Abstract
A 24-year-old male, habitual thinner sniffer, and suffering polyuria and mascle weakness was admitted to our institute after sniffing thinner for several weeks.
The data on the admission day indicated severe hypokalemia, severe metabolic acidosis with normal anion gap, and high urinary level of hippuric acid which is a metabolite of toluene, a major component of thinner. Although the function of acidifying urine was not fully damaged, toluene-induced tubular injury in both proximal as well as distal tubes caused renal tubular acidosis (RTA). The proximal type RTA inhibits reabsorption of HCO3- and the distal type, on the contrary, inhibits active excretion of H+. Thus either acid loading such as NH4Cl or low HCO3- concentration can acidify urine in the proximal type RTA.
Acid loading test done on the 25th admission day suggested our case to be the proximal type. Proximal type RTA is rarely reported so far as we reviewed but should be kept in mind of the physicians who take care.
