|first6=Vandana|last7=Lee|first7=Warren WR|last8=Mungai|first8=Lucy NW|last9=Rosenbloom|first9=Arlan L|last10=Sperling|first10=Mark A|last11=Hanas|first11=Ragnar|title=Diabetic ketoacidosis and hyperglycemic hyperosmolar state|journal=Pediatric Diabetes|volume=15|issue=S20|year=2014|pages=154–179|issn=1399543X|doi=10.1111/pedi.12165}}</ref> | |||
| align="center" style="background:#F5F5F5;" + | + | |||
| align="center" style="background:#F5F5F5;" + |− | |||
| align="center" style="background:#F5F5F5;" + |− | |||
| align="center" style="background:#F5F5F5;" + | + | |||
| align="center" style="background:#F5F5F5;" + | + | |||
| align="center" style="background:#F5F5F5;" + | + | |||
| align="center" style="background:#F5F5F5;" + | + | |||
| align="center" style="background:#F5F5F5;" + | + | |||
| align="center" style="background:#F5F5F5;" + |↓ | |||
| align="center" style="background:#F5F5F5;" + | + | |||
| align="center" style="background:#F5F5F5;" + |↓ | |||
| align="center" style="background:#F5F5F5;" + |↓ | |||
| align="center" style="background:#F5F5F5;" + |↓ | |||
| align="center" style="background:#F5F5F5;" + |Nl to ↓ | |||
| align="center" style="background:#F5F5F5;" + |↑ | |||
| align="center" style="background:#F5F5F5;" + |Nl to ↑ | |||
| align="center" style="background:#F5F5F5;" + |↑↑ | |||
| align="center" style="background:#F5F5F5;" + |Nl | |||
| align="center" style="background:#F5F5F5;" + |↑ | |||
| align="center" style="background:#F5F5F5;" + |↓ | |||
| align="center" style="background:#F5F5F5;" + |↑ | |||
| align="center" style="background:#F5F5F5;" + |↑ | |||
| align="center" style="background:#F5F5F5;" + |↑ | |||
| align="center" style="background:#F5F5F5;" + |↑ | |||
| align="center" style="background:#F5F5F5;" + |Nl to ↑ | |||
| align="center" style="background:#F5F5F5;" + |Nl | |||
| align="center" style="background:#F5F5F5;" + |↓ | |||
| align="center" style="background:#F5F5F5;" + | + | |||
| align="center" style="background:#F5F5F5;" + | + | |||
| align="center" style="background:#F5F5F5;" + |Clinical + [[hyperglycemia]] + [[ketosis]] | |||
| align="left" style="background:#F5F5F5;" + | | |||
*Labs might show elevated K<sup>+</sup> even in K<sup>+</sup> depletion due to extravasation of [[intracellular]] K+ in exchanged with extracellular H<sup>+</sup> | |||
|- | |||
! colspan="2" align="center" style="background:#DCDCDC;" + |Starvation<ref name="pmid27752032">{{cite journal |vauthors=Mostert M, Bonavia A |title=Starvation Ketoacidosis as a Cause of Unexplained Metabolic Acidosis in the Perioperative Period |journal=Am J Case Rep |volume=17 |issue= |pages=755–758 |date=October 2016 |pmid=27752032 |pmc=5070574 |doi= |url=}}</ref> | |||
| align="center" style="background:#F5F5F5;" + | + | |||
| align="center" style="background:#F5F5F5;" + |− | |||
| align="center" style="background:#F5F5F5;" + |− | |||
| align="center" style="background:#F5F5F5;" + |− | |||
| align="center" style="background:#F5F5F5;" + | + | |||
| align="center" style="background:#F5F5F5;" + |− | |||
| align="center" style="background:#F5F5F5;" + |− | |||
| align="center" style="background:#F5F5F5;" + | + | |||
| align="center" style="background:#F5F5F5;" + |↓ | |||
| align="center" style="background:#F5F5F5;" + | + | |||
| align="center" style="background:#F5F5F5;" + |↓ | |||
| align="center" style="background:#F5F5F5;" + |↓ | |||
| align="center" style="background:#F5F5F5;" + |↓ | |||
| align="center" style="background:#F5F5F5;" + |Nl | |||
| align="center" style="background:#F5F5F5;" + |Nl | |||
| align="center" style="background:#F5F5F5;" + |Nl | |||
| align="center" style="background:#F5F5F5;" + |Nl to ↓ | |||
| align="center" style="background:#F5F5F5;" + |Nl | |||
| align="center" style="background:#F5F5F5;" + |↓ | |||
| align="center" style="background:#F5F5F5;" + |↓ | |||
| align="center" style="background:#F5F5F5;" + |↑ | |||
| align="center" style="background:#F5F5F5;" + |Nl | |||
| align="center" style="background:#F5F5F5;" + |↑ | |||
| align="center" style="background:#F5F5F5;" + |Nl | |||
| align="center" style="background:#F5F5F5;" + |Nl | |||
| align="center" style="background:#F5F5F5;" + |Nl | |||
| align="center" style="background:#F5F5F5;" + |Nl | |||
| align="center" style="background:#F5F5F5;" + | + | |||
| align="center" style="background:#F5F5F5;" + |− | |||
| align="center" style="background:#F5F5F5;" + |Clinical manifestation | |||
| align="left" style="background:#F5F5F5;" + | | |||
*[[Refeeding syndrome]] may occur during or after treatment | |||
|- | |||
! colspan="2" align="center" style="background:#DCDCDC;" + |Alcoholic ketoacidosis ([[Ethanol]])<ref name="pmid28613672">{{cite journal |vauthors=Howard RD, Bokhari SRA |title= |journal= |volume= |issue= |pages= |date= |pmid=28613672 |doi= |url=}}</ref> | |||
| align="center" style="background:#F5F5F5;" + | + | |||
| align="center" style="background:#F5F5F5;" + |− | |||
| align="center" style="background:#F5F5F5;" + |− | |||
| align="center" style="background:#F5F5F5;" + |− | |||
| align="center" style="background:#F5F5F5;" + | + | |||
| align="center" style="background:#F5F5F5;" + |± | |||
| align="center" style="background:#F5F5F5;" + |− | |||
| align="center" style="background:#F5F5F5;" + | + | |||
| align="center" style="background:#F5F5F5;" + |↓ ↑ | |||
| align="center" style="background:#F5F5F5;" + | + | |||
| align="center" style="background:#F5F5F5;" + |Agitated | |||
| align="center" style="background:#F5F5F5;" + |↓ | |||
| align="center" style="background:#F5F5F5;" + |↓ | |||
| align="center" style="background:#F5F5F5;" + |↓ | |||
| align="center" style="background:#F5F5F5;" + |Nl to ↑ | |||
| align="center" style="background:#F5F5F5;" + |Nl to ↑ | |||
| align="center" style="background:#F5F5F5;" + |↓ Nl ↑ | |||
| align="center" style="background:#F5F5F5;" + |Nl | |||
| align="center" style="background:#F5F5F5;" + |↓ | |||
| align="center" style="background:#F5F5F5;" + |↓ | |||
| align="center" style="background:#F5F5F5;" + |↑↑ | |||
| align="center" style="background:#F5F5F5;" + |↑ | |||
| align="center" style="background:#F5F5F5;" + |↑ | |||
| align="center" style="background:#F5F5F5;" + |↑↑ | |||
| align="center" style="background:#F5F5F5;" + |↑ | |||
| align="center" style="background:#F5F5F5;" + |Nl | |||
| align="center" style="background:#F5F5F5;" + |↓ | |||
| align="center" style="background:#F5F5F5;" + | + | |||
| align="center" style="background:#F5F5F5;" + | + | |||
| align="center" style="background:#F5F5F5;" + |Clinical manifestation + [[ketosis]] | |||
| align="left" style="background:#F5F5F5;" + | | |||
*Chronic [[alcohol abuse]] | |||
*Zero or low [[Alcohol|alcohol level]] | |||
|- | |||
| rowspan="3" align="center" style="background:#4479BA; color: #FFFFFF;" + |Systemic | |||
! colspan="2" align="center" style="background:#DCDCDC;" + |[[Sepsis]]<ref name="pmid28149822">{{cite journal |vauthors=Ganesh K, Sharma RN, Varghese J, Pillai MG |title=A profile of metabolic acidosis in patients with sepsis in an Intensive Care Unit setting |journal=Int J Crit Illn Inj Sci |volume=6 |issue=4 |pages=178–181 |date=2016 |pmid=28149822 |pmc=5225760 |doi=10.4103/2229-5151.195417 |url=}}</ref> | |||
