گام آخر پرستاری

In this case the patient did not have excessive GI fluid losses, was not on any drugs that would contribute to NAGMA and had a recent short synACTHen test excluding adrenal insufficiency. An acid load test confirmed the presence of incomplete type 1 or distal renal tubular acidosis!?! (hence the title Really Tricky ABG – the biggest clue of all!).

Features of dRTA include:

urine pH >5.5 (after acid load test)
increased urine anion gap ([Na+]+ [K+] – [Cl-]) consistent with decreased urine NH4+
hypercalciuria (to my knowledge this doesn’t tend to cause hypocalcemia however)