“Chris. Michelle. You go on… I’ll catch up in a minute.” Mary hid her fear as sh
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“Chris. Michelle. You go on… I’ll catch up in a minute.” Mary hid her fear as she struggled to catch her breath. She had been so excited to go hiking with her children. Chris and Michelle were both home on fall break, and Mary had been looking forward to the family time. But she felt like she was hyperventilating, and now her chest was starting to hurt. “What, we’ve fi nally outlasted you on the trails?” Chris joked as he looked over his shoulder. “Mom, are you ok? You look awful.” “Don’t panic, but I think I need to go to the hospital.” “Michelle! Go get the car!” Chris yelled ahead. “Please don’t panic—I just want to get it checked out.” “Michelle!” After what seemed like an eternity, they arrived at the hospital. As Chris and Michelle helped their mother into the waiting room, the ER attendant noticed them and ushered the family into a small room. Dr. Rosen promptly took Mary’s medical history and ordered an EKG, chest x-ray, blood tests, and urinalysis. Th e tests were completed in short order, and about an hour later, Dr. Rosen appeared in the exam room. “I have some good news, and a little bad news. Th e good news is…” “Dr. Rosen to the ER, Code Blue. Stat!” said the voice on the PA. “Sorry, that’s my cue. But don’t worry, you’ll be fi ne…once we get you off of the Topamax®. Th is might take a while, so I’m leaving your chart. I hope I’ll be back to review the test results with you, but it might be someone else,” said the doctor as the door swung shut. “Mom, isn’t Topamax your migraine medicine?” asked Michelle. “Yes. It was originally designed as an epilepsy treatment, but I take it to prevent those migraines that used to put me in bed all day. How could it be causing this?” Mary wondered out loud.
3. Blood pH is normally regulated by the respiratory system to control the level of CO2 (g) and by the urinary system to control the levels of HCO3- and non-volatile acids in the blood. Given the overall reaction, CO2 (g) + H2O (l) ? H2CO3 (aq) ? HCO3- (aq) + H+ (aq), what effect would each of the following have on blood pH? Explain.
a. Hyperventilating
b. Holding your breath for an extended period of time
c. Chronic diarrhea
d. Excessive ingestion of baking soda
4. One of the effects of Topamax is to inhibit carbonic anhydrase. Predict the eff ect of Topamax on the function of each of the following cells:
a. Osteoclasts (bone)
b. Parietal cells (stomach)
c. Red blood cells (blood)
d. Epithelial cells of the proximal tubules (kidney)
Explanation / Answer
a. Hyperventilating
Hyperventilating is a condition when the rate of CO2 exhalation exceeds its production in the body. This decreases CO2 concentration in the body. CO2 is a reactant of the given reaction, so if concentration of reactant decreases, the equilibrium shift to the left to replenish the lack of CO2 in the system. This means using the body’s stores of H+ions, causing the blood pH to rise and become more basic. This is called respiratory alkalosis
b. Holding your breath for an extended period of time
When you hold your breath for a period of time, you are losing more oxygen and your CO2 levels begin to rise. This makes your blood pH decrease causing respiratory acidosis.
c. Chronic diarrhea.
Severe diarrhea causes a decrease in bicarbonate from blood. therefore the pH of is going to start to decrease making this a metabolic acidosis.
d. Excessive ingestion of baking soda.
Baking soda is a bicarbonate and it is an alkaline, making baking soda have a very high pH. So when an individual is taking an excessive amount of baking soda, it is going to spiral blood pH to very high levels.
4. One of the effects of Topamax is to inhibit carbonic anhydrase. Predict the eff ect of Topamax on the function of each of the following cells:
a. Osteoclasts (bone)
Since Topamax is used to inhibit carbonic anhydrase which is an enzyme used to dissolve bicarbonates, if Topamax is inhibiting that then your bones are not going any bicarbonate. Which could lead to a loss in the amount of calcium your bones are storing, making your bones weak and a loss in bone density.
b. Parietal cells (stomach)
Parietal cells need to secrete HCl, so they use carbonic anhydrase to make it. Stoppage of the production of HCl will temporally prevent food digestion, slowing down gastric motility. When anindividual gets stomach pains, this would be a side effect of Topamax.
Red blood cells (blood)
Topamax would increase the amount of CO2 that is being dissolved in your blood.When there is more CO2 in the blood, then the pH will decrease. So when Topamax is inhibiting carbonic anhydrase it is therefore messing with the binding sites in RBC’s which is why there is an increase in CO2.
Epithelial cells of the proximal tubules (kidney)
Topamax would slow down the amount of bicarbonate that the kidneys would be able to breakdown.
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