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Non AG Hyper Cl Acidosis: Diff dx determined by changes in Serum Potassium



Hyperkalemia
 - Determination of the serum K is especially useful in the evaluation of hyperchloremic metabolic acidosis.  Infusions of mineral acids result in elevated serum K levels because of the shift in K+ out of cells in exchange for H+ entry.  Thus, hyperalimentation, NH4 Cl, CaCl2 ingestion, and Cholestyramine administration, all cause a hyperkalemic Non Anion Gap Acidosis.  In addition, hypoadosteronism results in a defect in K+ excretion, leading to Hyperkalemia.
 - Hyperchloremic acidosis associated w/ hypokalemia:
      - Gastrointestinal HCO3 losing entities, including Diarrhea, pancreatic drainage, biliary drainage, uterosigmoidostomy, or obstructed ileal loop, distal RTA (I), and proximal RTA (II).