J Nephrol 2017 Oct 9. Epub 2017 Oct 9.

National Center for Competence in Research NCCR Kidney.CH, Zurich, Switzerland.

Distal renal tubular acidosis (dRTA) is a tubular disorder with a primary defect of urinary acidification and acid excretion in the collecting duct system. Consequently, patients develop hyperchloremic metabolic acidosis with an inappropriately alkaline urine. Inherited forms of dRTA are due to mutations in at least three distinct genes: SLC4A1, ATP6V1B1, ATP6V0A4. Read More

Crit Care Med 2017 Oct 6. Epub 2017 Oct 6.

1Servicio de Terapia Intensiva, Sanatorio de la Trinidad Ramos Mejía, Ramos Mejía, Argentina. 2Servicio de Terapia Intensiva, Sanatorio Otamendi y Miroli, Buenos Aires, Argentina.

Objectives: To investigate the association between the concentration of the causative anions responsible for the main types of metabolic acidosis and the outcome.

Design: Prospective observational study.

Setting: Teaching ICU. Read More

Saudi J Kidney Dis Transpl 2017 Sep-Oct;28(5):1165-1168

Division of Pediatric Nephrology, Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai, Maharashtra, India.

Branchio-oto-renal (BOR) syndrome is an autosomal dominant, clinically heterogeneous disorder characterized by branchial arch anomalies, hearing impairment, and renal malformations. We report the case of a 10-year-old boy with BOR syndrome who presented with hyperkalemic hyperchloremic metabolic acidosis due to hyporeninemic hypoaldosteronism. The child also had mental retardation and spastic diplegia which have hitherto not been described in BOR syndrome. Read More

Hosp Pract (1995) 2017 Sep 1:1-4. Epub 2017 Sep 1.

a Harvard Medical School , Massachusetts General Hospital , Boston , MA , USA.

Topiramate is an anticonvulsant that is being increasingly used for a number of different off-label indications. Its inhibition of carbonic anhydrase isoenzymes can lead to metabolic acidosis, elevated urine pH, reduced urine citrate, and hypercalciuria, thereby creating a milieu that is ripe for calcium phosphate stone formation. In this review, we describe a case of topiramate-induced metabolic acidosis. Read More

Am J Kidney Dis 2017 Aug 17. Epub 2017 Aug 17.

Department of Nephrology, Orlando, FL.

Apremilast is a recently developed phosphodiesterase 4-inhibitory medication approved for use to treat psoriasis and psoriatic arthritis. We report a case of Fanconi syndrome and proximal renal tubular acidosis that was associated with this medication. Our patient was started on treatment with apremilast 2 weeks before his admission. Read More

Pediatr Emerg Care 2017 Jul 24. Epub 2017 Jul 24.

From the *Comité de Docencia e Investigación, †Servicio de Nutrición y Diabetes, and ‡Servicio de Nefrología, Hospital General de Niños Pedro de Elizalde, Buenos Aires, Argentina.

Introduction: Hyperchloremic metabolic acidosis can occur in diabetic ketoacidosis (DKA) and may affect the acid-base interpretation during treatment.

Objectives: This study aims to describe the prevalence of hyperchloremia during the treatment of DKA and its effect on the interpretation of bicarbonate value.

Methods: A cross-sectional study, including all cases of DKA in patients aged 1 to 18 years old admitted from 2010 to 2015, was performed. Read More

Cas Lek Cesk 2017 ;156(3):150-152

In patients with advanced cirrhosis with ascites disorders of water and electrolyte metabolism are often present and they are associated with changes in acid-base balance. These changes can be very complicated, their diagnosis and treatment difficult. Dilutional hyponatremia is the most common disorder. Read More

J Coll Physicians Surg Pak 2016 Nov;26(11):124-126

Department of Gynaecology Unit-II, Jinnah Hospital, Lahore.

The patient was born with bladder exstrophy and underwent multiple surgeries for its correction. Finally, she had ureterosigmoidostomy at the age of 9 years, which ultimately led her to live till reproductive age. The children born with this defect are capable of surviving till adult life. Read More

Ann Intensive Care 2017 Dec 14;7(1):66. Epub 2017 Jun 14.

CHU d'Angers, 4 rue Larrey, 49000, Angers, France.

Background: According to international guidelines, volume expansion with crystalloids is the first-line treatment for hemodynamic management in patients with severe sepsis or septic shock. Compared to balanced crystalloids, 0.9% sodium chloride (0. Read More

Indian J Crit Care Med 2017 Apr;21(4):243-244

Department of Critical Care Medicine, Yashoda Multi-speciality Hospital, Hyderabad, Telangana, India.