| align="center" style="background:#F5F5F5;" + | + | |||
| align="center" style="background:#F5F5F5;" + |− | |||
| align="center" style="background:#F5F5F5;" + |− | |||
| align="center" style="background:#F5F5F5;" + | + | |||
| align="center" style="background:#F5F5F5;" + | + | |||
| align="center" style="background:#F5F5F5;" + |− | |||
| align="center" style="background:#F5F5F5;" + | + | |||
| align="center" style="background:#F5F5F5;" + | + | |||
| align="center" style="background:#F5F5F5;" + |↓ ↑ | |||
| align="center" style="background:#F5F5F5;" + | + | |||
| align="center" style="background:#F5F5F5;" + |↓ | |||
| align="center" style="background:#F5F5F5;" + |↓ | |||
| align="center" style="background:#F5F5F5;" + |↓ | |||
| align="center" style="background:#F5F5F5;" + |Nl to ↓ | |||
| align="center" style="background:#F5F5F5;" + |↑ | |||
| align="center" style="background:#F5F5F5;" + |Nl | |||
| align="center" style="background:#F5F5F5;" + |Nl | |||
| align="center" style="background:#F5F5F5;" + |Nl | |||
| align="center" style="background:#F5F5F5;" + |↑ | |||
| align="center" style="background:#F5F5F5;" + |↓ | |||
| align="center" style="background:#F5F5F5;" + |Nl | |||
| align="center" style="background:#F5F5F5;" + |Nl to ↑ | |||
| align="center" style="background:#F5F5F5;" + |Nl | |||
| align="center" style="background:#F5F5F5;" + |Nl | |||
| align="center" style="background:#F5F5F5;" + |↑ | |||
| align="center" style="background:#F5F5F5;" + |↑ | |||
| align="center" style="background:#F5F5F5;" + |Nl | |||
| align="center" style="background:#F5F5F5;" + |− | |||
| align="center" style="background:#F5F5F5;" + |− | |||
| align="center" style="background:#F5F5F5;" + |Clinical manifestation and lab finding | |||
| align="left" style="background:#F5F5F5;" + | | |||
*Not applicable | |||
|- | |||
! colspan="2" align="center" style="background:#DCDCDC;" + |[[Ischemia]]<ref name="KimmounNovy2015">{{cite journal|last1=Kimmoun|first1=Antoine|last2=Novy|first2=Emmanuel|last3=Auchet|first3=Thomas|last4=Ducrocq|first4=Nicolas|last5=Levy|first5=Bruno|title=Hemodynamic consequences of severe lactic acidosis in shock states: from bench to bedside|journal=Critical Care|volume=19|issue=1|year=2015|issn=1364-8535|doi=10.1186/s13054-015-0896-7}}</ref> | |||
| align="center" style="background:#F5F5F5;" + | + | |||
| align="center" style="background:#F5F5F5;" + |− | |||
| align="center" style="background:#F5F5F5;" + |− | |||
| align="center" style="background:#F5F5F5;" + |− | |||
| align="center" style="background:#F5F5F5;" + | + | |||
| align="center" style="background:#F5F5F5;" + |− | |||
| align="center" style="background:#F5F5F5;" + | + | |||
| align="center" style="background:#F5F5F5;" + | + | |||
| align="center" style="background:#F5F5F5;" + |↓ | |||
| align="center" style="background:#F5F5F5;" + | + | |||
| align="center" style="background:#F5F5F5;" + |− | |||
| align="center" style="background:#F5F5F5;" + |↓ | |||
| align="center" style="background:#F5F5F5;" + |↓ ↑ | |||
| align="center" style="background:#F5F5F5;" + |Nl to ↓ | |||
| align="center" style="background:#F5F5F5;" + |Nl to ↑ | |||
| align="center" style="background:#F5F5F5;" + |Nl | |||
| align="center" style="background:#F5F5F5;" + |Nl | |||
| align="center" style="background:#F5F5F5;" + |Nl | |||
| align="center" style="background:#F5F5F5;" + |↑ | |||
| align="center" style="background:#F5F5F5;" + |↓ | |||
| align="center" style="background:#F5F5F5;" + |Nl | |||
| align="center" style="background:#F5F5F5;" + |Nl to ↑ | |||
| align="center" style="background:#F5F5F5;" + |Nl | |||
| align="center" style="background:#F5F5F5;" + |Nl | |||
| align="center" style="background:#F5F5F5;" + |Nl to ↑ | |||
| align="center" style="background:#F5F5F5;" + |Nl to ↑ | |||
| align="center" style="background:#F5F5F5;" + |Nl | |||
| align="center" style="background:#F5F5F5;" + |− | |||
| align="center" style="background:#F5F5F5;" + |− | |||
| align="center" style="background:#F5F5F5;" + |Clinical manifestation and lab finding | |||
| align="left" style="background:#F5F5F5;" + | | |||
*Not applicable | |||
|- | |||
! colspan="2" align="center" style="background:#DCDCDC;" + |[[Lactic acidosis]]<ref name="KrautIngelfinger2014">{{cite journal|last1=Kraut|first1=Jeffrey A.|last2=Ingelfinger|first2=Julie R.|last3=Madias|first3=Nicolaos E.|title=Lactic Acidosis|journal=New England Journal of Medicine|volume=371|issue=24|year=2014|pages=2309–2319|issn=0028-4793|doi=10.1056/NEJMra1309483}}</ref> | |||
| align="center" style="background:#F5F5F5;" + | + | |||
| align="center" style="background:#F5F5F5;" + |− | |||
| align="center" style="background:#F5F5F5;" + |− | |||
| align="center" style="background:#F5F5F5;" + |± | |||
| align="center" style="background:#F5F5F5;" + | + | |||
| align="center" style="background:#F5F5F5;" + |− | |||
| align="center" style="background:#F5F5F5;" + |− | |||
| align="center" style="background:#F5F5F5;" + | + | |||
| align="center" style="background:#F5F5F5;" + |↓ ↑ | |||
| align="center" style="background:#F5F5F5;" + |± | |||
| align="center" style="background:#F5F5F5;" + |Agitated | |||
| align="center" style="background:#F5F5F5;" + |↓ | |||
| align="center" style="background:#F5F5F5;" + |↓ | |||
| align="center" style="background:#F5F5F5;" + |↓ | |||
| align="center" style="background:#F5F5F5;" + |Nl to ↑ | |||
| align="center" style="background:#F5F5F5;" + |↓ | |||
| align="center" style="background:#F5F5F5;" + |Nl | |||
| align="center" style="background:#F5F5F5;" + |Nl | |||
| align="center" style="background:#F5F5F5;" + |Nl | |||
| align="center" style="background:#F5F5F5;" + |Nl | |||
| align="center" style="background:#F5F5F5;" + |Nl | |||
| align="center" style="background:#F5F5F5;" + |↑ | |||
| align="center" style="background:#F5F5F5;" + |↑ | |||
| align="center" style="background:#F5F5F5;" + |↑ | |||
| align="center" style="background:#F5F5F5;" + |Nl or ↑ | |||
| align="center" style="background:#F5F5F5;" + |Nl | |||
| align="center" style="background:#F5F5F5;" + |↓ | |||
| align="center" style="background:#F5F5F5;" + |− | |||
| align="center" style="background:#F5F5F5;" + |− | |||
| align="center" style="background:#F5F5F5;" + |Clinical manifestation and lab finding | |||
| align="left" style="background:#F5F5F5;" + | | |||
*Not applicable | |||
|- | |||
| rowspan="5" align="center" style="background:#4479BA; color: #FFFFFF;" + |Renal | |||
! colspan="2" align="center" style="background:#DCDCDC;" + |[[Uremia]]<ref name="BrownMelamed2018">{{cite journal|last1=Brown|first1=Denver|last2=Melamed|first2=Michal L.|title=New Frontiers in Treating Uremic Metabolic Acidosis|journal=Clinical Journal of the American Society of Nephrology|volume=13|issue=1|year=2018|pages=4–5|issn=1555-9041|doi=10.2215/CJN.11771017}}</ref> | |||
| align="center" style="background:#F5F5F5;" + |− | |||
| align="center" style="background:#F5F5F5;" + |− | |||
