4. Mary has an acid-base disturbance that is being compensated for with another

Question

4. Mary has an acid-base disturbance that is being compensated for with another body system. Identify the type of disturbance and trace out the physiological pathway responsible for the compensating action. s. For each of the treatments listed below, indicate whether you would recommend it (yes) or not (no) to correct Mary's problem? Explain what effect each treatment would have upon her blood pH. a. Breathing in a paper bag b. An IV containing pure HCO, in an isotonic solution c. Holding her breath for as long as she can d. An IV containing pure CO,2 in an isotonic solution es

Explanation / Answer

5)

(a)Doing this several times can give the body the carbon dioxide it needs and bring levels back up to where they should be.

(b)After injection, intravenous sodium bicarbonate dissociates to provide sodium (Na+) and bicarbonate (HCO3?) anions. Bicarbonate anions can consume hydrogen ions (H+) and thereby be converted to carbonic acid (H2CO3), which can subsequently be converted to water (H2O) and carbon dioxide (CO2) which can be excreted by the lungs.

(c) Anaerobicrespiration is happening. This is so you get a different biochemical pathway that your body uses when there isn't oxygen as an energy source available. You produce lots of lactate, lots of CO2 and there's lots of hydrogen protons in the blood. That makes it acidic. Everybody has buffers in their blood to counteract the effects of this anaerobic respiration: buffers like bicarbonate which is alkaline so it means that you buffer the pH of your blood to keep it neutral. So these are chemicals that soak up acid and essentially stop the acid being just acid. You can put them into your bloodstream and the blood won't become acidic because the acid has bound onto something. That's the buffer.

You can find in some people that can hold their breath for a particularly long period of time that they'll excrete more of these buffers because they'll be producing higher levels of them [lactates] in the blood. In people who can hold their breath for a very long period of time they'll be very practised at it so they'll be very relaxed. This is true if you've ever had a scuba diving lesson you might have found you were very nervous. So when you practise with these things, the same as scuba diving and holding your breath. You can slow down your respiration and relax a lot more so you can hold your breath for longer.

(d)The carbonate ion is CO3-; the bicarbonate ion is HCO3--. Although sodium carbonate is soluble, calcium and magnesium carbonates are not, so carbonate solutions are not given intravenously. I presume therefore that we are talking about bicarbonate.
An acid state of the blood is a stimulus to breathing, so hyperventilation may be caused by the blood being very acid. In this case bicarbonate therapy may make the patient more comfortable, although we still have to find the reason for the acidity in the first place, and treat that appropriately. However, hyperventilation may be induced by excitement. If the individual breathes too fast when there is nothing really wrong with them, then the pH of the blood will rise anyway, and giving bicarbonate is an extremely bad idea.

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