A 52-year-old female patient was admitted to Intensive Care Unit with complaints of quadriparesis. Investigations revealed distal renal tubular acidosis (DRTA) secondary to Sjogren's syndrome with involvement of the parotid and thyroid glands. Laboratory investigations showed hyperchloremic metabolic acidosis and an alkaline urine pH with clinical signs of sicca syndrome. Read More

CEN Case Rep 2016 May 9;5(1):40-42. Epub 2015 Jul 9.

Renal Division, Department of Internal Medicine, Iwata City Hospital, 512-3 Ohkubo, Iwata, Shizuoka, 438-8550, Japan.

Ureterosigmoidostomy is a urological intervention performed to treat various conditions such as invasive bladder cancer, bladder exstrophy, vesicovaginal fistula, or urethral trauma. However, this intervention may lead to several metabolic complications. Here, we report an interesting case with quadriparesis and intestinal paralysis resulting from severe hypokalemia (the serum potassium level, 1. Read More

World J Surg 2017 May 8. Epub 2017 May 8.

Smiths Medical Professor of Anaesthesia and Critical Care, National Institute of Health Research Biomedical Research Centre, University College London Hospitals, London, UK.

Background: Intravenous fluid therapy is required for most surgical patients, but inappropriate regimens are commonly prescribed. The aim of this narrative review was to provide evidence-based guidance on appropriate perioperative fluid management.

Method: We did a systematic literature search of the literature to identify relevant studies and meta-analyses to develop recommendations. Read More

Urology 2017 Jun 22;104:225-229. Epub 2017 Feb 22.

Department of Urology, Indiana University School of Medicine, Indianapolis, IN. Electronic address:

Objective: To assess long-term renal preservation and surgical outcomes in patients undergoing ureteric substitution with ileum. This has been a mainstay of reconstruction options for lengthy ureteral defects.

Methods: Consecutive patients aged 18 or older undergoing ileal ureters at our institution were retrospectively reviewed (from 1989 to June 2013). Read More

J Pediatr Endocrinol Metab 2017 Mar;30(3):361-364

Background: Gordon syndrome (GS) is a rare form of monogenic hypertension characterized by low renin hypertension, hyperkalemia, hyperchloremic metabolic acidosis, and normal glomerular filtration rate. To date, four genes causing GS have been identified as: WNK1, WNK4, CUL3, and KLHL3.

Case Presentation: We report three cases of GS in two families. Read More

Indian J Crit Care Med 2017 Jan;21(1):55-56

Department of Paediatric Surgery, Post Graduate Institute and Medical Education Research, Chandigarh, India.

Use of 0.9% sodium chloride for total gut irrigation (TGI) through nasogastric route is an effective method of bowel preparation in children undergoing colorectal surgeries. TGI with normal saline (NS) can result in nausea, vomiting, abdominal distension, and mild electrolyte imbalance; however, hyperchloremic metabolic acidosis has not been documented. Read More

G Ital Nefrol 2016 Nov-Dec;33(6)

Metabolic acidosis is frequently observed in clinical practice, especially among critically ill patients and/or in the course of renal failure. Complex mechanisms are involved, in most cases identifiable by medical history, pathophysiology-based diagnostic reasoning and measure of some key acid-base parameters that are easily available or calculable. On this basis the bedside differential diagnosis of metabolic acidosis should be started from the identification of the two main subtypes of metabolic acidosis: the high anion gap metabolic acidosis and the normal anion gap (or hyperchloremic) metabolic acidosis. Read More

J Paediatr Child Health 2017 Jan;53(1):12-17

Department of Paediatric Critical Care, Women's and Children's Hospital, Adelaide, South Australia, Australia.

Aim: We aimed to determine whether using a balanced salt solution, Hartmann's solution (HS), in diabetic ketoacidosis (DKA) shortens the time to normalise acid-base status through the avoidance of hyperchloremic metabolic acidosis compared with 0.9% normal saline (NS).

Methods: We conducted a double-blind, randomised controlled trial comparing HS to NS as the initial intravenous fluid in children with DKA. Read More

Vet Clin North Am Small Anim Pract 2017 Mar 23;47(2):201-203. Epub 2016 Dec 23.

