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Topic:Metabolic Acidosis

Metabolic acidosis in horses is a condition characterized by an imbalance in the body's acid-base status, resulting in a lower than normal blood pH. This condition arises when there is an accumulation of acid or a significant loss of bicarbonate in the body, which can occur due to various factors such as intense exercise, gastrointestinal disturbances, or renal dysfunction. In horses, metabolic acidosis can affect cellular function and overall metabolic processes. The condition is typically assessed through blood gas analysis, measuring parameters such as blood pH, bicarbonate levels, and carbon dioxide concentration. This page compiles peer-reviewed research studies and scholarly articles that explore the causes, physiological impacts, and management strategies of metabolic acidosis in equine health.
Association of the type of metabolic acidosis and non-survival of horses with colitis.
The Canadian veterinary journal = La revue veterinaire canadienne    November 2, 2023   Volume 64, Issue 11 1044-1050 
Giraldo AF, Carballo R, Serrenho RC, Tran V, Valverde A, Renaud DL, Gomez DE.Metabolic acidosis (MA) is the most common acid-base disorder reported in horses with colitis but its association with survival is yet to be determined. Investigate the types of MA in horses with colitis to determine effects of various anions on fatality rates. We studied 158 horses with colitis. Horses were classified into 4 groups depending on the anion contributing to MA: i) no MA, ii) lactic acidosis (LA), iii) unmeasured strong ion (USI) acidosis, and iv) hyperchloremic acidosis (HA). Sixty percent (95/158) of horses had no MA, 22% (34/158) had LA, 12% (19/158) had HA, and 6% (10/158) had...
Tracing Acid-Base Variables in Exercising Horses: Effects of Pre-Loading Oral Electrolytes.
Animals : an open access journal from MDPI    December 24, 2022   Volume 13, Issue 1 73 doi: 10.3390/ani13010073
Waller AP, Lindinger MI.Oral electrolyte supplementation may influence acid-base state during exercise due to the intestinal absorption of administered water and electrolytes used to mitigating sweat losses. This study examined the effect of pre-exercise electrolyte supplementation (3 and 8 L) on plasma acid-base variables at rest, during moderate intensity exercise and during recovery. It was hypothesized that electrolyte supplementation will result in improved acid-base state compared to the alkalosis typical of prolonged exercise. In randomized crossover fashion, four horses were administered 3 L or 8 L of a hypot...
Effects of total parenteral nutrition associated with glutamine, enteral fluid therapy with or without glutamine, and fluid therapy on the acid-base and electrolyte balance of horses starved after exploratory laparotomy.
Brazilian journal of veterinary medicine    October 14, 2022   Volume 44 e003222 doi: 10.29374/2527-2179.bjvm003222
Melo UP, Palhares MS, Ferreira C, Leme FOP, Gheller VA.This study aimed to evaluate the effects of the total parenteral nutrition associated with glutamine, enteral fluid therapy with or without glutamine, and fluid therapy on the acid-base and electrolyte balance of horses starved after exploratory laparotomy. Sixteen healthy male and female adult horses of mixed breed, aged between 4 and 14 years, and having a mean body weight of 248.40 ± 2.28 kg and a body score index of 3-4 (scale of 1-5) were divided into four groups with four animals per group. After an adaptation period of 30 days, they were randomly divided into four experimental groups: ...
Physicochemical Analysis of Mixed Venous and Arterial Blood Acid-Base State in Horses at Core Temperature during and after Moderate-Intensity Exercise.
Animals : an open access journal from MDPI    July 22, 2022   Volume 12, Issue 15 1875 doi: 10.3390/ani12151875
Lindinger MI, Waller AP.The present study determined the independent contributions of temperature, strong ion difference ([SID]), total weak acid concentration ([Atot]) and PCO2 to changes in arterial and mixed venous [H+] and total carbon dioxide concentration ([TCO2]) during 37 min of moderate intensity exercise (~50% of heart rate max) and the first 60 min of recovery. Six horses were fitted with indwelling carotid and pulmonary artery (PA) catheters, had PA temperature measured, and had blood samples withdrawn for immediate analysis of plasma ion and gas concentrations. The increase in core temperature during exe...
Serial venous lactate measurement following gastrointestinal surgery in horses.
