Chronic acidosis with metabolic bone disease.

The case is reported of a woman in whom a chronic hyperchloraemic acidosis and osteomalacia developed follow implantation of her ureters into the rectum. For 14 years she took regular sodium bicarbonate, but a little over four years after discontinuing it she developed clinical, biochemical, radiological and radionuclide evidence of osteomalacia. The latter improved rapidly when sodium bicarbonate was recommenced. This clinical situation is one of the few instances in man where a chronic metabolic acidosis in the context of normal or only mildly impaired renal function can result in osteomalacia.