A 69-year-old with CKD G4 has serum bicarbonate 17 mEq/L on repeated tests, potassium 4.8 mEq/L, normal anion gap and progressive muscle wasting. She

Question

A 69-year-old with CKD G4 has serum bicarbonate 17 mEq/L on repeated tests, potassium 4.8 mEq/L, normal anion gap and progressive muscle wasting. She is euvolemic. Which treatment is indicated?

Accepted Answer

Start oral sodium bicarbonate with volume-status monitoring

Answer

Begin fludrocortisone with blood-pressure and potassium monitoring

Answer

Begin acetazolamide with bicarbonate and potassium monitoring

Answer

Restrict protein to 0.4 g/kg/day and repeat bicarbonate

Answer

Observe until arterial pH falls below 7.20

Metabolic acidosis in chronic kidney disease — ABIM Board MCQ

A 69-year-old with CKD G4 has serum bicarbonate 17 mEq/L on repeated tests, potassium 4.8 mEq/L, normal anion gap and progressive muscle wasting. She is euvolemic. Which treatment is indicated?