Department of Clinical Sciences, College of Veterinary Medicine, Oregon State University, 700 Southwest 30th Street, Corvallis, OR 97331, USA. Electronic address:

Metabolic acidosis results from an increase in the concentration of a strong anion. Metabolic acidosis is divided into hyperchloremic metabolic acidosis and high anion gap acidosis based on the changes in the anion gap. Hyperchloremic metabolic acidosis is the result of chloride retention, excessive loss of sodium relative to chloride, or excessive gain of chloride relative to sodium. Read More

J Nephrol 2017 Jun 22;30(3):455-460. Epub 2016 Dec 22.

Division of Nephrology, University Hospital Zurich, Rämistr. 100, 8091, Zurich, Switzerland.

Inherited distal renal tubular acidosis (dRTA) is caused by impaired urinary acid excretion resulting in hyperchloremic metabolic acidosis. Although the glomerular filtration rate (GFR) is usually preserved, and hypertension and overt proteinuria are absent, it has to be considered that patients with dRTA also suffer from chronic kidney disease (CKD) with an increased risk for adverse pregnancy-related outcomes. Typical complications of dRTA include severe hypokalemia leading to cardiac arrhythmias and paralysis, nephrolithiasis and nephrocalcinosis. Read More

Ochsner J 2016 ;16(4):525-530

Department of Anaesthesia and Intensive Care Medicine, Caboolture Hospital, Caboolture, Queensland, Australia.

Background: The term renal tubular acidosis (RTA) describes a group of uncommon kidney disorders characterized by defective acid-base regulation. Reaching the diagnosis of RTA is complex and often delayed, resulting in suboptimal treatment.

Methods: This article provides an overview of the clinical features of RTA and diagnostic approaches in a format accessible to physicians for everyday use. Read More

J Clin Pharm Ther 2017 Feb 14;42(1):122-124. Epub 2016 Dec 14.

Department of Nephrology, The Second Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China.

What Is Known And Objective: Calcineurin inhibitor (CNI)-based immunosuppressive regimen is widely used for preventing rejection in solid organ transplantation. Hyperkalemic renal tubular acidosis (RTA) caused by CNI is uncommon and potentially underappreciated. We reported four such cases to increase awareness of this risk and to provide recommendations for its management based on our experience. Read More

J Nephrol 2017 Aug 29;30(4):485-492. Epub 2016 Nov 29.

Division of Nephrology and Transplantation, Department of Internal Medicine, Erasmus Medical Center, Room D-438, PO Box 2040, 3000, CA, Rotterdam, The Netherlands.

The topic of intravenous (IV) fluids may be regarded as "reverse nephrology", because nephrologists usually treat to remove fluids rather than to infuse them. However, because nephrology is deeply rooted in fluid, electrolyte, and acid-base balance, IV fluids belong in the realm of our specialty. The field of IV fluid therapy is in motion due to the increasing use of balanced crystalloids, partly fueled by the advent of new solutions. Read More

Cell Mol Life Sci 2017 Apr 4;74(7):1261-1280. Epub 2016 Nov 4.

Division of Experimental Medicine and Immunotherapeutics, Department of Medicine, University of Cambridge, Cambridge, CB2 2QQ, UK.

Hypertension (high blood pressure) is a major public health problem affecting more than a billion people worldwide with complications, including stroke, heart failure and kidney failure. The regulation of blood pressure is multifactorial reflecting genetic susceptibility, in utero environment and external factors such as obesity and salt intake. In keeping with Arthur Guyton's hypothesis, the kidney plays a key role in blood pressure control and data from clinical studies; physiology and genetics have shown that hypertension is driven a failure of the kidney to excrete excess salt at normal levels of blood pressure. Read More

Anesth Analg 2016 Nov;123(5):1163-1171

From the *Anesthesiology Department, Hospital das Clinicas-FMUSP, SP, SP/Brazil; †Anesthesiology Department, Hospital do Servidor Público Estadual-IAMSPE, SP, SP/Brazil; and ‡Intensive Care Department, Hospital do Câncer de Barretos, SP, SP/Brazil.

Background: Metabolic acidosis frequently is present in surgical patients; however, different types of metabolic acidosis (hyperlactatemia, hyperchloremia, and others) may have different relationships to perioperative outcomes. We hypothesized that in postoperative surgical patients, distinctive types of metabolic acidosis would correlate differently with the outcomes of high-risk surgeries.

Methods: A prospective, multicenter observational study was performed in 3 different tertiary care hospitals. Read More

Anesth Essays Res 2016 Sep-Dec;10(3):532-537

Department of Anesthesiology and Intensive Care, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India.

