99doc
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1-When there is alkalosis, the urine normally becomes alkaline in a compensatory effort to get rid of HCO3.What is the condition of metabolic alkalosis in which Urine is acidic and it is called Pseudoacidurea?????? <?xml:namespace prefix = o ns = "urn:schemas-microsoft-com:office:office" />
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| kingsofke
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does it have something to do with action of aldosterone in distal tubule???
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| alphahmed
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I think in Conn's syndrom there will be an increase in Aldosterone leading to increased reabsorbtion of K in exchange of H ions so the patient will have renal tubular acidosis type 4 plus metabolic alkalosis...... am I right?
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| ssrpk
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good question man!
prolonged vomiting results in met.alkalosis + dehydration as well!
therefore initially to compensate for alkalosis, HCO3 are lost, but due to volume contraction Na+ reabsorption is enhanced from the proximal as well as distal segment tht results in acidic urine. Basically the whole theme is volume takes priority over pH.
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| sethigulshan
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hey ssrpk, why does vomiting result in metabolic alkalosis, What is the mechanism!!
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| ssrpk
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loss of HCl 
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| sethigulshan
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Is it that simple. no!! Try again.
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| ssrpk
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lolz
yeah man, realize tht with every H+ secreted [H+/K+ ATPase] by gastric parietal cells ,HCO3- is reabsorbed into systemic circulation [reaction is catalyzed by CA]
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| sethigulshan
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How do the kidneys react to the dehydration associated with vomiting, especially the proximal tubule?
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| ssrpk
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inc. sodium reabsorption, but more importantly due to high levels of aldosterone ,there is increased absorption of Na+ in the CD, with inc. secretion of K+ and H+!
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| sethigulshan
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You are also right!
What I was thinking was that, due to dehydration, the PCT blood flow is decreased, which induces an increase in Na reabsorption from the tubular fluid. Bicarb is a very important ion for the absorption of Na. A major fraction of all the Na absorbed in the PCT comes in with Bicarb.That is why Carbonic anhydrase are so effective diuretics, because they act in the PCT.
of course MOA of Bicarb absorption is via the Carbonic anhydrase, same as every where in the body.
what do you say?
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| sethigulshan
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I meant CA inhibitors.
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| ssrpk
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exactly, it's the cumulative effect of both.
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