Bilateral Adrenal Hyperplasia Medical Treatment — ESENeph MCQ

Correct answer: A — Consider oral bicarbonate with sodium-load and response monitoring

The best answer is “Consider oral bicarbonate with sodium-load and response monitoring”. NICE says to consider oral sodium bicarbonate when eGFR is below 30 mL/min/1.73m² and bicarbonate is below 20 mmol/L; blood pressure, oedema and serial response remain important. “Give intravenous bicarbonate for severe symptomatic acidemia” is less appropriate because stable chronic acidosis is not automatically an emergency intravenous indication “Begin dialysis for refractory acidosis with clinical complications” is less appropriate because kidney replacement depends on symptoms and refractory complications, not this value alone “Use acetazolamide when treatment-related alkalosis is present” is less appropriate because acetazolamide promotes bicarbonate loss “Use dietary alkali alongside individualized nutritional assessment” is less appropriate because animal protein generally increases dietary acid load

Reference: NICE NG203: chronic kidney disease assessment and management: https://www.nice.org.uk/guidance/ng203/chapter/Recommendations