Step I how does acetazolamide cause hyperchloremia?

[axeon123]

I'm trying to figure out why (mechanism). Acidosis makes sense, and so does hypokalemia. Thanks.

 

[IMGUSMLEStep1]

I think it's because carbonic anhydrase inhibitors prevent HCO3 reabsorption, so more sodium is being excreted as NaHCO3 instead of NaCl.

 

[turkeyjerky]

every non-anion gap acidosis has hyperchloremia. it's inevitable, and unimportant

 

[hartbot]

It causes a non-anion gap metabolic acidosis. As the negative bicarb is ridded by the kidney, another anion needs to fill its place in the serum, and this is done by Cl.

 

[DoctorBob]

What makes sense to me, but I could be totally wrong is:

Acidosis stimulates the release of aldosterone -> increase in activity of NaCl Cotransporter in early DCT-> Hyperchloremia

 

[username456789]

Pretty sure Aldo isn't involved in the NCC. What the others have said is correct.

 

[turkeyjerky]

What makes sense to me, but I could be totally wrong is:

Acidosis stimulates the release of aldosterone -> increase in activity of NaCl Cotransporter in early DCT-> Hyperchloremia

Lol, sorry to pick on you, but you couldn't be more wrong. I don't think there's one correct statement in there.

 

[username456789]

Lol, sorry to pick on you, but you couldn't be more wrong. I don't think there's one correct statement in there.

Technically, acidosis could INDIRECTLY stimulate Aldo via increased K+. But yeah, that response was certainly not correct (no offense to the poster).

 

[axeon123]

every non-anion gap acidosis has hyperchloremia. it's inevitable, and unimportant

It causes a non-anion gap metabolic acidosis. As the negative bicarb is ridded by the kidney, another anion needs to fill its place in the serum, and this is done by Cl.

Thanks - these make the most sense. 🙂

 

[DoctorBob]

Lol, sorry to pick on you, but you couldn't be more wrong. I don't think there's one correct statement in there.

Not even the part where I state "I could be totally wrong"?

Thanks for your input though, you're very helpful. 👍

 

[Dirt]

Recovered bicarb is transported into the blood across the basolateral membrane by HCO3/Cl exchanger. Decrease recovered bicarb and you decrease Cl exchange and thus secretion.

 

[turkeyjerky]

Not even the part where I state "I could be totally wrong"?

Thanks for your input though, you're very helpful. 👍

Hahaha, I stand corrected

 

[Onigiri]

It may be due to the b intercalated cells at the collecting ducts that take in cl- and excrete hco3-. More hco3- in the tubule, less hco3 from intracellular side wants to go into the lumen of the tubule, and hence less cl- being excreted out.