Acidemia is blood pH less than 7.35. Urinary pH and Urinary electrolytes to be advisd for RTA. Which urinary electrolytes ? If there is acidosis, do get serum Anion Gap. Anion Gap is due to unmeasured anions. Hyperchloremia occurs in metabolic acidosis with a normal anion gap. Anion gap lower than expected can occur in the presence of hyperkalemia, hypercalcemia, hypermagnesemia,hypolabuminemia, bromide intoxication, lab error. Blood lactate levels ? Toxicity with ethylene glycol, methanol, salicylates, starvation, GSD type 1, lactic acidosis due to (sepsis, hypotension and hypovolemia), acute kidney injury, chronic kidney disease, hypoaldosteronism, renal tubular acidosis, late metabolic acidosis of prematurity (will persist for 3 to 4 weeks due to abnormal HCO3- scavenging in preterms).
Alkalemia is urine pH > 7.45. Renal hypokalemia syndrome (Barter Syndrome), next, volume depletion results in aldosterone mediated sodium retention in exchange for potassium and H+ secretion which maintains alkalosis, next, hypokalemia is a stimulus for additional renal H+ secretion. In Bartter syndrome there is hypokalemin metabolic alkalosis, urinary chloride wasting, increased plasma renin and aldosterone levels, and normal to low BP.
Alkalemia is urine pH > 7.45. Renal hypokalemia syndrome (Barter Syndrome), next, volume depletion results in aldosterone mediated sodium retention in exchange for potassium and H+ secretion which maintains alkalosis, next, hypokalemia is a stimulus for additional renal H+ secretion. In Bartter syndrome there is hypokalemin metabolic alkalosis, urinary chloride wasting, increased plasma renin and aldosterone levels, and normal to low BP.
