I\'m confused with these questions. I tried to answer them but I don\'t feel con

Question

I'm confused with these questions. I tried to answer them but I don't feel confident at all. Please let me know if I was completely or partially wrong and an explanation. Thanks!

This diagram shows normally functioning proximal tubule epithelial cell of the kidney:

Drug A is an epilepsy medication. It also inhibits carbonic anhydrase (CA in the diagram) in proximal tubule epithelial cells.

1. Based on the diagram above, fill in the blanks with increase, decrease or not change: Drug A will decrease the generation of CO2 in the tubular lumen of the nephron. The reclamation of bicarbonate from the tubules back to the bloodstream will decrease and blood pH will decrease . Urine pH will increase.

2. What acid base disorder will Drug A cause? metabolic acidosis

3. Which of the following has the most analogous (most similar) mechanism for generating the acid base disorder caused by Drug A - uncontrolled diabetes or severe diarrhea? Explain your answer.

I'm pretty sure both can cause metabolic acidosis but I chose uncontrolled diabetes b/c buildup of ketoacids occur so there's an increase in the ketones in your blood. It will result in a highly acidic urine pH and acidic blood pH due to the increased ketoacids in your blood (though I have no idea how to explain the decrease CO2 generation and bicarbonate above).

4. What compensation for this disorder will occur? respiratory compensation (b/c I said it was metabolic acidosis).

5. If strenuous exercise results in an increase in lactic acid, will the symptoms of the acid-base disorder caused by Drug A get better or worse? Why?

I said increased lactic acid will increase the effect of the symptomps of metabolic acidosis (b/c I said it was metabolic acidosis) since this disorder indicates increase in pCO2 in the tubular lumen of the nephron. Honestly I don't even know...

Explanation / Answer

1. Yes the answer is right. Drug A causes increase in urine alkalinity due to elimination of bicarbonate ions and retention of chloride ions. Drug A also leads to acidity of blood.

2. Metabolic acidosis and tissue respiratory acidosis are the disorders commonly ocuuring. The reason for these disorders is not as simple as seen in the diagram. It involves many mechanisms including the interaction of salicylates with drug A.

3. Both the reasons are valid, but severe diarrhea is coomon factor for these disorders among many individuals taking this drug.

4. The compensatory response for metabolic acidosis is decrease in partial pressure of carbon dioxide in blood.

5. Lactic acid acidosis also leads to metabolic acidosis in a distinct way. Here, the lactic acid formed may or may not be directly associated with drug A but it increases acidity of blood adding to further lower blood pH worsing the healthcondition of the patient.

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