What is the primary defect in non-anion gap (AG) (hyperchloremic) 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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In hyperchloremic acidosis, reduced ammoniagenesis (secondary to loss of functioning renal mass) is the primary defect, leading to an inability of the kidneys to excrete the normal daily acid load. In addition, NH3 reabsorption and recycling may be impaired, leading to reduced medullary interstitial NH3 concentration.

In general, patients tend to have a serum HCO3- level greater than 12 mEq/L, and buffering by the skeleton prevents further decline in serum HCO3-.

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