| align="center" style="background:#F5F5F5;" + | + | |||
| align="center" style="background:#F5F5F5;" + | + | |||
| align="center" style="background:#F5F5F5;" + | + | |||
| align="center" style="background:#F5F5F5;" + |− | |||
| align="center" style="background:#F5F5F5;" + |− | |||
| align="center" style="background:#F5F5F5;" + | + | |||
| align="center" style="background:#F5F5F5;" + |↓ ↑ | |||
| align="center" style="background:#F5F5F5;" + |± | |||
| align="center" style="background:#F5F5F5;" + |↓ | |||
| align="center" style="background:#F5F5F5;" + |↓ | |||
| align="center" style="background:#F5F5F5;" + |↓ | |||
| align="center" style="background:#F5F5F5;" + |Nl to ↓ | |||
| align="center" style="background:#F5F5F5;" + |↑ | |||
| align="center" style="background:#F5F5F5;" + |↓ | |||
| align="center" style="background:#F5F5F5;" + |Nl | |||
| align="center" style="background:#F5F5F5;" + |Nl | |||
| align="center" style="background:#F5F5F5;" + |↑ | |||
| align="center" style="background:#F5F5F5;" + |↑ | |||
| align="center" style="background:#F5F5F5;" + |Nl | |||
| align="center" style="background:#F5F5F5;" + |Nl | |||
| align="center" style="background:#F5F5F5;" + |↑ | |||
| align="center" style="background:#F5F5F5;" + |↑ | |||
| align="center" style="background:#F5F5F5;" + |↑ | |||
| align="center" style="background:#F5F5F5;" + |↑ | |||
| align="center" style="background:#F5F5F5;" + |↓ | |||
| align="center" style="background:#F5F5F5;" + | + | |||
| align="center" style="background:#F5F5F5;" + |− | |||
| align="center" style="background:#F5F5F5;" + |Clinical manifestation and lab finding | |||
| align="left" style="background:#F5F5F5;" + | | |||
*May lead to [[pericarditis]] | |||
|- | |||
! colspan="2" align="center" style="background:#DCDCDC;" + |[[Renal failure]]<ref name="KrautMadias2016">{{cite journal|last1=Kraut|first1=Jeffrey A.|last2=Madias|first2=Nicolaos E.|title=Metabolic Acidosis of CKD: An Update|journal=American Journal of Kidney Diseases|volume=67|issue=2|year=2016|pages=307–317|issn=02726386|doi=10.1053/j.ajkd.2015.08.028}}</ref> | |||
| align="center" style="background:#F5F5F5;" + |− | |||
| align="center" style="background:#F5F5F5;" + |− | |||
| align="center" style="background:#F5F5F5;" + | + | |||
| align="center" style="background:#F5F5F5;" + |− | |||
| align="center" style="background:#F5F5F5;" + | + | |||
| align="center" style="background:#F5F5F5;" + |− | |||
| align="center" style="background:#F5F5F5;" + |− | |||
| align="center" style="background:#F5F5F5;" + | + | |||
| align="center" style="background:#F5F5F5;" + |↓ | |||
| align="center" style="background:#F5F5F5;" + | + | |||
| align="center" style="background:#F5F5F5;" + |↓ | |||
| align="center" style="background:#F5F5F5;" + |↓ | |||
| align="center" style="background:#F5F5F5;" + |↓ | |||
| align="center" style="background:#F5F5F5;" + |Nl to ↓ | |||
| align="center" style="background:#F5F5F5;" + |↑ | |||
| align="center" style="background:#F5F5F5;" + |↓ | |||
| align="center" style="background:#F5F5F5;" + |Nl | |||
| align="center" style="background:#F5F5F5;" + |↑ | |||
| align="center" style="background:#F5F5F5;" + |↑ | |||
| align="center" style="background:#F5F5F5;" + |↓ | |||
| align="center" style="background:#F5F5F5;" + |Nl | |||
| align="center" style="background:#F5F5F5;" + |Nl | |||
| align="center" style="background:#F5F5F5;" + |↑ | |||
| align="center" style="background:#F5F5F5;" + |↑ | |||
| align="center" style="background:#F5F5F5;" + |↑ | |||
| align="center" style="background:#F5F5F5;" + |↑ | |||
| align="center" style="background:#F5F5F5;" + |↓ | |||
| align="center" style="background:#F5F5F5;" + |− | |||
| align="center" style="background:#F5F5F5;" + |− | |||
| align="center" style="background:#F5F5F5;" + |[[Renal function tests|Renal function test]] | |||
| align="left" style="background:#F5F5F5;" + | | |||
*Not applicable | |||
|- | |||
! rowspan="3" align="center" style="background:#DCDCDC;" + |[[Renal tubular acidosis]]<ref name="Gil-PeñaMejía2014">{{cite journal|last1=Gil-Peña|first1=Helena|last2=Mejía|first2=Natalia|last3=Santos|first3=Fernando|title=Renal Tubular Acidosis|journal=The Journal of Pediatrics|volume=164|issue=4|year=2014|pages=691–698.e1|issn=00223476|doi=10.1016/j.jpeds.2013.10.085}}</ref> | |||
! align="center" style="background:#DCDCDC;" + |Type I<ref name="Hemstreet2004">{{cite journal|last1=Hemstreet|first1=Brian A|title=Antimicrobial-Associated Renal Tubular Acidosis|journal=Annals of Pharmacotherapy|volume=38|issue=6|year=2004|pages=1031–1038|issn=1060-0280|doi=10.1345/aph.1D573}}</ref> | |||
| align="center" style="background:#F5F5F5;" + |− | |||
| align="center" style="background:#F5F5F5;" + |− | |||
| align="center" style="background:#F5F5F5;" + | + | |||
| align="center" style="background:#F5F5F5;" + |± | |||
| align="center" style="background:#F5F5F5;" + |± | |||
| align="center" style="background:#F5F5F5;" + |− | |||
| align="center" style="background:#F5F5F5;" + |− | |||
| align="center" style="background:#F5F5F5;" + |− | |||
| align="center" style="background:#F5F5F5;" + |↓ ↑ | |||
| align="center" style="background:#F5F5F5;" + |− | |||
| align="center" style="background:#F5F5F5;" + |− | |||
| align="center" style="background:#F5F5F5;" + |↓ | |||
| align="center" style="background:#F5F5F5;" + |↓ | |||
| align="center" style="background:#F5F5F5;" + |Nl | |||
| align="center" style="background:#F5F5F5;" + |Nl | |||
| align="center" style="background:#F5F5F5;" + |Nl | |||
| align="center" style="background:#F5F5F5;" + |Nl | |||
| align="center" style="background:#F5F5F5;" + |↑ | |||
| align="center" style="background:#F5F5F5;" + |↓ | |||
| align="center" style="background:#F5F5F5;" + |↓ | |||
| align="center" style="background:#F5F5F5;" + |Nl | |||
| align="center" style="background:#F5F5F5;" + |Nl | |||
| align="center" style="background:#F5F5F5;" + |Nl | |||
| align="center" style="background:#F5F5F5;" + |Nl | |||
| align="center" style="background:#F5F5F5;" + |↑ | |||
| align="center" style="background:#F5F5F5;" + |↑ | |||
| align="center" style="background:#F5F5F5;" + |↑ | |||
| align="center" style="background:#F5F5F5;" + | + | |||
| align="center" style="background:#F5F5F5;" + |− | |||
| align="center" style="background:#F5F5F5;" + |Clinical manifestation and lab finding | |||
| align="left" style="background:#F5F5F5;" + | | |||
*Associated with [[Autoimmunity|autoimmune diseases]] | |||
*[[Delayed milestone|Growth retardation]] in children | |||
|- | |||
! align="center" style="background:#DCDCDC;" + |Type II | |||
| align="center" style="background:#F5F5F5;" + |− | |||
| align="center" style="background:#F5F5F5;" + | + | |||
| align="center" style="background:#F5F5F5;" + |− | |||
| align="center" style="background:#F5F5F5;" + |± | |||
| align="center" style="background:#F5F5F5;" + |± | |||
| align="center" style="background:#F5F5F5;" + |− | |||
| align="center" style="background:#F5F5F5;" + |− | |||
| align="center" style="background:#F5F5F5;" + |− | |||
| align="center" style="background:#F5F5F5;" + |↓ ↑ | |||
