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Review Question - QID 109999

Renal Tubular Acidosis (RTA) Introduction Renal Tubular Acidosis Type Etiology Pathogenesis Treatment Comments Type II (proximal) Fanconi syndrome Carbonic anhydrase II deficiency Medications acetazolamide ifosfamide topiramate Heavy metals e.g., mercury, cadmium, copper, and QID: 109999 (M2.RL.18.4874)
In scope icon M 5 C
QID 109999 (Type "109999" in App Search)
A 65-year-old man presents to the emergency department with shortness of breath while watching television. He has felt this way intermittently for the past week. The patient has a medical history of obesity, diabetes, constipation, and a neurogenic bladder. His current medications include atorvastatin, lisinopril, insulin, metformin, bethanechol, sodium docusate, and fiber supplements. His temperature is 98.4°F (36.9°C), blood pressure is 157/98 mmHg, pulse is 100/min, respirations are 11/min, and oxygen saturation is 98% on room air. An electrocardiogram is ordered as seen in Figure A. Basic labs are ordered as seen below.

Serum:
Na+: 137 mEq/L
Cl-: 107 mEq/L
HCO3-: 19 mEq/L
BUN: 26 mg/dL
Glucose: 159 mg/dL
Creatinine: 1.3 mg/dL
Ca2+: 10.2 mg/dL
pH: 7.3
AST: 12 U/L
ALT: 10 U/L

The remaining laboratory studies are pending. Which of the following is the underlying pathophysiology of this patient's presentation?
  • A
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  • A