Background: A major change in anesthesia practice as regards to intraoperative infusion therapy is the present requirement. Switching over to balanced fluids can substantially decrease the incidence of lactic acidosis and hyperchloremic acidosis. The deleterious effects of unbalanced fluids are more recognizable during major surgeries. Read More

Anesthesiology 2016 Oct;125(4):744-754

From the Department of Intensive Care, Erasme University Hospital, Unversité Libre de Bruxelles, Brussels, Belgium.

Background: Crystalloid solutions are used to restore intravascular volume in septic patients, but each solution has limitations. The authors compared the effects of three crystalloid solutions on hemodynamics, organ function, microcirculation, and survival in a sepsis model.

Methods: Peritonitis was induced by injection of autologous feces in 21 anesthetized, mechanically ventilated adult sheep. Read More

Nephrol Dial Transplant 2017 01;32(1):111-125

Department of Epidemiology & Biostatistics, Western University, London, ON, Canada.

Background: It remains unclear which phosphate binders should be preferred for hyperphosphatemia management in chronic kidney disease (CKD).

Methods: We performed a systematic review and meta-analysis of randomized trials comparing sevelamer or lanthanum with other phosphate binders in CKD.

Results: Fifty-one trials (8829 patients) were reviewed. Read More

Eur J Pediatr 2016 Dec 17;175(12):2011-2013. Epub 2016 Sep 17.

Queen Mathilde Mother and Child Care Centre, University Hospital Antwerp, Antwerp, Belgium.

Hyperkalemia in young children is a rare phenomenon and in many cases caused by hemolysis in the specimen due to difficulties in obtaining a sample. However, hyperkalemia can also be a sign of a rare Mendelian syndrome known as familial hyperkalemic hypertension or pseudohypoaldosteronism type II. This disease is characterized by hyperkalemia, hypertension, and mild hyperchloremic metabolic acidosis (with normal anion gap) despite normal glomerular filtration. Read More

Crit Care Med 2017 Feb;45(2):e146-e153

All authors: Center for Critical Care Nephrology and CRISMA Center, Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA.

Objective: We sought to investigate if the chloride content of fluids used in resuscitation was associated with short- and long-term outcomes.

Design: We identified patients who received large-volume fluid resuscitation, defined as greater than 60 mL/kg over a 24-hour period. Chloride load was determined for each patient based on the chloride ion concentration of the fluids they received during large-volume fluid resuscitation multiplied by the volume of fluids. Read More

Vnitr Lek Fall 2016;62(7-8):629-34

Unlabelled: The differential diagnosis of hyponatremia is often difficult. This most frequently occurring disorder of the water and electrolyte metabolism is frequently connected with deviations relating to the acid-base balance (ABB). This survey analyzes the relationship between the changes of the volume of body fluids and ABB and infers to what extent the analysis of combinations of the two disorders can support the differential diagnosis of different forms of hyponatremia (differentiation between the dilution vs. Read More

BMC Nephrol 2016 Aug 26;17(1):119. Epub 2016 Aug 26.

Intensive Care Department, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, 1090, Brussels, Belgium.

Background: Citrate, the currently preferred anticoagulant for continuous veno-venous hemofiltration (CVVH), may influence acid-base equilibrium.

Methods: The effect of 2 different citrate solutions on acid-base status was assessed according to the Stewart-Figge approach in two consecutive cohorts of critically ill adult patients. The first group received Prismocitrate 10/2 (PC10/2; 10 mmol citrate/L). Read More

BMC Pediatr 2016 Aug 2;16:117. Epub 2016 Aug 2.

Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.

Background: Compare the efficacy and safety of Plasma-Lyte A (PLA) versus 0.9 % sodium chloride (NaCl) intravenous (IV) fluid replacement in children with moderate to severe dehydration secondary to acute gastroenteritis (AGE).

Methods: Prospective, randomized, double-blind study conducted at eight pediatric emergency departments (EDs) in the US and Canada (NCT#01234883). Read More

Nephrology (Carlton) 2017 Sep;22(9):720-727

Department of Anesthesiology, Hamamatsu Rosai Hospital, Japan Organizaition of Occupational Health and Safety, Higashi-ku, Hamamatsu, Japan.

Aim: Hyperchloremic acidosis may have an important role as a precursor of acute kidney injury (AKI) in the hyperchloremic environment induced by chloride-rich fluids, but this remains unclear. We tested the hypothesis that hyperchloremic acidosis assessed by the Stewart approach is associated with postoperative AKI.