| align="center" style="background:#F5F5F5;" + |− | |||
| align="center" style="background:#F5F5F5;" + |− | |||
| align="center" style="background:#F5F5F5;" + |↓ | |||
| align="center" style="background:#F5F5F5;" + |↓ | |||
| align="center" style="background:#F5F5F5;" + |Nl | |||
| align="center" style="background:#F5F5F5;" + |Nl | |||
| align="center" style="background:#F5F5F5;" + |Nl | |||
| align="center" style="background:#F5F5F5;" + |Nl | |||
| align="center" style="background:#F5F5F5;" + |↑ | |||
| align="center" style="background:#F5F5F5;" + |↓ | |||
| align="center" style="background:#F5F5F5;" + |Nl | |||
| align="center" style="background:#F5F5F5;" + |Nl | |||
| align="center" style="background:#F5F5F5;" + |Nl | |||
| align="center" style="background:#F5F5F5;" + |Nl | |||
| align="center" style="background:#F5F5F5;" + |Nl | |||
| align="center" style="background:#F5F5F5;" + |Nl | |||
| align="center" style="background:#F5F5F5;" + |Nl | |||
| align="center" style="background:#F5F5F5;" + |Nl | |||
| align="center" style="background:#F5F5F5;" + |− | |||
| align="center" style="background:#F5F5F5;" + |− | |||
| align="center" style="background:#F5F5F5;" + |Clinical manifestation and lab finding | |||
| align="left" style="background:#F5F5F5;" + | | |||
*Not applicable | |||
|- | |||
! align="center" style="background:#DCDCDC;" + |Type IV | |||
| align="center" style="background:#F5F5F5;" + |− | |||
| align="center" style="background:#F5F5F5;" + |− | |||
| align="center" style="background:#F5F5F5;" + | + | |||
| align="center" style="background:#F5F5F5;" + |± | |||
| align="center" style="background:#F5F5F5;" + |± | |||
| align="center" style="background:#F5F5F5;" + |± | |||
| align="center" style="background:#F5F5F5;" + |− | |||
| align="center" style="background:#F5F5F5;" + |− | |||
| align="center" style="background:#F5F5F5;" + |↓ | |||
| align="center" style="background:#F5F5F5;" + |− | |||
| align="center" style="background:#F5F5F5;" + |− | |||
| align="center" style="background:#F5F5F5;" + |↓ | |||
| align="center" style="background:#F5F5F5;" + |↓ | |||
| align="center" style="background:#F5F5F5;" + |Nl | |||
| align="center" style="background:#F5F5F5;" + |Nl | |||
| align="center" style="background:#F5F5F5;" + |Nl | |||
| align="center" style="background:#F5F5F5;" + |Nl | |||
| align="center" style="background:#F5F5F5;" + |↑ | |||
| align="center" style="background:#F5F5F5;" + |↑ | |||
| align="center" style="background:#F5F5F5;" + |Nl | |||
| align="center" style="background:#F5F5F5;" + |Nl | |||
| align="center" style="background:#F5F5F5;" + |Nl | |||
| align="center" style="background:#F5F5F5;" + |Nl | |||
| align="center" style="background:#F5F5F5;" + |Nl | |||
| align="center" style="background:#F5F5F5;" + |Nl | |||
| align="center" style="background:#F5F5F5;" + |Nl | |||
| align="center" style="background:#F5F5F5;" + |Nl | |||
| align="center" style="background:#F5F5F5;" + | + | |||
| align="center" style="background:#F5F5F5;" + |− | |||
| align="center" style="background:#F5F5F5;" + |Clinical manifestation and lab finding | |||
| align="left" style="background:#F5F5F5;" + | | |||
*[[Hypoaldosteronism]] | |||
|- | |||
| rowspan="2" align="center" style="background:#4479BA; color: #FFFFFF;" + |Heart | |||
! colspan="2" align="center" style="background:#DCDCDC;" + |[[Heart failure]]<ref name="ParkChoi2015">{{cite journal|last1=Park|first1=Jin Joo|last2=Choi|first2=Dong-Ju|last3=Yoon|first3=Chang-Hwan|last4=Oh|first4=Il-Young|last5=Lee|first5=Ju Hyun|last6=Ahn|first6=Soyeon|last7=Yoo|first7=Byung-Su|last8=Kang|first8=Seok-Min|last9=Kim|first9=Jae-Joong|last10=Baek|first10=Sang-Hong|last11=Cho|first11=Myeong-Chan|last12=Jeon|first12=Eun-Seok|last13=Chae|first13=Shung Chull|last14=Ryu|first14=Kyu-Hyung|last15=Oh|first15=Byung-Hee|title=The prognostic value of arterial blood gas analysis in high-risk acute heart failure patients: an analysis of the Korean Heart Failure (KorHF) registry|journal=European Journal of Heart Failure|volume=17|issue=6|year=2015|pages=601–611|issn=13889842|doi=10.1002/ejhf.276}}</ref> | |||
| align="center" style="background:#F5F5F5;" + | + | |||
| align="center" style="background:#F5F5F5;" + | + | |||
| align="center" style="background:#F5F5F5;" + |− | |||
| align="center" style="background:#F5F5F5;" + |− | |||
| align="center" style="background:#F5F5F5;" + |± | |||
| align="center" style="background:#F5F5F5;" + |− | |||
| align="center" style="background:#F5F5F5;" + | + | |||
| align="center" style="background:#F5F5F5;" + | + | |||
| align="center" style="background:#F5F5F5;" + |↓ ↑ | |||
| align="center" style="background:#F5F5F5;" + | + | |||
| align="center" style="background:#F5F5F5;" + |− | |||
| align="center" style="background:#F5F5F5;" + |↓ | |||
| align="center" style="background:#F5F5F5;" + |↓ ↑ | |||
| align="center" style="background:#F5F5F5;" + |↓ | |||
| align="center" style="background:#F5F5F5;" + |Nl | |||
| align="center" style="background:#F5F5F5;" + |Nl | |||
| align="center" style="background:#F5F5F5;" + |Nl | |||
| align="center" style="background:#F5F5F5;" + |Nl | |||
| align="center" style="background:#F5F5F5;" + |↓ | |||
| align="center" style="background:#F5F5F5;" + |↓ | |||
| align="center" style="background:#F5F5F5;" + |Nl | |||
| align="center" style="background:#F5F5F5;" + |Nl | |||
| align="center" style="background:#F5F5F5;" + |Nl | |||
| align="center" style="background:#F5F5F5;" + |Nl | |||
| align="center" style="background:#F5F5F5;" + |Nl to ↑ | |||
| align="center" style="background:#F5F5F5;" + |Nl to ↑ | |||
| align="center" style="background:#F5F5F5;" + |Nl | |||
| align="center" style="background:#F5F5F5;" + |− | |||
| align="center" style="background:#F5F5F5;" + |− | |||
| align="center" style="background:#F5F5F5;" + |Clinical manifestation+ [[echocardiogram]] | |||
| align="left" style="background:#F5F5F5;" + | | |||
*[[Hypoalbuminemia]] | |||
*Elevated [[Natriuretic peptides|serum natriuretic peptide]] | |||
|- | |||
! colspan="2" align="center" style="background:#DCDCDC;" + |[[Myocardial infarction]]<ref name="MannBajulaiye2014">{{cite journal|last1=Mann|first1=Sarah|last2=Bajulaiye|first2=Akinyemi|last3=Sturgeon|first3=Kathleen|last4=Sabri|first4=Abdelkarim|last5=Muthukumaran|first5=Geetha|last6=Libonati|first6=Joseph R.|title=Effects of acute angiotensin II on ischemia reperfusion injury following myocardial infarction|journal=Journal of the Renin-Angiotensin-Aldosterone System|volume=16|issue=1|year=2014|pages=13–22|issn=1470-3203|doi=10.1177/1470320314554963}}</ref> | |||
| align="center" style="background:#F5F5F5;" + | + | |||
| align="center" style="background:#F5F5F5;" + |− | |||
| align="center" style="background:#F5F5F5;" + |− | |||
| align="center" style="background:#F5F5F5;" + |− | |||
| align="center" style="background:#F5F5F5;" + | + | |||
| align="center" style="background:#F5F5F5;" + |− | |||
| align="center" style="background:#F5F5F5;" + | + | |||
| align="center" style="background:#F5F5F5;" + | + | |||
| align="center" style="background:#F5F5F5;" + |↓ ↑ | |||
