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What should I do with renal tubular acidosis?

2017-05-13 10:03

Urine examination, type 1 patients with urinary pH often more than 5.5, often increased to 7 (despite the obvious blood acidosis), incomplete in the ammonium chloride load test after the emergence of such a situation. In type 2 patients, the urine pH value increases only when severe acidosis occurs. When the acidosis is not serious, the urine pH value can be <5.5. The urine pH values of type 4 and type 3 patients were all <5.5. Except for type 1, titratable uric acid and urinary ammonium in all other types of urine decreased. Except for type 3 urinary potassium excretion, the other types of urine sodium, potassium, calcium and phosphorus were increased. In addition to the 2 type patients with glucose and amino acids increased, the type of urine glucose and urine amino acids did not increase. 1,2 type of glomerular filtration rate normal, 3,4 type reduced.
Blood biochemical values of all patients decreased with pH. Only patients with incomplete type 1 blood pH values are within normal limits. Blood CO2 binding force was identical with blood pH value. 1, type 2 blood potassium decreased, type 3 normal, type 4 increased. Secondary blood ammonia increases when severe distal renal tubular acidosis occurs. Miller et al reported that in 1 infants with severe distal tubular acidosis, there may be an increase in ammonia synthesis in the kidneys, but not excretion from urine, resulting in an increase in blood ammonia levels when the ammonia is expanded into the circulation of the blood.
Load test for incomplete type 1 renal tubular acidosis can be done by ammonium chloride loading test to help diagnose. Test method for fasting in acidic or alkaline drugs after oral administration of ammonium chloride 2G, 3 /d, even for 5 days, the blood pH values decreased when the pH value of urine is still not below 5.5 can be diagnosed as incomplete type 1 renal tubular acidosis. After oral administration of calcium chloride 0.2g/kg and 5h, the urinary pH value could not be reduced to below 5.5, indicating that there was an obstruction of urinary acidification, which could be diagnosed as incomplete renal tubular acidosis of type 1. Intravenous drip of 400ml, bicarbonate of soda and high concentration of HCO3- in 2H support the diagnosis of type 2 renal tubular acidosis.
Electrocardiogram examination hypokalemia patients have ST segment downward, T wave inversion, appear U wave. X-ray bone examination: osteoporosis and softening are obvious, with lower limbs and pelvis as the main weight. Some show fractures. Radionuclide bone scan showed that the nuclide absorption was sparse and uneven. The urinary citrate / creatinine ratio in all patients with complete or incomplete type 1 renal tubular acidosis was lower than 2.5.Urine and blood CO2 gradient (urine and blood CO2 gradient <14mmHg) were measured. Urine and blood CO2 gradient increased to 20mmHg after urinary bicarbonate up to 89mEq / L, heavy bicarbonate and neutral phosphate , Suggesting that the manifold pump is not fully functional.

 

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