Journal of veterinary science    July 15, 2022   Volume 23, Issue 5 e66 doi: 10.4142/jvs.22038
Smanik LE, Moser DK, Rothers KP, Hackett ES.Prospective clinical study of blood lactate concentration in horses undergoing colic surgery is needed to determine utility in outcome prediction. Objective: To evaluate venous lactate measurements in horses following colic surgery, including immediately after anesthetic recovery and daily throughout hospitalization, as well as to determine if lactate concentrations were significantly higher in horses that developed postoperative complications or did not survive to hospital discharge. Methods: Horses > 1 year of age undergoing surgery for colic and recovered from general anesthesia were sample...
Metabolic Disorders Associated with Renal Disease in Horses.
The Veterinary clinics of North America. Equine practice    March 10, 2022   Volume 38, Issue 1 109-122 doi: 10.1016/j.cveq.2021.11.008
Mullen KR.This article overviews metabolic disorders associated with renal disease. Included is a discussion of the pathophysiology, clinical signs, and treatment of hyperchloremic metabolic acidosis associated with renal tubular acidosis. Conditions affecting the central nervous system including uremic encephalopathy and hyponatremic encephalopathy secondary to renal disease are presented. Finally, a discussion of the unique features of calcium and phosphorus homeostasis in horses is provided with special emphasis on a recently described syndrome of calcinosis and calciphylaxis of unknown etiology.
The pathophysiology of uncontrolled hemorrhage in horses.
Journal of veterinary emergency and critical care (San Antonio, Tex. : 2001)    January 20, 2022   Volume 32, Issue S1 63-71 doi: 10.1111/vec.13122
Hurcombe SDA, Radcliffe RM, Cook VL, Divers TJ.Hemorrhagic shock in horses may be classified in several ways. Hemorrhage may be considered internal versus external, controlled or uncontrolled, or described based on the severity of hypovolemic shock the patient is experiencing. Regardless of the cause, as the severity of hemorrhage worsens, homeostatic responses are stimulated to ameliorate the systemic and local effects of an oxygen debt. In mild to moderate cases of hemorrhage (<15% blood volume loss), physiological adaptations in the patient may not be clinically apparent. As hemorrhage worsens, often in the uncontrolled situation suc...
Effect of lactic acid addition to equine whole blood on platelet aggregation measured by impedance aggregometry.
Veterinary clinical pathology    January 5, 2022   Volume 51, Issue 1 65-69 doi: 10.1111/vcp.13034
Lanier CJ, Taintor JS, Christopherson PW, Spangler EA.Acidemia in sick or injured horses is often due to lactic acid accumulation. Alterations in platelet function and hemostasis are among numerous deleterious effects caused by decreased physiologic pH. Objective: We aimed to evaluate the effect of hyperlactatemia and resultant acidemia on platelet aggregation in equine whole blood using impedance aggregometry. Methods: Platelet aggregation was measured using the Multiplate analyzer in whole blood from 34 healthy horses at baseline and after in vitro addition of lactic acid to adjust the pH. Platelet aggregation of each sample was quantified by t...
Development of Electrochemical DNA Biosensor for Equine Hindgut Acidosis Detection.
Sensors (Basel, Switzerland)    March 26, 2021   Volume 21, Issue 7 2319 doi: 10.3390/s21072319
Davies J, Thomas C, Rizwan M, Gwenin C.The pH drop in the hindgut of the horse is caused by lactic acid-producing bacteria which are abundant when a horse's feeding regime is excessively carbohydrate rich. This drop in pH below six causes hindgut acidosis and may lead to laminitis. Lactic acid-producing bacteria and have been found to produce high amounts of L-lactate and D-lactate, respectively. Early detection of increased levels of these bacteria could allow the horse owner to tailor the horse's diet to avoid hindgut acidosis and subsequent laminitis. Therefore, 16s ribosomal ribonucleic acid (rRNA) sequences were identified a...
[Uroperitoneum in neonatal foals – a review of the literature].
Tierarztliche Praxis. Ausgabe G, Grosstiere/Nutztiere    February 15, 2021   Volume 49, Issue 1 41-50 doi: 10.1055/a-1345-7148
Bernick A, Nieth J, Wehrend A.Uroperitoneum is a typical disease in newborn foals. An accumulation of urine develops in the abdominal cavity in consequence to a congenital or acquired leakage in the urinary tract. Colts are more frequently affected than fillies. The most common cause of uroperitoneum is a rupture of the dorsal urinary bladder wall. The urinary bladder is affected in 73.1 %, the urachus in 21.6 % and the ureter in 5.2 % of cases. Typical clinical signs occur 2-5 days postpartum, and encompass reduced general condition, abdominal distention, mild colic symptoms and unphysiologic micturition. Ultrasou...
