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Old 12-11-2012
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Default A 65-year-old man with mixed Respiratory and Metabolic Acidosis

A 65-year-old man with chronic obstructive pulmonary disease requiring home oxygen at night and cor pulmonale presents to the emergency department (ED) with worsening shortness of breath. On examination, the man’s respiratory rate is 22/min and he has a heart rate of 104/min. He has distant breath sounds and is using accessory muscles of breathing. In addition to his baseline chronic respiratory acidosis, the man is found to have a metabolic acidosis on arterial blood gas analysis. Laboratory tests show:
Na+ 138 mEq/L
K+ 3.6 mEq/L
Cl− 118 mmol/L
HCO3 − 16 mEq/L
Phosphate 2.0 mg/dL
Glucose 98 mg/dL
Blood urea nitrogen 10 mg/dL
Creatinine 0.8 mg/dL
Urinalysis is positive for glucose.
Which of the following diagnoses explains this patient’s laboratory findings?

(A) Right heart failure
(B) Steroid-induced glucosuria
(C) Type I renal tubular acidosis
(D) Type II renal tubular acidosis
(E) Type IV renal tubular acidosis
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Old 12-11-2012
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(D) Type II renal tubular acidosis

He has NAGMA associated with bicarb & phosphate wasting as well as glycosuria. All points to proximal tubular defect (fanconi).
Type II renal tubular acidosis is also associated with osteomalacia/rickets due to phosphate wasting due to Vit. D deficiency (since 25 D3 get converted to 1.25 D3 in proximal tubules by hydroxylase).
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Old 12-13-2012
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Quote:
Originally Posted by Novobiocin View Post
(D) Type II renal tubular acidosis

He has NAGMA associated with bicarb & phosphate wasting as well as glycosuria. All points to proximal tubular defect (fanconi).
Type II renal tubular acidosis is also associated with osteomalacia/rickets due to phosphate wasting due to Vit. D deficiency (since 25 D3 get converted to 1.25 D3 in proximal tubules by hydroxylase).
That is all
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