Clinical Case Scenario
A 62-year-old diabetic and hypertensive male with chronic kidney disease (CKD) with eGFR) of 50 mL per minute per 1.73 m2 presents with generalized weakness and hyperkalemia. The lab investigations are given below:
Lab values:
pH: 7.31
HCO₃⁻: 17 mEq/L
PaCO₂: 38 mmHg
Na⁺: 138 mEq/L
K⁺: 6.2 mEq/L
Cl⁻: 108 mEq/L
Urine pH: 5.0
Urine Na⁺: 25 mEq/L
Plasma Aldosterone: Low
Which of the following is the most likely cause of this patient’s acid-base disturbance?