| align="center" style="background:#F5F5F5;" + |− | |||
| align="center" style="background:#F5F5F5;" + |↓ | |||
| align="center" style="background:#F5F5F5;" + |↓ | |||
| align="center" style="background:#F5F5F5;" + |↓ ↑ | |||
| align="center" style="background:#F5F5F5;" + |Nl to ↓ | |||
| align="center" style="background:#F5F5F5;" + |Nl to ↑ | |||
| align="center" style="background:#F5F5F5;" + |Nl | |||
| align="center" style="background:#F5F5F5;" + |Nl | |||
| align="center" style="background:#F5F5F5;" + |Nl | |||
| align="center" style="background:#F5F5F5;" + |↑ | |||
| align="center" style="background:#F5F5F5;" + |↓ | |||
| align="center" style="background:#F5F5F5;" + |Nl | |||
| align="center" style="background:#F5F5F5;" + |↑ | |||
| align="center" style="background:#F5F5F5;" + |Nl | |||
| align="center" style="background:#F5F5F5;" + |Nl | |||
| align="center" style="background:#F5F5F5;" + |Nl to ↑ | |||
| align="center" style="background:#F5F5F5;" + |Nl to ↑ | |||
| align="center" style="background:#F5F5F5;" + |Nl | |||
| align="center" style="background:#F5F5F5;" + |− | |||
| align="center" style="background:#F5F5F5;" + |− | |||
| align="center" style="background:#F5F5F5;" + |Clinical manifestation + [[ECG]] | |||
| align="left" style="background:#F5F5F5;" + | | |||
*Not applicable | |||
|- | |||
! rowspan="3" align="center" style="background:#4479BA; color: #FFFFFF;" + |GI | |||
! colspan="2" align="center" style="background:#DCDCDC;" + |[[Diarrhea]]<ref name="GuerrantVan Gilder2001">{{cite journal|last1=Guerrant|first1=R. L.|last2=Van Gilder|first2=T.|last3=Steiner|first3=T. S.|last4=Thielman|first4=N. M.|last5=Slutsker|first5=L.|last6=Tauxe|first6=R. V.|last7=Hennessy|first7=T.|last8=Griffin|first8=P. M.|last9=DuPont|first9=H.|last10=Bradley Sack|first10=R.|last11=Tarr|first11=P.|last12=Neill|first12=M.|last13=Nachamkin|first13=I.|last14=Reller|first14=L. B.|last15=Osterholm|first15=M. T.|last16=Bennish|first16=M. L.|last17=Pickering|first17=L. K.|title=Practice Guidelines for the Management of Infectious Diarrhea|journal=Clinical Infectious Diseases|volume=32|issue=3|year=2001|pages=331–351|issn=1058-4838|doi=10.1086/318514}}</ref> | |||
| align="center" style="background:#F5F5F5;" + |− | |||
| align="center" style="background:#F5F5F5;" + | + | |||
| align="center" style="background:#F5F5F5;" + |− | |||
| align="center" style="background:#F5F5F5;" + |± | |||
| align="center" style="background:#F5F5F5;" + | + | |||
| align="center" style="background:#F5F5F5;" + | + | |||
| align="center" style="background:#F5F5F5;" + |− | |||
| align="center" style="background:#F5F5F5;" + | + | |||
| align="center" style="background:#F5F5F5;" + |↓ | |||
| align="center" style="background:#F5F5F5;" + | + | |||
| align="center" style="background:#F5F5F5;" + |May be lethargic | |||
| align="center" style="background:#F5F5F5;" + |↓ | |||
| align="center" style="background:#F5F5F5;" + |↓ | |||
| align="center" style="background:#F5F5F5;" + |Nl | |||
| align="center" style="background:#F5F5F5;" + |Nl | |||
| align="center" style="background:#F5F5F5;" + |↓ | |||
| align="center" style="background:#F5F5F5;" + |↓ | |||
| align="center" style="background:#F5F5F5;" + |↑ | |||
| align="center" style="background:#F5F5F5;" + |↑ | |||
| align="center" style="background:#F5F5F5;" + |Nl | |||
| align="center" style="background:#F5F5F5;" + |Nl | |||
| align="center" style="background:#F5F5F5;" + |Nl | |||
| align="center" style="background:#F5F5F5;" + |Nl | |||
| align="center" style="background:#F5F5F5;" + |Nl | |||
| align="center" style="background:#F5F5F5;" + |↑ | |||
| align="center" style="background:#F5F5F5;" + |Nl | |||
| align="center" style="background:#F5F5F5;" + |Nl | |||
| align="center" style="background:#F5F5F5;" + |− | |||
| align="center" style="background:#F5F5F5;" + |− | |||
| align="center" style="background:#F5F5F5;" + |[[Stool examination|Stool exam]] | |||
| align="left" style="background:#F5F5F5;" + | | |||
*Not applicable | |||
|- | |||
! colspan="2" align="center" style="background:#DCDCDC;" + |[[Hyperalimentation]]<ref name="ErlingssonHerard2009">{{cite journal|last1=Erlingsson|first1=Styrbjörn|last2=Herard|first2=Sebastian|last3=Dahlqvist Leinhard|first3=Olof|last4=Lindström|first4=Torbjörb|last5=Länne|first5=Toste|last6=Borga|first6=Magnus|last7=Nystrom|first7=Fredrik H.|title=Men develop more intraabdominal obesity and signs of the metabolic syndrome after hyperalimentation than women|journal=Metabolism|volume=58|issue=7|year=2009|pages=995–1001|issn=00260495|doi=10.1016/j.metabol.2009.02.028}}</ref> | |||
| align="center" style="background:#F5F5F5;" + | + | |||
| align="center" style="background:#F5F5F5;" + | + | |||
| align="center" style="background:#F5F5F5;" + |− | |||
| align="center" style="background:#F5F5F5;" + |− | |||
| align="center" style="background:#F5F5F5;" + |− | |||
| align="center" style="background:#F5F5F5;" + | + | |||
| align="center" style="background:#F5F5F5;" + |− | |||
| align="center" style="background:#F5F5F5;" + |− | |||
| align="center" style="background:#F5F5F5;" + |Nl | |||
| align="center" style="background:#F5F5F5;" + |− | |||
| align="center" style="background:#F5F5F5;" + |− | |||
| align="center" style="background:#F5F5F5;" + |↓ | |||
| align="center" style="background:#F5F5F5;" + |↓ | |||
| align="center" style="background:#F5F5F5;" + |Nl | |||
| align="center" style="background:#F5F5F5;" + |Nl | |||
| align="center" style="background:#F5F5F5;" + |↓ | |||
| align="center" style="background:#F5F5F5;" + |Nl | |||
| align="center" style="background:#F5F5F5;" + |↑ | |||
| align="center" style="background:#F5F5F5;" + |↑ | |||
| align="center" style="background:#F5F5F5;" + |Nl | |||
| align="center" style="background:#F5F5F5;" + |Nl | |||
| align="center" style="background:#F5F5F5;" + |Nl | |||
| align="center" style="background:#F5F5F5;" + |Nl | |||
| align="center" style="background:#F5F5F5;" + |Nl | |||
| align="center" style="background:#F5F5F5;" + |Nl | |||
| align="center" style="background:#F5F5F5;" + |Nl | |||
| align="center" style="background:#F5F5F5;" + |Nl | |||
| align="center" style="background:#F5F5F5;" + |− | |||
| align="center" style="background:#F5F5F5;" + |− | |||
| align="center" style="background:#F5F5F5;" + |Clinical manifestation | |||
| align="left" style="background:#F5F5F5;" + | | |||
*Not applicable | |||
|- | |||
! colspan="2" align="center" style="background:#DCDCDC;" + |[[Liver failure]]<ref name="LangeBojunga2009">{{cite journal|last1=Lange|first1=Christian M.|last2=Bojunga|first2=Jörg|last3=Hofmann|first3=Wolf Peter|last4=Wunder|first4=Katrin|last5=Mihm|first5=Ulrike|last6=Zeuzem|first6=Stefan|last7=Sarrazin|first7=Christoph|title=Severe lactic acidosis during treatment of chronic hepatitis B with entecavir in patients with impaired liver function|journal=Hepatology|volume=50|issue=6|year=2009|pages=2001–2006|issn=02709139|doi=10.1002/hep.23346}}</ref> | |||
| align="center" style="background:#F5F5F5;" + |− | |||
| align="center" style="background:#F5F5F5;" + | + | |||