Agreement of 2 electrolyte analyzers for identifying electrolyte and acid-base disorders in sick horses.
Journal of veterinary internal medicine    September 23, 2020   Volume 34, Issue 6 2758-2766 doi: 10.1111/jvim.15889
Gomez DE, Buczinski S, Darby S, Palmisano M, Beatty SSK, Mackay RJ.Use of different analyzers to measure electrolytes in the same horse can lead to different interpretation of acid-base balance when using the simplified strong ion difference (sSID) approach. Objective: Investigate the level of agreement between 2 analyzers in determining electrolytes concentrations, sSID variables, and acid-base disorders in sick horses. Methods: One hundred twenty-four hospitalized horses. Methods: Retrospective study using paired samples. Electrolytes were measured using a Beckman Coulter AU480 Chemistry analyzer (PBMA) and a Nova Biomedical Stat Profile (WBGA), respectivel...
Venous Blood Acid-Base Status in Show Jumper Horses Subjected to Different Physical Exercises.
Journal of equine veterinary science    September 12, 2020   Volume 94 103251 doi: 10.1016/j.jevs.2020.103251
Arfuso F, Giannetto C, Giudice E, Fazio F, Panzera F, Piccione G.The aim of this study was to assess whether acid-base profile exhibits changes in regularly trained show jumping horses undergoing increasing exercise workloads. Seven female Italian saddle horses were subjected to three different physical exercise trials of increasing workload identified as three exercise phases (EPs). During EPI horses were subjected to a standardized exercise test consisting of 15 minutes of treadmill, during EPII horses were subjected to a show jumping test (height, 0.9-1.1 m; course length, 300 m), during EPIII horses underwent two jumping sessions carried out over two...
Traditional and quantitative analysis of acid-base and electrolyte imbalances in horses competing in cross-country competitions at 2-star to 5-star level.
Journal of veterinary internal medicine    January 27, 2020   Volume 34, Issue 2 909-921 doi: 10.1111/jvim.15708
Kirsch K, Sandersen C.Early recognition and management of acid-base, fluid, and electrolyte disorders are crucial for the maintenance of health and performance in equine athletes. Objective: To analyze changes in acid-base and electrolyte status associated with exercise during cross-country competitions at different levels using traditional and quantitative approaches. Methods: Thirty-eight eventing horses. Methods: Prospective observational study. Jugular venous blood samples were collected before and after the cross-country test of 25 international eventing competitions ranging from 2-star (formerly 1-star) to 5-...
Outcome and complications in horses administered sterile or non-sterile fluids intravenously.
Journal of veterinary internal medicine    October 14, 2019   Volume 33, Issue 6 2739-2745 doi: 10.1111/jvim.15631
Kopper JJ, Bolger ME, Kogan CJ, Schott HC.Obtaining commercial fluids for intravenous administration (IVF) was challenging during a recent shortage. This necessitated use of custom-made non-sterile fluids for intravenous administration (JUGs) in some hospitals. There are no studies comparing outcome of horses treated with JUG versus IVF and limited information is available about adverse effects of JUGs. Objective: To evaluate death, complications, blood pH, and plasma electrolyte concentrations of horses that received JUG versus IVFs. Methods: One hundred eighty-six horses that received IVFs and 37 that received JUGs. Methods: A retro...
Controlled delay of the expulsive phase of foaling affects sympathoadrenal activity and acid base balance of foals in the immediate postnatal phase.
Theriogenology    July 18, 2019   Volume 139 8-15 doi: 10.1016/j.theriogenology.2019.07.017
Melchert M, Aurich C, Aurich J, Gautier C, Nagel C.Stress at foaling has been demonstrated to delay birth. In this study, we followed the hypothesis that even a short delay of foaling increases catecholamine and cortisol release in foals, induces acidosis and impairs neonatal adaptation. Foaling was prolonged for 5 min by transferring mares to an unfamiliar environment at rupture of the allantochorion (group delay, n = 6) while control mares (n = 5) were left undisturbed. In their foals, times from birth to first standing and first suckling, heart rate, heart rate variability (HRV) and salivary cortisol concentration were analysed. B...
