eMedicine Specialties > Nephrology > Acid-Base, Fluid, and Electrolyte Disorders

Hyperchloremic Acidosis: Follow-up

Author: Mahendra Agraharkar, MD, MBBS, FACP, FASN, Clinical Associate Professor of Medicine, Baylor College of Medicine, President & CEO, Space City Associates of Nephrology
Coauthor(s): Mark T Fahlen, MD, Inc; Kanwarpreet Baweja, MD, Fellow in Nephrology, Division of Renal Diseases and Hypertension, University of Texas Health Science Center
Contributor Information and Disclosures

Updated: Jul 30, 2009

Follow-up

Deterrence/Prevention

Avoiding drugs that can aggravate hyperchloremic acidose

  • Drugs that increase GI bicarbonate loss include calcium chloride, magnesium sulfate, and cholestyramine.
  • Drugs or toxins that can induce pRTA include streptozotocin, lead, mercury, arginine, valproic acid, gentamicin, ifosfamide, and outdated tetracycline
  • Drugs or toxins that can cause dRTA include amphotericin B, toluene, nonsteroidal anti-inflammatory drugs, lithium,5 and cyclamate

Complications

  • Underlying GI, renal, or autoimmune conditions
  • Hereditary disorders
  • Effects of agents used in treatment (eg, cardiac complications)

Patient Education

Miscellaneous

Medicolegal Pitfalls

  • Failure to confirm the cause of the acidosis
  • Failure to diagnose a primary condition
  • Failure to inform patients about dietary issues related to their acidosis
  • Failure to recognize and to inform the patient about possible adverse effects of agents used for treatment
 


More on Hyperchloremic Acidosis

Overview: Hyperchloremic Acidosis
Differential Diagnoses & Workup: Hyperchloremic Acidosis
Treatment & Medication: Hyperchloremic Acidosis
Follow-up: Hyperchloremic Acidosis
References
Further Reading

References

  1. Liborio AB, Daher EF, de Castro MC. Characterization of acid-base status in maintenance hemodialysis: physicochemical approach. J Artif Organs. 2008;11(3):156-9. [Medline].

  2. Davenport A. Potential adverse effects of replacing high volume hemofiltration exchanges on electrolyte balance and acid-base status using the current commercially available replacement solutions in patients with acute renal failure. Int J Artif Organs. Jan 2008;31(1):3-5. [Medline].

  3. Blake-Palmer KG, Karet FE. Cellular physiology of the renal H+ATPase. Curr Opin Nephrol Hypertens. Jun 24 2009;[Medline].

  4. Basic DT, Hadzi-Djokic J, Ignjatovic I. The history of urinary diversion. Acta Chir Iugosl. 2007;54(4):9-17. [Medline].

  5. Grünfeld JP, Rossier BC. Lithium nephrotoxicity revisited. Nat Rev Nephrol. May 2009;5(5):270-6. [Medline].

  6. Batlle D, Kurtzman NA. Distal renal tubular acidosis: pathogenesis and classification. Am J Kidney Dis. May 1982;1(6):328-44. [Medline].

  7. Burton DR. Metabolic acidosis. In: Clinical Physiology of Acid-Base and Electrolyte Disorders. 4th ed. New York, NY: McGraw-Hill; 1994:. 540-604.

  8. DuBose TD Jr. Hyperkalemic hyperchloremic metabolic acidosis: pathophysiologic insights. Kidney Int. Feb 1997;51(2):591-602. [Medline].

  9. Garella S, Salem MM. Clinical acid-base disorders. In: Oxford Textbook of Clinical Nephrology. 2nd ed. Oxford, UK: Oxford University Press; 1998:. 313-26.

  10. Lash JP, Arruda JA. Laboratory evaluation of renal tubular acidosis. Clin Lab Med. Mar 1993;13(1):117-29. [Medline].

  11. Rothstein M, Obialo C, Hruska KA. Renal tubular acidosis. Endocrinol Metab Clin North Am. Dec 1990;19(4):869-87. [Medline].