| align="center" style="background:#F5F5F5;" + |− | |||
| align="center" style="background:#F5F5F5;" + |− | |||
| align="center" style="background:#F5F5F5;" + | + | |||
| align="center" style="background:#F5F5F5;" + | + | |||
| align="center" style="background:#F5F5F5;" + |− | |||
| align="center" style="background:#F5F5F5;" + | + | |||
| align="center" style="background:#F5F5F5;" + |↓ | |||
| align="center" style="background:#F5F5F5;" + | + | |||
| align="center" style="background:#F5F5F5;" + |Confused | |||
| align="center" style="background:#F5F5F5;" + |↓ | |||
| align="center" style="background:#F5F5F5;" + |↓ | |||
| align="center" style="background:#F5F5F5;" + |Nl | |||
| align="center" style="background:#F5F5F5;" + |Nl | |||
| align="center" style="background:#F5F5F5;" + |↓ | |||
| align="center" style="background:#F5F5F5;" + |↓ ↑ | |||
| align="center" style="background:#F5F5F5;" + |↑ | |||
| align="center" style="background:#F5F5F5;" + |↓ | |||
| align="center" style="background:#F5F5F5;" + |↓ | |||
| align="center" style="background:#F5F5F5;" + |Nl | |||
| align="center" style="background:#F5F5F5;" + |Nl | |||
| align="center" style="background:#F5F5F5;" + |Nl | |||
| align="center" style="background:#F5F5F5;" + |Nl | |||
| align="center" style="background:#F5F5F5;" + |Nl | |||
| align="center" style="background:#F5F5F5;" + |Nl | |||
| align="center" style="background:#F5F5F5;" + |Nl | |||
| align="center" style="background:#F5F5F5;" + |− | |||
| align="center" style="background:#F5F5F5;" + |− | |||
| align="center" style="background:#F5F5F5;" + |[[Liver biopsy]] | |||
| align="left" style="background:#F5F5F5;" + | | |||
*Not applicable | |||
|- | |||
! rowspan="2" align="center" style="background:#4479BA; color: #FFFFFF;" + |Endocrine | |||
! colspan="2" align="center" style="background:#DCDCDC;" + |[[Hyperparathyroidism]]<ref name="BilezikianPotts2002">{{cite journal|last1=Bilezikian|first1=John P.|last2=Potts|first2=John T.|last3=Fuleihan|first3=Ghada El-Hajj|last4=Kleerekoper|first4=Michael|last5=Neer|first5=Robert|last6=Peacock|first6=Munro|last7=Rastad|first7=Jonas|last8=Silverberg|first8=Shonni J.|last9=Udelsman|first9=Robert|last10=Wells|first10=Samuel A.|title=Summary Statement from a Workshop on Asymptomatic Primary Hyperparathyroidism: A Perspective for the 21st Century|journal=The Journal of Clinical Endocrinology & Metabolism|volume=87|issue=12|year=2002|pages=5353–5361|issn=0021-972X|doi=10.1210/jc.2002-021370}}</ref> | |||
| align="center" style="background:#F5F5F5;" + |− | |||
| align="center" style="background:#F5F5F5;" + | + | |||
| align="center" style="background:#F5F5F5;" + | + | |||
| align="center" style="background:#F5F5F5;" + |− | |||
| align="center" style="background:#F5F5F5;" + | + | |||
| align="center" style="background:#F5F5F5;" + |− | |||
| align="center" style="background:#F5F5F5;" + |− | |||
| align="center" style="background:#F5F5F5;" + |− | |||
| align="center" style="background:#F5F5F5;" + |Nl | |||
| align="center" style="background:#F5F5F5;" + | + | |||
| align="center" style="background:#F5F5F5;" + |Confused | |||
| align="center" style="background:#F5F5F5;" + |↓ | |||
| align="center" style="background:#F5F5F5;" + |↓ | |||
| align="center" style="background:#F5F5F5;" + |Nl | |||
| align="center" style="background:#F5F5F5;" + |Nl | |||
| align="center" style="background:#F5F5F5;" + |Nl | |||
| align="center" style="background:#F5F5F5;" + |Nl | |||
| align="center" style="background:#F5F5F5;" + |Nl | |||
| align="center" style="background:#F5F5F5;" + |Nl | |||
| align="center" style="background:#F5F5F5;" + |Nl | |||
| align="center" style="background:#F5F5F5;" + |Nl | |||
| align="center" style="background:#F5F5F5;" + |Nl | |||
| align="center" style="background:#F5F5F5;" + |Nl | |||
| align="center" style="background:#F5F5F5;" + |Nl | |||
| align="center" style="background:#F5F5F5;" + |Nl to ↑ | |||
| align="center" style="background:#F5F5F5;" + |Nl | |||
| align="center" style="background:#F5F5F5;" + |Nl | |||
| align="center" style="background:#F5F5F5;" + |− | |||
| align="center" style="background:#F5F5F5;" + |− | |||
| align="center" style="background:#F5F5F5;" + |[[Parathyroid hormone|PTH]] level | |||
| align="left" style="background:#F5F5F5;" + | | |||
*Not applicable | |||
|- | |||
! colspan="2" align="center" style="background:#DCDCDC;" + |[[Addison's disease]]<ref name="TenNew2001">{{cite journal|last1=Ten|first1=Svetlana|last2=New|first2=Maria|last3=Maclaren|first3=Noel|title=Addison’s Disease 2001|journal=The Journal of Clinical Endocrinology & Metabolism|volume=86|issue=7|year=2001|pages=2909–2922|issn=0021-972X|doi=10.1210/jcem.86.7.7636}}</ref> | |||
| align="center" style="background:#F5F5F5;" + |− | |||
| align="center" style="background:#F5F5F5;" + | + | |||
| align="center" style="background:#F5F5F5;" + |− | |||
| align="center" style="background:#F5F5F5;" + |− | |||
| align="center" style="background:#F5F5F5;" + | + | |||
| align="center" style="background:#F5F5F5;" + | + | |||
| align="center" style="background:#F5F5F5;" + |− | |||
| align="center" style="background:#F5F5F5;" + |− | |||
| align="center" style="background:#F5F5F5;" + |↓ | |||
| align="center" style="background:#F5F5F5;" + | + | |||
| align="center" style="background:#F5F5F5;" + |Irritable | |||
| align="center" style="background:#F5F5F5;" + |↓ | |||
| align="center" style="background:#F5F5F5;" + |↓ | |||
| align="center" style="background:#F5F5F5;" + |Nl | |||
| align="center" style="background:#F5F5F5;" + |Nl | |||
| align="center" style="background:#F5F5F5;" + |Nl | |||
| align="center" style="background:#F5F5F5;" + |↓ | |||
| align="center" style="background:#F5F5F5;" + |Nl | |||
| align="center" style="background:#F5F5F5;" + |↑ | |||
| align="center" style="background:#F5F5F5;" + |↓ | |||
| align="center" style="background:#F5F5F5;" + |Nl | |||
| align="center" style="background:#F5F5F5;" + |Nl | |||
| align="center" style="background:#F5F5F5;" + |Nl | |||
| align="center" style="background:#F5F5F5;" + |Nl | |||
| align="center" style="background:#F5F5F5;" + |Nl | |||
| align="center" style="background:#F5F5F5;" + |Nl | |||
| align="center" style="background:#F5F5F5;" + |Nl | |||
| align="center" style="background:#F5F5F5;" + |− | |||
| align="center" style="background:#F5F5F5;" + |− | |||
| align="center" style="background:#F5F5F5;" + |[[Hormone]] level | |||
| align="left" style="background:#F5F5F5;" + | | |||
*[[Weakness]] | |||
*[[Hyperpigmentation]] | |||
*[[Adrenal crisis|Adrenal Crisis]] | |||
|} | |||
</small> | |||
==References== | ==References== | ||
{{reflist|2}} | {{reflist|2}} | ||
Latest revision as of 21:08, 14 February 2019
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] ; Associate Editor(s)-in-Chief: Aditya Ganti M.B.B.S. [2]
Overview
Renal tubular acidosis must be differentiated form other diseases as most of them have a similar presentation of acidosis on ABG, dehydration (nausea and vomiting) and specific history pertaining to underlying etiology.
