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- W2063215354 abstract "A 48-year-old Hispanic man was admitted for resection of a squamous cell cancer of the lung. He had been known to have moderate chronic renal insufficiency for about 3 years, with stable serum creatinine levels (265 I'mollL [-3 mg/dL)). On admission he had a hyperchloremic, hyperkalemic metabolic acidosis without hypercapnia and a positive urine anion gap (UNa + UK UCI) of 51 (Table 1). Creatinine clearance was 21 mLimin. The urine sediment showed three to five RBCs per high-power field and a few tubular cells but no cellular casts. Renal ultrasound revealed normal-sized kidneys without evidence of hydronephrosis. Medication on admission included trimethoprim/sulfamethoxazole, acetaminophen, and diphenylhydantoin, of which only the latter was continued for a seizure disorder attributed to alcohol abuse. The preoperative cortisol levels were normal, 11 ng/dL in the morning and 22 ng/dL shortly after noon. The plasma renin activity was 1.6 ng/ mLih (normal, 1 to 3.0) and the plasma aldosterone was 4 ng/ dL (normal, 4 to 20), when the serum potassium was 5.8 mmol/L. Therefore, a diagnosis of type IV, generalized distal renal tubular acidosis (RTA) was made. No further work-Up of the cause of the renal insufficiency was performed preoperatively. The patient underwent tumor removal with resection of the right middle and lower lobes. His postoperative course was complicated by sustained hypercapnia and acidemia in addition to persistent hyperkalemia (Fig 1; Table 1). He remained euvolemic and his BP (150/90) and pulse rate (80 beats/min) were stable. Throughout the preoperative and postoperative course the patient received parenteral nutrition. He was always euglycemic and ketones in urine and blood remained negative. After more than three days of hypercapnia (postoperative day 4), plasma total CO2 did not increase, suggesting inadequate renal" @default.
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- W2063215354 date "1989-08-01" @default.
- W2063215354 modified "2023-10-17" @default.
- W2063215354 title "Hyperkalemia Suppresses the Renal Adaptation to Chronic Respiratory Acidosis" @default.
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- W2063215354 doi "https://doi.org/10.1016/s0272-6386(89)80192-1" @default.
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