new_n_lost
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C. His urine has an elevated amount of titratable acidity.
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| paganini
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Answer A is certainly true. This a respiratory acidosis. Answer B is false. In response to the prolonged acidosis, the patient's bicarbonate would be elevated as compensation, not depressed. Answer C is false. Although the development of compensation would require increased acid excretion, the maintenance would only require a urinary excretion to match the input of fixed acid. CO2, no matter how much it is elevated, cannot be excreted as urinary acid.
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| new_n_lost
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Emphysema Pt Results in Respiratory Alkalosis with ur PCO2 Normal or Decreased Goljan RR 2nd Edtion Pg 315. Plz Look it up
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| paganini
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This is a common common and common board questions and you can't imaging how many people get this question wrong. People use to answer these question from memorization and is a big mistake. There is a big difference between acute onset and and chronic acid-base disorders. I know a person who got the same question about an acid-base disorder and the question just change by saying after 12 days in the middle of the stem. Here the concept is that as emphysema progresses, there is a loss in diffusing capacity, hypoxemia, and hypercapnia leading to respiratory acidosis.
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| duki
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i agree paganini..A would be true because of the factors you mention, but considering the fact that it mentions the chronic onset of the disorder, i would say C...am i wrong?
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| drduck
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yup...........i go with option A.......
this was easy....
patients with COPD or those having any kind of obstructive lung disorder have problem with pushing out the CO2.....bcos the have obstruction during expiration......
this increases the PCO2 in their lung.......respiratory acidosis
what i remember goljan also agrees with this....atleast in the general patho.
NNL please share ur concept with us.....might be we missing out something...
i will check again my golnotes
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| tompat
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sorry but my choice is lil diff.
i wud go for B.his bicarbonate is low.
emphysema has obstruction at the level of respiratory bronchioles or down at alveolar ducts, or entire respi. unit.this will prevent significant o2 exchange but will not affect CO2 exchange much as CO2 exchange can be done with less surface area effectively.thats the reason these pt. appear PINK, n called as PINK PUFFERS.
THESE PT. hyperventilate so that they can maintain normal oxigenation of Hb.
this leads to CO2 being normal or less than normal.but not increased levels as said DR.GOLJAN.so these pt. have respiratory ALKOLOSIS. there is no doubt about that.
the compensation for this has to be metabolic acidosis, if it has to develop in late stage.
to make this sure kidney will have to decrease the production of HCO3- or increase it's excretion, one and the same.
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| tompat
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in case of chronic bronchitis obstruction is at the level proximal to what it is in emphysema, that is at terminal bronchioles.
this obstruction is due to mucus production and or fibrosis at this level.this effectively cuts off any gas exchange distal to the obstruction.now this area is larger than what we see in emphysema.so much that CO2 retaintion occurs also O2 exchange is severly compromised and pt. develop cynosis.
this is the reason these pt. are called BLUE BLOATERS, as they tend to put on weight and are cynosed.
in this obstructive pattern we have respiratory acidosis cause of CO2 retaintion, all is given in DR. GOLJAN'S nrr 2 nd edition.
please let me know if i m overlooking some thing.
thanks
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| paganini
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Read the question again, here we are talking about chronic obstruction. With increasing obstruction, increasing PCo2 and respiratory acidosis, with compensatory metabolic alkalosis are seen.
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| drhouse
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hello paganini,
so it is something like, initially there will be respiratory alkalosis but as disease progress there will be respiratory acidosis....
pl explain..
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| tompat
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ok .now we have this thing to add to it. in emphysema pt has dyspnea prior to developing hypoxia. so he cud have dyspnea for a long time without developing significant hypoxia, which is followed or accompanied by CO2 retention.
i think the q doesn't give us exact idea what is his respiratory status now, it just mentions long standing dyspnea, which is seen in emphysema.
one needs to add to q stem that there is cynosis or hypoxemia set in to assume that there might be now respi. acidosis set in.
i agree that respiratory acidosis occures in emphysema.
thanks, for ur reply paganini.
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| paganini
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Yes, initially you'll see resp. alkalosis but with progression a resp. acidosis.
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