Methods: A historical cohort study was conducted in adult patients who had normal renal function preoperatively and required admission to the intensive care unit after elective abdominal surgery. Read More

Mol Genet Genomic Med 2016 May 14;4(3):303-11. Epub 2016 Feb 14.

Département de Génetique Hôpital Européen Georges Pompidou Paris France.

Background: Autosomal recessive distal renal tubular acidosis (dRTA) is a rare disease characterized by a hyperchloremic metabolic acidosis with normal anion gap, hypokalemia, hypercalciuria, hypocitraturia, nephrocalcinosis, and conserved glomerular filtration rate. In some cases, neurosensorial deafness is associated. dRTA is developed during the first months of life and the main manifestations are failure to thrive, vomiting, dehydration, and anorexia. Read More

Clin Chest Med 2016 06 8;37(2):277-88. Epub 2016 Mar 8.

Division of Critical Care Medicine, Department of Anesthesia, University of California, San Francisco, 533 Parnassus Avenue, San Francisco, CA 94143, USA. Electronic address:

Acute kidney injury (AKI) is an abrupt decrease in kidney function that takes place over hours to days. Sepsis is the leading cause of AKI and portends a particularly high morbidity and mortality, although the severity may vary from a transient rise in serum creatinine to end-stage renal disease. With regard to acid-base management in septic AKI, caution should be used with hyperchloremic crystalloid solutions, and dialysis is often used in the setting of severe acidosis. Read More

Rev Med Suisse 2016 Feb;12(504):270-2, 274

Sodium chloride 0.9%, often incorrectly called physiological saline, contains higher concentration of chloride compared to plasma. It is known that the administration of sodium chloride 0. Read More

Contrib Nephrol 2016 8;187:84-93. Epub 2016 Feb 8.

Division of General Medicine, Department of Medicine, Taipei Veterans General Hospital, and Department of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan.

The goal of fluid therapy in critical care medicine is to restore hemodynamic stability and vital organ perfusion while avoiding interstitial edema. Acute kidney injury (AKI) is a common complication in critically ill patients. Decisions regarding fluid management in critically ill patients with AKI are difficult, as these patients often have accompanying oliguria as well as body fluid overload. Read More

Rev Gastroenterol Peru 2015 Oct-Dec;35(4):355-7

Servicio de Endocrinología del Hospital Guillermo Almenara Irigoyen. EsSalud. Lima, Perú.

Chronic secretory diarrhea is a frequent entity. Causes are multiple, that is why reaching final diagnosis can result in delay with complications that this causes in the general condition of the patient. We present the case of one older adult with chronic diarrhea, mild hypokalemia and metabolic hyperchloremic acidosis secondary to a VIPoma in retroperitoneum which is an unusual location of this type of tumor that was diagnosed by biopsy guided by tomography. Read More

Curr Opin Anaesthesiol 2016 Apr;29(2):158-65

Department of Intensive Care Medicine University Hospital, Aachen, Germany.

Purpose Of Review: Evidence-based fluid therapy is complicated by blurred boundaries toward other fields of therapy and the majority of trials not focusing on patient-relevant outcomes. Additionally, recent trials unsettled the faith in traditional concepts on fluid therapy. The article reviews the evidence on diagnosis and treatment of hypovolemia and discusses the use of balanced solutions and early goal-directed therapy (EGDT) in septic shock resuscitation. Read More

J Cardiothorac Vasc Anesth 2015 Dec 29;29(6):1432-40. Epub 2015 Jul 29.

Anesthesiology and Critical Care.

Objective: To determine the severity, duration, and contributing factors for metabolic acidosis after deep hypothermic circulatory arrest (DHCA).

Design: Retrospective observational study.

Setting: University hospital. Read More

Med Intensiva 2016 Mar 3;40(2):113-7. Epub 2015 Dec 3.

Cátedra de Medicina Intensiva, Centro de Tratamiento Intensivo, Hospital de Clínicas Dr. Manuel Quintela, Facultad de Medicina, Universidad de la República (UdeLaR), Montevideo, Uruguay.

Intracranial hypertension (ICH) is the most important modifiable factor with predictive negative value in brain injury patients. Osmotherapy is the most important first level specific measure in the treatment of ICH. Mannitol 20%, and 3, 7. Read More

Pol Merkur Lekarski 2015 Oct;39(232):237-40

Professor emeritus Department of Medical Rehabilitation Shalgren's Hospital Goethenburg University, Sweden.