Differentiating Renal tubular acidosis from other diseases
Renal tubular acidosis must be differentiated form other diseases as most of them have a similar presentation of acidosis on ABG, dehydration (nausea and vomiting) and specific history pertaining to underlying etiology.
| Category | Disease | Mechanism | Clinical | Paraclinical | Gold standard diagnosis | Other findings | |||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Symptoms | Signs | Lab data | |||||||||||||||||||||||||||||||
| ABG | CBC | Chemistry | Renal | U/A | |||||||||||||||||||||||||||||
| ↑ acid
production |
Loss of
bicarbonate |
↓ renal acid
excretion |
Fever | N/V | Diarrhea | Dyspnea | Toxic/ill | BP | Dehydration | Level of consciousness | HCO3− | paCO2 | O2 | WBC | Hb | BS | Cl− | K+ | Na+ | Ketones | Lactic acid | Serum AG[1] | Osmolar gap[2] | Bun | Cr | Urine pH | Urine AG | Urine ketone | |||||
| Ketoacidosis | Diabetic ketoacidosis[3] | + | − | − | + | + | + | + | + | ↓ | + | ↓ | ↓ | ↓ | Nl to ↓ | ↑ | Nl to ↑ | ↑↑ | Nl | ↑ | ↓ | ↑ | ↑ | ↑ | ↑ | Nl to ↑ | Nl | ↓ | + | + | Clinical + hyperglycemia + ketosis |
| |
| Starvation[4] | + | − | − | − | + | − | − | + | ↓ | + | ↓ | ↓ | ↓ | Nl | Nl | Nl | Nl to ↓ | Nl | ↓ | ↓ | ↑ | Nl | ↑ | Nl | Nl | Nl | Nl | + | − | Clinical manifestation |
| ||
| Alcoholic ketoacidosis (Ethanol)[5] | + | − | − | − | + | ± | − | + | ↓ ↑ | + | Agitated | ↓ | ↓ | ↓ | Nl to ↑ | Nl to ↑ | ↓ Nl ↑ | Nl | ↓ | ↓ | ↑↑ | ↑ | ↑ | ↑↑ | ↑ | Nl | ↓ | + | + | Clinical manifestation + ketosis |
| ||
| Systemic | Sepsis[6] | + | − | − | + | + | − | + | + | ↓ ↑ | + | ↓ | ↓ | ↓ | Nl to ↓ | ↑ | Nl | Nl | Nl | ↑ | ↓ | Nl | Nl to ↑ | Nl | Nl | ↑ | ↑ | Nl | − | − | Clinical manifestation and lab finding |
| |
| Ischemia[7] | + | − | − | − | + | − | + | + | ↓ | + | − | ↓ | ↓ ↑ | Nl to ↓ | Nl to ↑ | Nl | Nl | Nl | ↑ | ↓ | Nl | Nl to ↑ | Nl | Nl | Nl to ↑ | Nl to ↑ | Nl | − | − | Clinical manifestation and lab finding |
| ||
| Lactic acidosis[8] | + | − | − | ± | + | − | − | + | ↓ ↑ | ± | Agitated | ↓ | ↓ | ↓ | Nl to ↑ | ↓ | Nl | Nl | Nl | Nl | Nl | ↑ | ↑ | ↑ | Nl or ↑ | Nl | ↓ | − | − | Clinical manifestation and lab finding |
| ||
| Renal | Uremia[9] | − | − | + | + | + | − | − | + | ↓ ↑ | ± | ↓ | ↓ | ↓ | Nl to ↓ | ↑ | ↓ | Nl | Nl | ↑ | ↑ | Nl | Nl | ↑ | ↑ | ↑ | ↑ | ↓ | + | − | Clinical manifestation and lab finding |
| |
| Renal failure[10] | − | − | + | − | + | − | − | + | ↓ | + | ↓ | ↓ | ↓ | Nl to ↓ | ↑ | ↓ | Nl | ↑ | ↑ | ↓ | Nl | Nl | ↑ | ↑ | ↑ | ↑ | ↓ | − | − | Renal function test |
| ||
| Renal tubular acidosis[11] | Type I[12] | − | − | + | ± | ± | − | − | − | ↓ ↑ | − | − | ↓ | ↓ | Nl | Nl | Nl | Nl | ↑ | ↓ | ↓ | Nl | Nl | Nl | Nl | ↑ | ↑ | ↑ | + | − | Clinical manifestation and lab finding |
| |
| Type II | − | + | − | ± | ± | − | − | − | ↓ ↑ | − | − | ↓ | ↓ | Nl | Nl | Nl | Nl | ↑ | ↓ | Nl | Nl | Nl | Nl | Nl | Nl | Nl | Nl | − | − | Clinical manifestation and lab finding |
| ||
| Type IV | − | − | + | ± | ± | ± | − | − | ↓ | − | − | ↓ | ↓ | Nl | Nl | Nl | Nl | ↑ | ↑ | Nl | Nl | Nl | Nl | Nl | Nl | Nl | Nl | + | − | Clinical manifestation and lab finding | |||
| Heart | Heart failure[13] | + | + | − | − | ± | − | + | + | ↓ ↑ | + | − | ↓ | ↓ ↑ | ↓ | Nl | Nl | Nl | Nl | ↓ | ↓ | Nl | Nl | Nl | Nl | Nl to ↑ | Nl to ↑ | Nl | − | − | Clinical manifestation+ echocardiogram |
| |
| Myocardial infarction[14] | + | − | − | − | + | − | + | + | ↓ ↑ | − | ↓ | ↓ | ↓ ↑ | Nl to ↓ | Nl to ↑ | Nl | Nl | Nl | ↑ | ↓ | Nl | ↑ | Nl | Nl | Nl to ↑ | Nl to ↑ | Nl | − | − | Clinical manifestation + ECG |
| ||
| GI | Diarrhea[15] | − | + | − | ± | + | + | − | + | ↓ | + | May be lethargic | ↓ | ↓ | Nl | Nl | ↓ | ↓ | ↑ | ↑ | Nl | Nl | Nl | Nl | Nl | ↑ | Nl | Nl | − | − | Stool exam |
| |
| Hyperalimentation[16] | + | + | − | − | − | + | − | − | Nl | − | − | ↓ | ↓ | Nl | Nl | ↓ | Nl | ↑ | ↑ | Nl | Nl | Nl | Nl | Nl | Nl | Nl | Nl | − | − | Clinical manifestation |
| ||
| Liver failure[17] | − | + | − | − | + | + | − | + | ↓ | + | Confused | ↓ | ↓ | Nl | Nl | ↓ | ↓ ↑ | ↑ | ↓ | ↓ | Nl | Nl | Nl | Nl | Nl | Nl | Nl | − | − | Liver biopsy |
| ||
| Endocrine | Hyperparathyroidism[18] | − | + | + | − | + | − | − | − | Nl | + | Confused | ↓ | ↓ | Nl | Nl | Nl | Nl | Nl | Nl | Nl | Nl | Nl | Nl | Nl | Nl to ↑ | Nl | Nl | − | − | PTH level |
| |
| Addison's disease[19] | − | + | − | − | + | + | − | − | ↓ | + | Irritable | ↓ | ↓ | Nl | Nl | Nl | ↓ | Nl | ↑ | ↓ | Nl | Nl | Nl | Nl | Nl | Nl | Nl | − | − | Hormone level | |||
References
- ↑ Brubaker RH, Meseeha M. High Anion Gap Metabolic Acidosis. [Updated 2017 Oct 9]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2018 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK448090/
- ↑ Kraut JA, Xing SX (September 2011). "Approach to the evaluation of a patient with an increased serum osmolal gap and high-anion-gap metabolic acidosis". Am. J. Kidney Dis. 58 (3): 480–4. doi:10.1053/j.ajkd.2011.05.018. PMID 21794966.
