common USMLE topic
Non anion gap metabolic acidosis
Type 1:
Distal RTA
Failure of H+ secretion by the α intercalated cells of distal tubes
There's hypokalaemia
Met. acidosis is severe, more alkaline urine >5.3
May be associated with urolithiasis , rickets
Type 2:
Proximal RTA.
e.g Fanconi syndrome (prox tubular cell dysfunction)
Failure of HCO3− reabsorption from the urine by the proximal tubular cells
There's hypokalaemia. Also associated with rickets
Met acidosis is less severe because distal tubular function is normal. urine PH<5.3
Type 4:
No aldosterone (Addisson's disease,ACEIs,ARBs,DM nephropathy,Sickle cell nephropathy)
or
Na/K pump not responding to aldosterone (NSAID nephropathy,CKD,)
There's hyperkalaemia, hyponatremia, hyperchloraemia
urine PH<5.3. . Met. acidosis is mild
this is a great little summary, to the point! thanx for this :)
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