This is a real-world medical entrance exam question, please give the true answer based on the question and selection. Topic name: Metabolic disorders, Subject name: Pediatrics
Abnormality in A with rickets is 
Select and explain. 
A. Loss of HCO-3, B. Loss of Ca++, C. Lass of K+, D. All of the above
A: Loss of HCO-3
Answer: A: Loss of HCO-3 
Explanation: Proximal or distal renal tubular acidosis(A) are impoant causes of refractory rickets in children.The conditions are characterised by hyperchloremic metabolic acidosis with loss of HCO-3 and normal blood levels of urea and creatinine.Patients with proximal A may show low blood levels of phosphate,aminoaciduria and low molecular weight proteinuria.The use of bicarbonate and phosphate supplementation in proximal A results in healing of rickets. Reference:Essential pediatrics-Ghai,8th edition,page no:115