Clinical use of plasma lactate concentration. Part 2: Prognostic and diagnostic utility and the clinical management of hyperlactatemia.
Journal of veterinary emergency and critical care (San Antonio, Tex. : 2001)    March 14, 2018   Volume 28, Issue 2 106-121 doi: 10.1111/vec.12706
Rosenstein PG, Tennent-Brown BS, Hughes D.To review the current literature pertaining to the use of lactate as a prognostic indicator and therapeutic guide, the utility of measuring lactate concentrations in body fluids other than blood or plasma, and the clinical management of hyperlactatemia in dogs, cats, and horses. Methods: Articles were retrieved without date restrictions primarily via PubMed, Scopus, and CAB Abstracts as well as by manual selection. Unassigned: Increased plasma lactate concentrations are associated with increased morbidity and mortality. In populations with high mortality, hyperlactatemia is moderately predicti...
Effects of dystocia on blood gas parameters, acid-base balance and serum lactate concentration in heavy draft newborn foals.
Journal of equine science    March 28, 2017   Volume 28, Issue 1 27-30 doi: 10.1294/jes.28.27
Kimura Y, Aoki T, Chiba A, Nambo Y.Dystocia is often lethal for neonatal foals; however, its clinicopathological features remain largely unknown. We investigated the effect of dystocia on the foal blood profile. Venous blood samples were collected from 35 foals (5 Percheron and 30 crossbreds between Percheron, Belgian, and Breton heavy draft horses) at 0 hr, 1 hr, 12 hr and 1 day after birth. Dystocia was defined as prolonged labor >30 min with strong fetal traction with or without fetal displacement. The dystocia group (n=13) showed lower mean values for pH (P<0.01), bicarbonate (P<0.01), total carbon dioxide (P<0....
Effects of Different Oral Doses of Sodium Chloride on the Basal Acid-Base and Mineral Status of Exercising Horses Fed Low Amounts of Hay.
PloS one    January 3, 2017   Volume 12, Issue 1 e0168325 doi: 10.1371/journal.pone.0168325
Zeyner A, Romanowski K, Vernunft A, Harris P, Müller AM, Wolf C, Kienzle E.The provision of NaCl, according to current recommendations, to horses in moderate work has been shown to induce immediate postprandial acidosis. The present study aimed to clarify whether this NaCl induced acidosis i) persists beyond the immediate postprandial period, and ii) is still present after a 2 week adaptation period. Six adult warmblood mares in moderate work received daily 1.00 kg hay per 100 kg body weight (bwt) only together with 0.64 kg unprocessed cereal grains/100 kg bwt.d as fed basis. Using a 3x3 Latin Square, either 0 (NaCl-0), 50 (NaCl-50) or 100 (NaCl-100) g NaCl/d were fe...
Repeated measurements of blood lactate concentration as a prognostic marker in horses with acute colitis evaluated with classification and regression trees (CART) and random forest analysis.
Veterinary journal (London, England : 1997)    March 15, 2016   Volume 213 18-23 doi: 10.1016/j.tvjl.2016.03.012
Petersen MB, Tolver A, Husted L, Tølbøll TH, Pihl TH.The objective of this study was to investigate the prognostic value of single and repeated measurements of blood l-lactate (Lac) and ionised calcium (iCa) concentrations, packed cell volume (PCV) and plasma total protein (TP) concentration in horses with acute colitis. A total of 66 adult horses admitted with acute colitis (<24 h) to a referral hospital in the 2002-2011 period were included. The prognostic value of Lac, iCa, PCV and TP recorded at admission and 6 h post admission was analysed with univariate analysis, logistic regression, classification and regression trees, as well as ran...
Acid base imbalances in ill neonatal foals and their association with survival.
Equine veterinary journal    December 25, 2015   Volume 49, Issue 1 51-57 doi: 10.1111/evj.12542
Viu J, Armengou L, Ríos J, Cesarini C, Jose-Cunilleras E.Acid-base imbalances observed in human paediatric patients are associated with outcome. Likewise, neonatal foals may have different acid-base imbalances associated with diagnosis or prognosis. Objective: To determine acid-base imbalances by the quantitative method in ill neonatal foals and assess their association with diagnosis and prognosis. Methods: Observational prospective clinical study. Methods: This study included 65 ill neonatal foals (32 septic, 33 nonseptic) admitted to an equine referral hospital from 2005 to 2011with acid-base parameters determined on admission and a control group...
