Diarrhea enterostomy

RF

RTA

 Proximal

 Distal-hypokalemic

 Distal-hyperkalemic

 Distal-hyporeninemic hypoaldosteronism

Dilutional

Ureterosigmoidostomy

Hyperalimentation

Acetazolamide, NH₄Cl, lysine HCl, arginine HCl, sevelamer-HCl

Hx; ↑ K⁺ drainage

Early chronic kidney disease

↓K⁺ , presence of other proximal tubular defects (Fanconi syndrome)

↓K⁺ ; hypercalciuria; UpH >5.5

↑K⁺ ; nl PRA/aldo; UpH >5.5

↑K⁺ ; ↓ PRA/aldo; UpH <5.5

Massive volume expansion with saline

Obstructed ileal loop

Amino acid infusion

Hx of administration of these agents

DKA

RF

Lactic acidosis

(L-lactate)

Alcoholic ketoacidosis

Starvation

Salicylates

Methanol

Ethylene glycol

D-lactic acidosis

Propylene glycol

Pyroglutamic aciduria, 5-oxoprolinuria

Hyperglycemia, ketones

Late chronic kidney disease

Clinical setting + ↑ serum lactate

Hx; weak + ketones; + osm gap

Hx; mild acidosis; + ketones

Hx; tinnitus; high serum level; + ketones; + lactate

Large AG; concomitant respiratory alkalosis; retinitis; + toxic screen; + osm gap

RF; CNS symptoms; + toxic screen; crystalluria; + osm gap

Small-bowel disease; prominent neuro symptoms

IV infusions, e.g., lorazepam; + osm gap; RF

Large AG; chronic acetaminophen