renal tubular acidosis (RTA), an abnormal condition associated with persistent dehydration, metabolic acidosis, hypokalemia, hyperchloremia, and nephrocalcinosis. It is caused by the kidney’s inability to conserve bicarbonate and to adequately acidify the urine. Some forms of RTA are more prevalent in women, older children, and young adults. Prolonged RTA can cause hypercalciuria and the formation of kidney stones. Prognosis depends on treatment and the extent of renal damage but is usually good. Compare distal renal tubular acidosis, ketoacidosis, metabolic acidosis, proximal renal tubular acidosis, respiratory acidosis. ▪ OBSERVATIONS: Common signs and symptoms of RTA, especially in children, include anorexia, vomiting, constipation, delayed growth, excessive urination, nephrocalcinosis, and rickets. RTA can also cause urinary tract infections and pyelonephritis. Confirming diagnosis of distal RTA is based on laboratory tests that show impaired urine acidification in association with systemic metabolic acidosis. Confirming diagnosis of proximal RTA is based on tests that show bicarbonate wasting as a result of impaired reabsorption. Other significant laboratory findings may include decreased sodium bicarbonate, pH, potassium, and phosphorus; increased serum chloride, alkaline phosphatase, urinary bicarbonate, and potassium; and urine with low specific gravity. ▪ INTERVENTIONS: Treatment includes the replacement of excessively secreted substances, especially bicarbonate, and may include the administration of sodium bicarbonate tablets, potassium, vitamin D to preserve calcium metabolism, and antibiotics to counter pyelonephritis. Surgery may be required to remove renal calculi. ▪ PATIENT CARE CONSIDERATIONS: The health care team carefully monitors the results of altered laboratory tests, especially those involving potassium levels and urine pH. The patient’s urine is strained to capture any kidney stones for analysis, and the nurse is alert to any signs of hematuria. A patient with a low potassium level is usually advised to eat potassium-rich foods such as bananas, oranges, and baked potatoes. The patient and family are encouraged to seek genetic counseling and RTA screening.
