01-01-2014, 06:59 PM
A 65-year-old man with chronic obstructive pulmonary disease requiring home oxygen at night and cor pulmonale presents to the emergency department (ED) with worsening shortness of breath. On examination, the man’s respiratory rate is 22/min and he has a heart rate of 104/min. He has distant breath sounds and is using accessory muscles of breathing. In addition to his baseline chronic respiratory acidosis, the man is found to have a metabolic acidosis on arterial blood gas analysis. Laboratory tests show:
Na+ 138 mEq/L
K+ 3.6 mEq/L
Cl− 118 mmol/L
HCO3 − 16 mEq/L
Phosphate 2.0 mg/dL
Glucose 98 mg/dL
Blood urea nitrogen 10 mg/dL
Creatinine 0.8 mg/dL
Urinalysis is positive for glucose.
Which of the following diagnoses explains this patient’s laboratory findings?
(A) Right heart failure
(B) Steroid-induced glucosuria
© Type I renal tubular acidosis
(D) Type II renal tubular acidosis
(E) Type IV renal tubular acidosis
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