Produção Nacional
Revisado por pares
A physiology-based approach to a patient with hyperkalemic renal tubular acidosis
2018; Sociedade Brasileira de Nefrologia; Volume: 40; Issue: 4 Linguagem: Inglês
10.1590/2175-8239-jbn-3821
ISSN2175-8239
AutoresJuliana Menegussi, Luiza Sarmento Tatagiba, Júlia Guasti P. Vianna, Antônio Carlos Seguro, Weverton Machado Luchi,
Tópico(s)Potassium and Related Disorders
ResumoHyperkalemic 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.
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