The cornerstone of medical treatment for type 1 RTA first entails addressing the underlying metabolic derangements. This is accomplished by replenishing potassium with oral and intravenous potassium chloride or potassium citrate. The latter is often more beneficial in patients with recurrent renal stones. In addition, oral sodium bicarbonate (1-2 mEq/kg/d) can often help meet the alkali requirements and compensate for the lost bicarbonate. In inherited type 1 RTA, early medical therapy can mitigate growth retardation and bone demineralization.
The patient in this case was treated with large amounts of oral and intravenous potassium chloride and admitted to the medical intensive care unit for further management. During her 1-week hospitalization, the nephrology and obstetrics services were both consulted. The obstetrics service performed transabdominal ultrasound, which demonstrated an intrauterine 8-week embryo with normal cardiac motion. A regular regimen of oral potassium citrate, bicarbonate, folate, and prenatal vitamins was initiated.
On the day of discharge, the patient's electrolyte derangements had corrected with oral therapy, and her nausea was controlled with oral ondansetron. The patient was discharged home on hospital day 7, and she had a normal basic metabolic panel 3 weeks after discharge.
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