HCO₃⁻ Base
H⁺ Acid
K⁺ Potassium
Cl⁻ Chloride
Ca²⁺ Calcium
Try a question on this topic A 66-year-old man with a 20-year history of type 2 diabetes mellitus comes to the physician for a routine visit. He reports mild fatigue for several months. He has had no vomiting or diarrhea. Medications are metformin and atorvastatin; he takes no potassium supplements, diuretics, or anti-inflammatory drugs. Blood pressure is 142/86 mm Hg, and pulse is 72/min. Vibration sensation is decreased in both feet, and there is trace ankle edema. Urinalysis shows 2+ protein and a pH of 5.2. The urine anion gap is positive. Arterial blood gas analysis shows a pH of 7.32 with appropriate respiratory compensation. Laboratory studies show:
Serum Test Result Sodium 138 mEq/L Potassium 6.0 mEq/L Chloride 112 mEq/L Bicarbonate 17 mEq/L Creatinine 1.6 mg/dL Plasma renin activity 0.2 ng/mL/h Aldosterone 2 ng/dL
Which of the following best explains this patient's metabolic acidosis?
A. Reduced ammonium production by proximal tubule cells B. Impaired proton secretion by alpha-intercalated cells C. Decreased bicarbonate reclamation by proximal tubule D. Accumulation of lactate from impaired hepatic uptake E. Gastrointestinal loss of bicarbonate-rich fluid
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HCO₃⁻ H⁺ K⁺ Urine pH
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