Feb 12, 1976

Role of hyperkalemia in the metabolic acidosis of isolated hypoaldosteronism

The New England Journal of Medicine
P SzylmanA Rosler


We studied the relative importance of hyperkalemia and mineralocorticoid deficiency in the metabolic acidosis of a patient with proved isolated hyporeninemic hypoaldosteronism and moderate kidney failure. The hyperkalemia and acidosis were severe in relation to the slight azotemia. Despite the systemic acidosis and urinary pH of 4.9, urinary ammonium excretion was distinctly blunted. Correction of the hyperkalemia by potassium-sodium exchange resin alone resolved the acidosis and restored the previously diminished urinary ammonium excretion to normal. Administration of mineralocorticoids only partially corrected the hyperkalemia and the acidosis. Hyperkalemia by itself, rather than hypoaldosteronism per se, caused the acidosis in this patient. Hyperkalemia apparently suppresses urinary ammonium excretion and thus interferes with urinary acidification.

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Mentioned in this Paper

Aldosterone, (+-)-Isomer
Renal Insufficiency
Kidney Failure, Chronic
Mineralocorticoid Effect
Ion Exchange Resins

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