In uremia, which electrolyte and acid-base disturbances are commonly observed?

• A. Hyperkalemia and Acidemia
• B. Hypokalemia and Alkalemia
• C. Hyperkalemia and Alkalemia
• D. Hypokalemia and Acidemia

Answer: (A)

In uremia, the kidneys can’t excrete potassium or clear hydrogen ions effectively. This leads to potassium building up in the blood (hyperkalemia) and hydrogen ions accumulating, which lowers serum bicarbonate and causes metabolic acidosis (acidemia). The combination of high potassium and acidosis is a typical pattern seen with advanced renal failure because the failing kidneys lose both the ability to excrete K+ and to maintain acid-base balance.

Hyperkalemia arises from reduced distal tubule potassium secretion and the shift of potassium out of cells in the setting of acidosis, while the acidosis reflects impaired acid elimination and decreased bicarbonate regeneration. The alternatives—low potassium or a tendency toward alkalosis—do not fit the usual renal failure scenario, where potassium retention and acid retention are common.