Urine AG = Urine (Na + K - Cl)
measured in normalAG metabolic acidosis..--e.g in GI loss
The urine AG has a negative value in most patients with a normal AG metabolic acidosis due to the appropriate increase in urinary ammonium in an attempt to excrete the excess acid. Ammonium is an unmeasured cation; as a result, an increase in its excretion as NH4Cl will lead to a rise in the urine Cl concentration and a negative urine AG, usually ranging from -20 to -50 meq/L.
In comparison, patients with renal failure, type 1 (distal) renal tubular acidosis (RTA), or hypoaldosteronism (type 4 RTA) are unable to excrete ammonium normally. As a result, the urine AG will have a positive value .
Urine K+ is also good finding---< 25 meq/L is normal response to GI loss of K+
but if it is > 25 MEq/l with hypokalemia---then suggest RTA type 2
measured in normalAG metabolic acidosis..--e.g in GI loss
The urine AG has a negative value in most patients with a normal AG metabolic acidosis due to the appropriate increase in urinary ammonium in an attempt to excrete the excess acid. Ammonium is an unmeasured cation; as a result, an increase in its excretion as NH4Cl will lead to a rise in the urine Cl concentration and a negative urine AG, usually ranging from -20 to -50 meq/L.
In comparison, patients with renal failure, type 1 (distal) renal tubular acidosis (RTA), or hypoaldosteronism (type 4 RTA) are unable to excrete ammonium normally. As a result, the urine AG will have a positive value .
Urine K+ is also good finding---< 25 meq/L is normal response to GI loss of K+
but if it is > 25 MEq/l with hypokalemia---then suggest RTA type 2
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