  12. Walmsley RN, White GH. Normal "anion gap" (hyperchloremic) acidosis. Clin Chem. Feb 1985;31(2):309-13. [Medline].

Further Reading

Clinical guidelines:
Metabolic acidosis and growth in children. Caring for Australasians with Renal Impairment - Disease Specific Society. 2005 Dec. 3 pages. NGC:006105

Clinical trials:
Genetic Study of Nephrolithiasis in Gouty Diathesis

Keywords

hyperchloremic acidosis, acidosis, metabolic acidosis, renal acidosis, renal tubular, renal acidosis, metabolic acidosis anion gap, renal tubular acidosis, anion gap, AG acidosis, nonanion gap acidosis, normal anion gap acidosis, low plasma bicarbonate, low bicarbonate concentration, chronic metabolic acidosis, bicarbonate-wasting acidosis, hyperchloremic metabolic acidosis, proximal renal tubular acidosis, pRTA, distal renal tubular acidosis, dRTA, hypokalemic distal renal tubular acidosis, RTA type I, type I RTA, hyperkalemic distal renal tubular acidosis, RTA type IV, type IV RTA, classic distal tubular acidosis, uremic acidosis, gastrointestinal bicarbonate loss, bicarbonaturia, bicarbonate wasting, potassium wasting, hypokalemia

Contributor Information and Disclosures

Author

Mahendra Agraharkar, MD, MBBS, FACP, FASN, Clinical Associate Professor of Medicine, Baylor College of Medicine, President & CEO, Space City Associates of Nephrology
Mahendra Agraharkar, MD, MBBS, FACP, FASN is a member of the following medical societies: American College of Physicians, American Society of Nephrology, and National Kidney Foundation
Disclosure: South Shore DaVita Dialysis Center  Ownership interest Other

Coauthor(s)

Mark T Fahlen, MD, Inc
Mark T Fahlen, MD is a member of the following medical societies: American College of Physicians and Renal Physicians Association
Disclosure: Nothing to disclose.

Kanwarpreet Baweja, MD, Fellow in Nephrology, Division of Renal Diseases and Hypertension, University of Texas Health Science Center
Kanwarpreet Baweja, MD is a member of the following medical societies: American Medical Association, American Society of Nephrology, Medical Council of India, and National Kidney Foundation
Disclosure: Nothing to disclose.

Medical Editor

Anil Kumar Mandal, MD, Clinical Professor, Department of Internal Medicine, Division of Nephrology, University of Florida School of Medicine
Anil Kumar Mandal, MD is a member of the following medical societies: American College of Clinical Pharmacology, American College of Physicians, American Society of Nephrology, and Central Society for Clinical Research
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Christie P Thomas, MBBS, FRCP, FASN, FAHA, Professor, Department of Internal Medicine, Division of Nephrology; Medical Director, Kidney and Kidney/Pancreas Transplant Program, University of Iowa Hospitals and Clinics
Christie P Thomas, MBBS, FRCP, FASN, FAHA is a member of the following medical societies: American College of Physicians, American Federation for Medical Research, American Heart Association, American Society of Nephrology, American Society of Transplantation, American Thoracic Society, International Society of Nephrology, and Royal College of Physicians
Disclosure: Genzyme Grant/research funds Other

CME Editor

Rebecca J Schmidt, DO, FACP, FASN, Professor of Medicine, Section Chief, Department of Medicine, Section of Nephrology, West Virginia University School of Medicine
Rebecca J Schmidt, DO, FACP, FASN is a member of the following medical societies: American College of Osteopathic Internists, American College of Physicians, American Medical Association, American Society of Nephrology, International Society of Nephrology, National Kidney Foundation, Renal Physicians Association, and West Virginia State Medical Association
Disclosure: Abbott Grant/research funds Speaking and teaching; Genzyme Honoraria Consulting; Amgen Honoraria Speaking and teaching; Ortho Biotech Honoraria Speaking and teaching

Chief Editor

Vecihi Batuman, MD, FACP, FASN, Professor of Medicine, Section of Nephrology-Hypertension, Tulane University School of Medicine; Chief, Medicine Service, Southeast Louisiana Veterans Health Care System
Vecihi Batuman, MD, FACP, FASN is a member of the following medical societies: American College of Physicians, American Society of Hypertension, American Society of Nephrology, and International Society of Nephrology
Disclosure: Nothing to disclose.

 
 
HONcode

We subscribe to the
HONcode principles of the
Health On the Net Foundation

All material on this website is protected by copyright, Copyright© 1994- by Medscape.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.