Abnormalities in acid-base metabolism and in renal handling of bicarbonate are present in patients with increased or decreased activity of the parathyroid glands. Thus, many investigators have noted hyperchloremic acidosis in some patients with primary hyperparathyroidism,1-4 and others have found impaired urinary acidification in response to acid load in such patients.5-7 On the other hand, elevated levels of serum bicarbonate were found in patients with hypercalcemia when the latter was not due to hyperactivity of the parathyroid glands and in patients with hypoparathyroidism.2,8-11 Furthermore, Barzel reported that patients with hypoparathyroidism have mild metabolic alkalosis.10,11 Also, mild systemic acidosis, low levels of serum bicarbonate, excessive urinary loss of bicarbonate, and impaired urinary acidification have been observed in patients with osteomalacia and secondary hyperparathyroidism.7,12-14 Finally, successful treatment of the hyperparathyroidism is usually associated with reversal of these abnormalities.15
Hyperchloremic acidosis in patients with parathyroid adenoma is
Massry SG, KUROKAWA K, Arieff AI, Ben-Isaac C. Metabolic Acidosis of Hyperparathyroidism. Arch Intern Med. 1974;134(2):385–387. doi:10.1001/archinte.1974.00320200195032
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