What is the role of hyperkalemia in the pathogenesis of metabolic acidosis?

Updated: Dec 08, 2020
  • Author: Christie P Thomas, MBBS, FRCP, FASN, FAHA; Chief Editor: Vecihi Batuman, MD, FASN  more...
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Hyperkalemia has an effect on acid-base regulation opposite to that observed in hypokalemia. Hyperkalemia impairs NH4+ excretion through reduction of NH3 synthesis in the proximal tubule and reduction of NH4+ reabsorption in the thick ascending limb, resulting in reduced medullary interstitial NH3 concentration. This leads to a decrease in net renal acid secretion and is a classic feature of primary or secondary hypoaldosteronism. Consistent with the central role of hyperkalemia in the generation of the acidosis, lowering the serum K+ concentration can correct the associated metabolic acidosis.

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