This protocol applies to patients with distal renal tubular acidosis who are already on alkali supplementation and have achieved reasonable control of their acidosis, yet plasma potassium remains persistently below the age-appropriate normal range.
First-line management with alkali supplementation — whether potassium-containing or sodium-containing — targets normalisation of plasma bicarbonate, chloride, and potassium, alongside urinary calcium excretion. When acidosis is under control but plasma potassium remains uncorrected, this specific failure criterion triggers escalation to the next step.
The protocol adds dedicated potassium supplementation on top of the continued alkali regimen, with the choice of preparation guided by patient tolerability. The full regimen details remain in the structured protocol.
Normalisation of plasma potassium within the age-appropriate normal range.