Fred has emphysema, a form of chronic obstructive pulmonary disease. Blood tests show that his pH is low but almost normal, yet his bicarbonate levels are elevated significantly. How can this be? What would urinalysis show?
What will be an ideal response?
Emphysema limits ventilation in the alveoli of the lungs, leading to increased carbon dioxide in Fred's body. Because Fred's condition is chronic, his body has compensated for the excess carbonic acid (the result of hypercapnia due to poor ventilation) by increasing the amount of bicarbonate to match the elevated level of hydrogen ion. This compensation for respiratory acidosis was accomplished by the kidney's secretion of hydrogen ion in both the proximal and distal convoluted tubules and the retention of bicarbonate from the elevated carbonic acid. Urinalysis would indicate a very low pH and high levels of ammonia, produced by the distal tubule to absorb the secreted hydrogen ion.
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