Kidneys Inc.

medicine and nephrology updates and interesting cases by a practicing nephrologist in USA

Archive for the category “electrolytes”

Article in American Journal of Kidney Diseases

This is an article in press in AJKD. Thanks to Dr. Goldwasser again for making me a part of this.

This is about an interesting scenario we came across where the (measured) serum bicarbonate and calculated (blood gas) bicarbonate were consistently discrepant despite excluding all known possible causes. Interestingly enough, the patient also had pseudo elevation of troponins. The cause likely secondary to an interferent in the assay.

Here is the article

http://www.ajkd.org/article/S0272-6386(11)00943-7/abstract

Bile salts and hypokalemia

Last week, I saw a 53 y old man admitted with end stage liver disease due to chronic alcoholism. He was admitted for altered mental status, acute kidney injury with rise in creatinine from 0.8 about two months ago to 3.4 at the time of admission. However, his serum potassium was 2.4 with transtubular potassium gradient (TTKG ) of 13 (indicates renal wasting). His total bilirubin was 32.

Bile acids are known to cause this low aldosterone and salt retentive states by inhibiting 11 beta hydroxy steroid dehydrogenase enzyme. This enzyme normally converts cortisol into cortisone. When inhibited, as in the above example, it allows normal cortisol to drive sodium absorption and renal potassium wasting in the distal tubules.

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