A man arrives in the emergency room. His primary complaint is “difficulty breathing” for the last...
A man arrives in the emergency room. His primary complaint is “difficulty breathing” for the last several days. A blood test reveals arterial PCO2of 33mmHg and blood pH of 7.47.
a. Is the man hypoventilating or hyperventilating? Explain
b. Use the chemical equations we covered in class to explain the relationship between blood PCO2 and blood pH.
c. Would a urinalysis mostly likely show a lower-than-normal or higher-than-normal urine pH in this patient? Briefly explain why.
d. Would intravenous administration of sodium bicarbonate (NaHCO3) be an appropriate treatment? Explain why or why not? (2 pts)
Homework Answers
a The patient is having hyperventilation due to respiratory alkalosis. Increased CO2 excretion from hyperventilation,compensatory response of HCO3 excretion by kidney.
b
The lungs helps to maintain a normal pH by excreting CO2 and water ,which are by-products of cellular metabolism.When released into circulation ,CO2 enter RBCs and combines with H2O to form H2CO3.This carbonic acid dissociates into hydrogen ions and bicarbonate.The free hydrogen is buffered by haemoglobin molecules,and the bicarbonate diffuses into the plasma.In the pulmonary capillaries,this process is reversed and CO2 is formed and excreted by the lungs .The overall reversible reaction is expressed as follows
CO2 +H2O reversible arrows
H2CO3reversible arrowH+ +HCO3-
c Under normal conditions,the kidneys reabsorb and conserve all of the bicarbonate they filter.The kidneys can generate additional bicarbonate and eliminate excess H+as compensation for acidosis.The three mechanisms of acid elimination are secretion of small amounts of free hydrogen ion into the renal tubule,combination of H+ with ammonia to form ammonium and excretion of weak acids.The body depends on the kidneys to excrete a portion of the acid produced by cellular metabolism.Thus the kidneys normally excrete acidic urine .As a compensatory mechanism ,the pH of the urine can decrease to 4 and increase to 8.if the renal system is the cause of an acid-base balance,it loses its ability to correct a pH alteration.In this situation urine pH will be greater than 6
d Sodium bicarbonate is used in the treatment of metabolic acidosis.
d
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