Intravenous administration of a polyionic solution containing 84 mEq/l of lactate resolves experimentally induced hyperchloraemic acidosis in horses.
Equine veterinary journal    December 10, 2015   Volume 49, Issue 1 87-93 doi: 10.1111/evj.12525
Romão FT, Pereira PF, Flaiban KK, Dearo AC, Fernandes TM, Lisbôa JA.Treatment of metabolic acidosis using sodium bicarbonate solutions is safe when blood gas analysis is available. The evidence that solutions containing metabolisable buffers can be used as an alternative for treatment of metabolic acidosis in horses is of practical interest. Objective: To investigate the safety and efficacy of a polyionic solution containing 84 mEq/l of lactate (L84) for the correction of induced hyperchloraemic metabolic acidosis. Methods: Non-randomised crossover design. Methods: Five healthy, adult, crossbred horses were used. A solution containing 100 mmol/l of HCl was inf...
Analysis of metronidazole in equine plasma using liquid chromatography/tandem mass spectrometry and high-resolution accurate mass spectrometry.
Rapid communications in mass spectrometry : RCM    September 26, 2015   Volume 29, Issue 8 753-763 doi: 10.1002/rcm.7158
Ilomuanya M, Uboh C, Ciallella J, Li X, Liu Y, Ifudu N, Azubuike C, Igwilo C.Treatment of racehorses with bicarbonate solutions to manage acidosis and muscle cramps prior to competition is banned in Pennsylvania (PA). Use of excess bicarbonate in horses causes diarrhea, requiring treatment with an antibiotic such as metronidazole (MTNZ). At present no method exists for detecting MTNZ in equine plasma. Thus, a liquid chromatography/tandem mass spectrometry (LC/MS/MS) method for the detection, quantification and confirmation of MTNZ was developed. Methods: The analyte was recovered from plasma by liquid-liquid extraction using methyl tert-butyl ether and separated on an ...
Imaging Diagnosis – Use of Multiphase Computed Tomographic Urography in the Diagnosis of Ureteral Tear in a 6-Day-Old Foal. Beccati F, Cercone M, Angeli G, Santinelli I, Pepe M.A 6-day-old foal was evaluated for depression and inappetence. After initial stabilization, the filly developed a hypochloremic metabolic alkalosis and persistent hypercreatinemia. Abdominal ultrasound revealed fluid accumulation around the left kidney and a well-defined rounded fluid filled structure dorsal to the urinary bladder. Computed tomography revealed a partial tear of the left ureter with distension of the retroperitoneal membrane. Exploratory celiotomy was performed to allow left kidney nephrectomy. At 6 months follow-up, the filly was growing normally without complications. Ultraso...
Physicochemical Approach to Determine the Mechanism for Acid-Base Disorders in 793 Hospitalized Foals.
Journal of veterinary internal medicine    August 10, 2015   Volume 29, Issue 5 1395-1402 doi: 10.1111/jvim.13590
Gomez DE, Biermann NM, Sanchez LC.The quantitative effect of strong electrolytes, unmeasured strong anions (UAs), pCO2, and plasma protein concentrations in determining plasma pH can be demonstrated using the physicochemical approach. Plasma anion gap (AG) and strong ion gap (SIG) are used to assess UAs in different species. Objective: Strong ions are a major factor influencing changes in plasma pH of hospitalized foals. AG and SIG accurately predict severe hyper-L-lactatemia ([L-lac(-)] > 7 mmol/L). Methods: Seven hundred and ninety three hospitalized foals < 7 days old. Methods: Retrospective study. The relationship be...
Preliminary investigation of the area under the L-lactate concentration-time curve (LACArea) in critically ill equine neonates.
Journal of veterinary internal medicine    March 31, 2015   Volume 29, Issue 2 659-662 doi: 10.1111/jvim.12559
Wilkins PA, Sheahan BJ, Vander Werf KA, Castagnetti C, Hardy J, Schoster A, Boston RC.A variety of measures of L-lactate concentration ([LAC]) in the blood of critically ill neonatal foals have shown utility as prognostic indicators. These measures, evaluating either the severity of hyperlactatemia or the duration of exposure to hyperlactatemia, perform fairly well and have correctly classified 75-80% of foals examined in several studies. The area under the L-lactate concentration versus time curve (LACArea) encompasses both severity and duration of hyperlactatemia and should improve correct classification of patient survival. Objective: LACArea is larger in nonsurviving critic...
