Use of Urine Electrolytes and Urine Osmolality in the Clinical Diagnosis of Fluid, Electrolytes, and Acid-Base Disorders

Abstract

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Ibuprofen-Associated Hypokalemia and Metabolic Acidosis: Systematic Literature Review

“…Furthermore, an inability to lower urinary pH below 6.0 was frequently noted. 5-7 Finally, signs consistent with an impaired urinary ammonium excretion were also observed. 5-7 It is therefore concluded that hypokalemia and acidosis were of renal (likely distal tubular) origin in the cases included in this analysis.…”

“…5-7 Finally, signs consistent with an impaired urinary ammonium excretion were also observed. 5-7 It is therefore concluded that hypokalemia and acidosis were of renal (likely distal tubular) origin in the cases included in this analysis. The blood anion gap, which is usually normal in the context of hypokalemia and acidosis of renal origin, was higher in acute than long-term cases.…”

“…5 On the contrary, in subjects with metabolic acidosis, a positive difference between the sum of the urine sodium plus potassium concentrations and the urine chloride concentration (ie,: Na + + K + -Cl -) is indicative of an impaired renal ammonium excretion ability. 5 Furthermore, in the context of acidosis, the inability to lower urinary pH <6.0 and the absence of glucosuria are considered distinctive features of renal acidosis of distal type. 6,7 The sum of chloride and bicarbonate subtracted from sodium on blood was used to calculate blood anion gap and to further classify the cause of metabolic acidosis.…”

“…Completeness of reporting was judged in consensus by 2 different authors for each included case using following 2 components: (1) detailed description of history, findings, and course (rating: 0-3) and (2) information on laboratory values and diagnostic work up (rating: 0-3). The reporting quality was graded according to the sum of each item as excellent (5)(6), good (3)(4), or acceptable (2). Categorical data are presented as counts and were analyzed using the Fisher's exact test.…”

Molecular Basis, Diagnostic Challenges and Therapeutic Approaches of Bartter and Gitelman Syndromes: A Primer for Clinicians

“…Additionally, an elevation in blood of renin, aldosterone and prostaglandin E 2 (PGE 2 ) are specific parameters that can shed light on the precise clinical diagnosis for GS and BS, disregarding other tubulopathies [ 95 ]. One possible parameter that can provide a differential diagnosis of Bartter and Gitelman over other diseases that exhibit metabolic alkalosis, includes the assessment on Cl − concentration in urine, which is persistently high [ 96 ]. Moreover, chloride status is considered as an important biomarker before the start of any pharmacological treatment [ 85 ].…”