Physiological saline can hardly be treated as physiological as it contains qualitatively and quantitatively different amounts of electrolytes. In particular, it contains 50% more chlorine ions than serum. Physiological saline can cause metabolic acidosis and in diabetic patients hyperchloremic acidosis. Read More

Anaesthesiol Intensive Ther 2015 20;47 Spec No:s78-88. Epub 2015 Nov 20.

Dipartimento di Anestesia, Rianimazione ed Emergenza Urgenza, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Milan, Italy.

"Balanced" solutions are commonly defined as intravenous fluids having an electrolyte composition close to that of plasma. As such, they should minimally affect acid-base equilibrium, as compared to the commonly reported 0.9% NaCl-related hyperchloremic metabolic acidosis. Read More

Urology 2016 Feb 11;88:201-6. Epub 2015 Nov 11.

Department of Urology, Shanghai Jiaotong University Affiliated Sixth People's Hospital, Shanghai, China; Shanghai Eastern Institute for Urologic Repair and Reconstruction, Shanghai, China.

Objective: To investigate the long-term outcome of ileal ureteric replacement using a proximal antirefluxing technique for the treatment of long-segment ureteric strictures.

Patients And Methods: Between January 1997 and December 2013, 41 patients with a long ureteral stricture or defect and 3 patients with unilateral mid-lower ureteral cancer (20 bilateral and 24 unilateral, 28 males and 16 females) were treated by ureteral substitution using a proximal antirefluxing technique. The distal part of the upper ureter (4 cm) was fixed between the psoas muscle and the ileal segment (the iliopsoas tunnel technique). Read More

Pediatr Int 2016 May 6;58(5):379-382. Epub 2015 Nov 6.

Department of Pediatric Gastroenterology, Gazi University Medical School, Ankara, Turkey.

Congenital diarrheal disorders are caused by disruption in nutrient digestion, absorption, or transport, enterocyte development and functioning, or enteroendocrine functioning. Many additional rare forms of congenital diarrhea are expected to be linked to genes associated with appropriate intestinal fluid and electrolyte balance. Neurogenin-3 mutation, a very rare form of congenital diarrhea, disrupts enteroendocrine cell differentiation and is characterized by malabsorption and the absence of pancreatic islet cells. Read More

CEN Case Rep 2015 Nov 19;4(2):200-205. Epub 2015 Feb 19.

Department of Pediatrics, Batra Hospital and Medical Research Centre, Delhi, India.

A 14-year-old female came with the history of sudden onset weakness; during work up, she was found to have hyperchloremic metabolic acidosis with normal anion gap and normal renal function suggesting the possibility of renal tubular acidosis (RTA). On further evaluation of RTA, she had positive antinuclear antibody, anti-Ro, and anti-La antibodies. On nuclear scan of salivary glands, her left parotid gland was nonfunctional. Read More

J Clin Lab Anal 2016 Sep 29;30(5):510-2. Epub 2015 Oct 29.

Department of Pathology and Laboratory Medicine, University of Texas at Houston, Houston, Texas.

Background: Monoclonal gammopathies associated with acquired Fanconi's syndrome (AFS) have been reported in the adult population. AFS is characterized by renal dysfunction resulting in proteinuria, aminoaciduria, hypophosphatemia, glucosuria, and hyperchloremic metabolic acidosis. In this case report, we document the clinical and laboratory findings of a preterm infant with features of both AFS and monoclonal gammopathy in the urine. Read More

Case Rep Nephrol 2015 3;2015:309791. Epub 2015 Sep 3.

University of Toronto and University Health Network, Toronto General Hospital, Room 8N-842, 200 Elizabeth Street, Toronto, ON, Canada M5G 2C4.

Cholestyramine is a bile acid sequestrant that has been used in the treatment of hypercholesterolemia, pruritus due to elevated bile acid levels, and diarrhea due to bile acid malabsorption. This medication can rarely cause hyperchloremic nonanion gap metabolic acidosis, a complication featured in this report of an adult male with concomitant acute kidney injury. This case emphasizes the caution that must be taken in prescribing cholestyramine to patients who may also be volume depleted, in renal failure, or taking spironolactone. Read More

Am J Med Sci 2015 Nov;350(5):427-8

University of Tennessee Health Science Center and Veterans Affairs Medical Center, Memphis, Tennessee, Division of Nephrology.

Eur J Clin Pharmacol 2016 Feb 24;72(2):247-8. Epub 2015 Sep 24.

Department of Biomedical and Clinical Sciences, Unit of Clinical Pharmacology, "Luigi Sacco" University Hospital, University of Milano, Milan, Italy.