keepgoing
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perhaps A
notice ph is WNL whereas co2(resp component) and bicarbonate(kidney component) are abnormal..indicating kidney is compensating for lung's abnormal co2 value by retaning bicrabonate
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| tompat
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but does kidney actually secret bicarb?
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| tompat
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yes ur right nkeep going but i cudn't digest this thing, kidneys actually secreting bicarb cud u explain a bit, i mean how which pump , where exactly
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| edie
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B?
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| keepgoing
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okay tompat...when there are excess of H ions in tubular lumen thn it is secreted to neutrilize them...
Production of new bicarbonate in distal tubule:
-->The distal tubule has fine control over bicarbonate
-->Secreted into the blood raises the pH
-->Secretion into tubule lowers the pH indirectly
hope it clears...what is your answer?
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| tompat
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right keep going the ans is A.
BUT why not E?
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| keepgoing
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reason for raised bicrabonate is incraese in bicrabonate secretion into blood circulation by newly synthesis of bicrabonate or retaining bicrabonate(raising blood ph) by excess secretion of H+, so it becomes obvious A is right answer,and INcraesed CA is not right b/c it is not compensatory component plus simply indicates increase production of carbonic acid while acid base story swings between reaction...
CO2<---> H+ + bicarbonate....
Edited by keepgoing on 07/24/07 - 03:23 AM
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| d
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Hey keepgoing,
when we have increased H+ why do we want to keep bicarbonate normal / decreased?
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| tompat
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i dont think when we gain bicarb from kidney it is called as secretion!!
secretion is only into the tulular lumen.
also increased activity of carbonic anhydrase will lead to gain of bicarb which is necessary in this respiratory acidosis as said by 'd'.
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| tompat
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oh i m sorry i cud not get what u said in post #14 kee going.
i think i m missing out some thing, please elaborate a bit.
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| keepgoing
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tompat...1st i would like to know what is ur understanding and what is ur doubt..plzz i could be wrong as well so plzz check txtbooks as well!!!
(ps.i have edited and expalined my understanding in detail, at post #11)
Edited by keepgoing on 07/23/07 - 01:58 AM
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| Aria
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what the heck !
Hco3....be it secreted or reabsorbed , in proximal tube or in distal tube , inside or outside the cell for compensation or not for compensation...H2o + co2----> Hco3- ,H+ the equiation always needs carbonic anhydrase .
more Hco3 in blood whether it is new or not new helps to compensate.
is there a magic point or trick in this question ?
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| keepgoing
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if im not wrong post at #4,11 did explain this thing only  no magic but if someone had confusion and asked what is the problem,u better be polite..this forum is for all and for learning...
goodday
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| Aria
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huh ??!! me impolite, why ? ...interesting comment !hahaha so here instead of learning , people are judging people ...anyways
i was talking to " tompat " and if he is offended he can speak for himself 
Now Miss Sincere i do appreciate your very nice explanation but if you don't mind , there are some small points that i wanted to ask you please :
1-Newly synthesized bicarbonte as you said in post 4, you mean making more Bicabonte out of co2 in distal tube right ?does it need more CA or not ?
2- "acid Carbonic " you said ,is it STABLE in our kidney or in anywhere else ?!
3- what is the difference b/w newly synthesized Bicarbonate and not brand new bicarbonate in terms of compensation ?
best regards
to tompat :
what is the damn explanation... man ? normally we never lose bicarbonate in the urine right ? there is no net gain for Hco3. and for acid-base imbalance we just make new ones and we need more CA to create more Hco3. so what is the reason behind this q ? is it because Long term adaption of kidney as it is Chronic Bronchitis ...or....?
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| keepgoing
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Aria wrote:huh ??!! me impolite, why ? ...interesting comment !hahaha so here instead of learning , people are judging people ...anyways i was talking to " tompat " and if he is offended he can speak for himself Now Miss Sincere i do appreciate your very nice explanation but if you don't mind , there are some small points that i wanted to ask you please : 1-Newly synthesized bicarbonte as you said in post 4, you mean making more Bicabonte out of co2 in distal tube right ?does it need more CA or not ? 2- "acid Carbonic " you said ,is it STABLE in our kidney or in anywhere else ?! 3- what is the difference b/w newly synthesized Bicarbonate and not brand new bicarbonate in terms of compensation ? best regards to tompat : what is the damn explanation... man ? normally we never lose bicarbonate in the urine right ? there is no net gain for Hco3. and for acid-base imbalance we just make new ones and we need more CA to create more Hco3. so what is the reason behind this q ? is it because Long term adaption of kidney as it is Chronic Bronchitis ...or....?
sorry if misunderstood..noone has extra time to waste...
1st,i know who did u comment to,above
2nd thanks for appreciating
3rd..if u read again my posts u will notice i nowhere mentioned that CA will not get affected in terms of concentration===> CO2 +H2O<--(CA)-->H2CO3<---->H+ + HCO3-, hence the CA
4th..okay Mr aria..see,there are two ways by which H ions would combine in the lumen..ist with filtered bicraboante and 2nd if H ions combine with other buffre thn bicarbonate and get excreted instaed making co2 and water,so in this case..cell in the tubule would make new bicarbonate(from its own metabolic co2 and water under CA, and secrete it in to blood..hope got my point
Edited by keepgoing on 07/25/07 - 01:15 AM
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| Aria
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Hello Miss Keepgoing.How have you been ?
I totally agree with your nice explanation in buffer system and H+ excretion. But what about Net gain, i mean 1 H+ excretion = 1 Hco3- absorption. we have More H+ in acidosis so we have to make More and equal amount of Hco3- , thus More CA is involved.
sincerely yours
PS : I think something is wrong with this q
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| Ig F
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here is my explanation.not really sure if itz rite,,plz correct me if i m wrong..........
first of all trhe situation given in the question indicates Respiratory acidosis,the compensatory mechanism will be from renal..then the kidneys will be forming extra HCO3- as shown in the question high level of plasma Bicarbonate....dnt forget its a brand new HCO3 which is formed by the kidney in the distal tubule... in order to balance the acidosis kidneys will be forming very acidic urine.........
___________________
i m not perfect but i wanna get close to it......
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| hope4dabest
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agree with fatima .....in respi acidosis bicarbonate is increased to some extent like if pco2 is 60, hco3 increase is of 26-27 and not of 32 like here...so new hco3 to compensate,,,gain of hco3 occurs when there is excretion of secreted H ion...
As far as your doubt of choice of E..if more carbonic anydrase...more conversion to H ion and hco3 ....Hco3 will increase but then its a weak base and H ion is a strong acid..
I hope i didnt confuse more
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| Aria
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The correct answer is A.
Hypercapnia (high arterail carbon dixide tention)is relatively common in patients with Chronic bronchitis,which is a type of chronic Ob.Pul. Dis .COPD.pts with COPD may have stable hypercapnia for years.The renal compensation (decreased bicarbonate secretion)for chronic hypercapnia in this woman has had plenty of timeto compensateso the acidemia is mild and the PH is actually within a normal range in this particular case.
A decrease in the renal secretion of Hydrogen ions(choice B) would worsen the respiratory acidosis.
Hyperventilation ( choice C) is not an option for a patient with COPD because the primary problem is Hypoventilation(choice D )
Cabonic anhydrase inhibitor (choice E ) rather than increased activity of the enzyme,maybe of benefit in some cases of chronic hypercapnic ventilatory failure.
Q bank Kaplan. renal physio. <<<<----- I dont like this q.
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| genes
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the answer is A undoubtedly....
donno y there was so much discussion!
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