正常阴离子间隙代谢性酸中毒的诊断评估综述
Review of the Diagnostic Evaluation of Normal Anion Gap Metabolic Acidosis.
作者信息
Berend Kenrick
机构信息
St. Elisabeth Hospital, Willemstad, Curaçao.
出版信息
Kidney Dis (Basel). 2017 Dec;3(4):149-159. doi: 10.1159/000479279. Epub 2017 Sep 1.
Abstract
BACKGROUND
Normal anion gap metabolic acidosis is a common but often misdiagnosed clinical condition associated with diarrhea and renal tubular acidosis (RTA). Early identification of RTA remains challenging for inexperienced physicians, and diagnosis and treatment are often delayed.
SUMMARY
The presence of RTA should be considered in any patient with a high chloride level when the CL/Na ratio is above 0.79, if the patient does not have diarrhea. In patients with significant hyperkalemia one should evaluate for RTA type 4, especially in diabetic patients, with a relatively conserved renal function. A still growing list of medications can produce RTA.
KEY MESSAGES
This review highlights practical aspects concerning normal anion gap metabolic acidosis.
摘要
背景
正常阴离子间隙代谢性酸中毒是一种常见但常被误诊的临床病症，与腹泻和肾小管酸中毒（RTA）相关。对于经验不足的医生而言，早期识别RTA仍具有挑战性，诊断和治疗往往会延迟。
总结
当CL/Na比值高于0.79且患者无腹泻时，任何高氯水平的患者均应考虑存在RTA。对于有明显高钾血症的患者，尤其是肾功能相对保留的糖尿病患者，应评估是否为4型RTA。越来越多的药物可导致RTA。
关键信息
本综述强调了正常阴离子间隙代谢性酸中毒的实际相关方面。
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2
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Indian J Crit Care Med. 2017 Jan;21(1):55-56. doi: 10.4103/0972-5229.198329.
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