Metabolic profile of broodmares during late pregnancy and early post-partum.
Reproduction in domestic animals = Zuchthygiene    September 23, 2014   Volume 49, Issue 6 947-953 doi: 10.1111/rda.12411
Bazzano M, Giannetto C, Fazio F, Arfuso F, Giudice E, Piccione G.Pregnancy represents a specific physiological status characterized by continuous adjustments that affect maternal metabolism of all nutrients. In the last trimester of pregnancy, mare's nutrient requirements greatly increase and most pregnancy-associated diseases are likely to occur. Therefore, we aimed to assess the metabolic profile of broodmares focusing on the last 3 months of pregnancy and the early post-partum. Fifteen pregnant mares (Group A) were monitored from 263 ± 3 days of pregnancy until 21 days after foaling. Seven non-pregnant mares (Group B) were used as the control group...
Clinical utility of serum biochemical variables for predicting acid-base balance in critically ill horses.
Veterinary clinical pathology    September 12, 2014   Volume 43, Issue 4 547-556 doi: 10.1111/vcp.12200
Stämpfli HR, Schoster A, Constable PD.Profiles from serum biochemical analyzers include the concentration of strong electrolytes (including l-lactate), total carbon dioxide (tCO2 ), and total protein. These variables are associated with changes in acid-base balance. Application of physicochemical principles may allow predicting acid-base balance from serum biochemistry without measuring whole blood pH and pCO2 . Objective: The purpose of the study was to determine if the acid-base status of critically ill horses could be accurately predicted using variables included in standard serum biochemical profiles. Methods: Two jugular veno...
Blood lactate measurement and interpretation in critically ill equine adults and neonates.
The Veterinary clinics of North America. Equine practice    June 10, 2014   Volume 30, Issue 2 399-viii doi: 10.1016/j.cveq.2014.04.006
Tennent-Brown B.Admission blood lactate concentration is widely used as a prognostic indicator in equine medicine and can be a useful indicator of disease severity but typically fails to completely discriminate survivors from nonsurvivors. Increased admission lactate concentrations in adult horses typically return to normal within 12 to 24 hours. Lactate concentrations in neonatal foals are higher than adult concentrations for the first 24 to 72 hours of life. Serial measures reflecting both the magnitude and duration of hyperlactatemia might enable more accurate prognostication and provide insight into dis...
Protein catabolism and high lipid metabolism associated with long-distance exercise are revealed by plasma NMR metabolomics in endurance horses.
PloS one    March 21, 2014   Volume 9, Issue 3 e90730 doi: 10.1371/journal.pone.0090730
Le Moyec L, Robert C, Triba MN, Billat VL, Mata X, Schibler L, Barrey E.During long distance endurance races, horses undergo high physiological and metabolic stresses. The adaptation processes involve the modulation of the energetic pathways in order to meet the energy demand. The aims were to evaluate the effects of long endurance exercise on the plasma metabolomic profiles and to investigate the relationships with the individual horse performances. The metabolomic profiles of the horses were analyzed using the non-dedicated methodology, NMR spectroscopy and statistical multivariate analysis. The advantage of this method is to investigate several metabolomic path...
Transient Fanconi syndrome in Quarter horses.
The Canadian veterinary journal = La revue veterinaire canadienne    February 4, 2014   Volume 55, Issue 2 147-151 
Ohmes CM, Davis EG, Beard LA, Vander Werf KA, Bianco AW, Giger U.Two Quarter horses with weight loss had glucosuria, euglycemia, and a mild metabolic acidosis suggesting a proximal renal tubular defect. Further testing revealed transient generalized aminoaciduria, lactic aciduria, and glucosuria, indicating Fanconi syndrome. Both horses recovered with supportive therapy. This is the first report of acquired Fanconi syndrome in horses. Deux chevaux Quarter horse ayant subi une perte de poids étaient atteints de glucosurie, d’euglycémie et d’une acidose métabolique légère suggérant un défaut tubulaire rénal proximal. De nouveaux tests ont révél...
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