The Pathophysiology Of Hyperchloremic Metabolic Acidosis After Urinary Diversion Through Intestinal Segments.
The pathophysiology of hyperchloremic metabolic acidosis after urinary diversion through intestinal segments. The pathophysiology of hyperchloremic metabolic acidosis after urinary diversion through intestinal segments has not been defined. This study employs a caninemodel in which an ileal segment is interposed between one kidney and the urinary bladder. Comparison of urinary solute excretion rates between the normal andinterposed renal units allows quantitation of solute reabsorption and secretionby the ileal segment. Ileal segments reabsorb urinary chloride, potassium, andammonium. Ammonium is reabsorbed in part as its conjugate free base, ammonia,with the liberated hydrogen ion reabsorbed with chloride or excreted astitratable acid. Inability to excrete acid as ammonium results in depletion ofbody buffers and a diminished capacity to compensate an additional acidchallenge. Bicarbonate is secreted by the ileal segments but not in amounts that are physiologically significant. Impaired renal function predisposes to thedevelopment of this syndrome but is not a primary pathophysiologic mechanism. Continue reading >>