A 58-year-old woman with diabetic kidney disease has potassium 6.0 mmol/L, bicarbonate 17 mmol/L and a normal anion gap. Urine pH is 5.1 and there is

Question

A 58-year-old woman with diabetic kidney disease has potassium 6.0 mmol/L, bicarbonate 17 mmol/L and a normal anion gap. Urine pH is 5.1 and there is no diarrhoea. Which mechanism best explains this pattern?

Accepted Answer

Reduced aldosterone effect impairing renal ammonium excretion

Answer

Gastrointestinal bicarbonate loss causing secondary hypokalaemia

Answer

Retention of unmeasured organic acids in kidney disease

Answer

Reduced distal hydrogen secretion despite high urine pH

Answer

Reduced proximal bicarbonate reabsorption in Fanconi syndrome

Metabolic acidosis from renal tubular acidosis — SCE Acute Medicine MCQ

A 58-year-old woman with diabetic kidney disease has potassium 6.0 mmol/L, bicarbonate 17 mmol/L and a normal anion gap. Urine pH is 5.1 and there is no diarrhoea. Which mechanism best explains this pattern?