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Step 1: Identify Normal Anion Gap Metabolic Acidosis Step 2: Calculate Urine Anion Gap (UAG) UAG = Urine Na + Urine K Urine Cl Negative UAG: Kidney acid excretion is intact think diarrhea or gastrointestinal bicarbonate loss Positive UAG: Defective renal acid excretion suggests RTA Types of Renal Tubular Acidosis 1 Type 1 (Distal RTA) Defect: Failure of distal nephron -intercalated cells to secrete H

Then, sprinkle in the coarsely ground black pepper and stir well

friction may cause it to detach or the needles to break