- ↑ Wolfsdorf, Joseph I; Allgrove, Jeremy; Craig, Maria E; Edge, Julie; Glaser, Nicole; Jain, Vandana; Lee, Warren WR; Mungai, Lucy NW; Rosenbloom, Arlan L; Sperling, Mark A; Hanas, Ragnar (2014). "Diabetic ketoacidosis and hyperglycemic hyperosmolar state". Pediatric Diabetes. 15 (S20): 154–179. doi:10.1111/pedi.12165. ISSN 1399-543X.
- ↑ Mostert M, Bonavia A (October 2016). "Starvation Ketoacidosis as a Cause of Unexplained Metabolic Acidosis in the Perioperative Period". Am J Case Rep. 17: 755–758. PMC 5070574. PMID 27752032.
- ↑ Howard RD, Bokhari S. PMID 28613672. Vancouver style error: initials (help); Missing or empty
|title=(help) - ↑ Ganesh K, Sharma RN, Varghese J, Pillai MG (2016). "A profile of metabolic acidosis in patients with sepsis in an Intensive Care Unit setting". Int J Crit Illn Inj Sci. 6 (4): 178–181. doi:10.4103/2229-5151.195417. PMC 5225760. PMID 28149822.
- ↑ Kimmoun, Antoine; Novy, Emmanuel; Auchet, Thomas; Ducrocq, Nicolas; Levy, Bruno (2015). "Hemodynamic consequences of severe lactic acidosis in shock states: from bench to bedside". Critical Care. 19 (1). doi:10.1186/s13054-015-0896-7. ISSN 1364-8535.
- ↑ Kraut, Jeffrey A.; Ingelfinger, Julie R.; Madias, Nicolaos E. (2014). "Lactic Acidosis". New England Journal of Medicine. 371 (24): 2309–2319. doi:10.1056/NEJMra1309483. ISSN 0028-4793.
- ↑ Brown, Denver; Melamed, Michal L. (2018). "New Frontiers in Treating Uremic Metabolic Acidosis". Clinical Journal of the American Society of Nephrology. 13 (1): 4–5. doi:10.2215/CJN.11771017. ISSN 1555-9041.
- ↑ Kraut, Jeffrey A.; Madias, Nicolaos E. (2016). "Metabolic Acidosis of CKD: An Update". American Journal of Kidney Diseases. 67 (2): 307–317. doi:10.1053/j.ajkd.2015.08.028. ISSN 0272-6386.
- ↑ Gil-Peña, Helena; Mejía, Natalia; Santos, Fernando (2014). "Renal Tubular Acidosis". The Journal of Pediatrics. 164 (4): 691–698.e1. doi:10.1016/j.jpeds.2013.10.085. ISSN 0022-3476.
- ↑ Hemstreet, Brian A (2004). "Antimicrobial-Associated Renal Tubular Acidosis". Annals of Pharmacotherapy. 38 (6): 1031–1038. doi:10.1345/aph.1D573. ISSN 1060-0280.
- ↑ Park, Jin Joo; Choi, Dong-Ju; Yoon, Chang-Hwan; Oh, Il-Young; Lee, Ju Hyun; Ahn, Soyeon; Yoo, Byung-Su; Kang, Seok-Min; Kim, Jae-Joong; Baek, Sang-Hong; Cho, Myeong-Chan; Jeon, Eun-Seok; Chae, Shung Chull; Ryu, Kyu-Hyung; Oh, Byung-Hee (2015). "The prognostic value of arterial blood gas analysis in high-risk acute heart failure patients: an analysis of the Korean Heart Failure (KorHF) registry". European Journal of Heart Failure. 17 (6): 601–611. doi:10.1002/ejhf.276. ISSN 1388-9842.
- ↑ Mann, Sarah; Bajulaiye, Akinyemi; Sturgeon, Kathleen; Sabri, Abdelkarim; Muthukumaran, Geetha; Libonati, Joseph R. (2014). "Effects of acute angiotensin II on ischemia reperfusion injury following myocardial infarction". Journal of the Renin-Angiotensin-Aldosterone System. 16 (1): 13–22. doi:10.1177/1470320314554963. ISSN 1470-3203.
- ↑ Guerrant, R. L.; Van Gilder, T.; Steiner, T. S.; Thielman, N. M.; Slutsker, L.; Tauxe, R. V.; Hennessy, T.; Griffin, P. M.; DuPont, H.; Bradley Sack, R.; Tarr, P.; Neill, M.; Nachamkin, I.; Reller, L. B.; Osterholm, M. T.; Bennish, M. L.; Pickering, L. K. (2001). "Practice Guidelines for the Management of Infectious Diarrhea". Clinical Infectious Diseases. 32 (3): 331–351. doi:10.1086/318514. ISSN 1058-4838.
- ↑ Erlingsson, Styrbjörn; Herard, Sebastian; Dahlqvist Leinhard, Olof; Lindström, Torbjörb; Länne, Toste; Borga, Magnus; Nystrom, Fredrik H. (2009). "Men develop more intraabdominal obesity and signs of the metabolic syndrome after hyperalimentation than women". Metabolism. 58 (7): 995–1001. doi:10.1016/j.metabol.2009.02.028. ISSN 0026-0495.
- ↑ Lange, Christian M.; Bojunga, Jörg; Hofmann, Wolf Peter; Wunder, Katrin; Mihm, Ulrike; Zeuzem, Stefan; Sarrazin, Christoph (2009). "Severe lactic acidosis during treatment of chronic hepatitis B with entecavir in patients with impaired liver function". Hepatology. 50 (6): 2001–2006. doi:10.1002/hep.23346. ISSN 0270-9139.
- ↑ Bilezikian, John P.; Potts, John T.; Fuleihan, Ghada El-Hajj; Kleerekoper, Michael; Neer, Robert; Peacock, Munro; Rastad, Jonas; Silverberg, Shonni J.; Udelsman, Robert; Wells, Samuel A. (2002). "Summary Statement from a Workshop on Asymptomatic Primary Hyperparathyroidism: A Perspective for the 21st Century". The Journal of Clinical Endocrinology & Metabolism. 87 (12): 5353–5361. doi:10.1210/jc.2002-021370. ISSN 0021-972X.
- ↑ Ten, Svetlana; New, Maria; Maclaren, Noel (2001). "Addison's Disease 2001". The Journal of Clinical Endocrinology & Metabolism. 86 (7): 2909–2922. doi:10.1210/jcem.86.7.7636. ISSN 0021-972X.