How is hyperchloremic acidosis diagnosed?

Updated: Oct 18, 2018
  • Author: Sai-Ching Jim Yeung, MD, PhD, FACP; Chief Editor: Romesh Khardori, MD, PhD, FACP  more...
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Answer

Metabolic acidosis due to loss of intestinal secretions, medications, or exogenous acid intake is usually apparent from the history. An exception is diarrhea due to laxative abuse, for which the history is difficult to obtain. When this condition is suggested because of hypokalemia and a normal AG metabolic acidosis, it may be confirmed by findings of low sodium concentration in the urine from volume contraction, positive test results for stool phenolphthalein, or high fecal magnesium levels.

Loss of intestinal secretions as the cause of acidosis may be confirmed by measuring the pH and AG ([Na+] + [K+] - [Cl-]) of the volume lost; an alkaline pH and elevated AG suggest bicarbonate loss.

If the cause of acidosis is not apparent from the history and physical examination findings, the next step is to determine whether hyperchloremic acidosis is present. Urinary ammonium excretion and urine pH can be used to define the etiology of the disorder.


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