Mechanism of the metabolic acidosis of selective mineralocorticoid deficiency.

The mechanism of generation of metabolic acidosis in selective mineralocorticoid deficiency was investigated in bilaterally adrenalectomized (ADX) rats treated with dexamethasone and in sham-operated (S) rats. ADX rats had significantly lower plasma sodium and bicarbonate concentrations and significantly higher plasma potassium concentrations than S rats did. ADX rats developed negative sodium balance when fed a "zero" sodium diet. The minimum urine pH achieved during sodium sulfate infusion and during ammonium chloride administration was not significantly different between ADX and S rats. Bicarbonate reabsorption and urine minus blood PCO2 gradient were not different between ADX and S rats. For any given urine pH, absolute ammonium excretion was significantly lower in ADX than it was in S rats, both during sodium sulfate infusion and during chronic ammonium chloride administration. Glomerular filtration rate (GFR) was significantly lower in ADX than it was in S rats; ammonium excretion corrected for GFR was not different between the two groups. To determine the role of decreased distal sodium delivery (secondary to decrease in GFR and enhanced proximal sodium reabsorption which resulted from distal sodium chloride wastage) on ammonium excretion, ADX rats were fed 0.9% sodium chloride in an effort to keep body weight constant. Salt-loaded ADX rats had a plasma bicarbonate concentration higher than did S rats. Salt-loading also led to a significant increase in GFR; absolute ammonium excretion was significantly higher than that of other ADX rats with the same degree of acidosis. At comparable levels of GFR, there was no difference in ammonium excretion between ADX and S rats. Ammonium excretion was linearly related to GFR. ADX rats fed a zero potassium diet had significantly greater ammonium excretion than did all other groups of ADX or S rats receiving a normal potassium intake. These data suggest that volume contraction is a major factor responsible for the acidosis of selective mineralocorticoid deficiency.