Integrative Examples
- Hypoaldosteronism decreases distal sodium ion (Na⁺) reabsorption, potassium ion (K⁺) secretion, and hydrogen ion (H⁺) secretion.
- The resulting volume contraction can cause orthostatic hypotension.
- Reduced potassium secretion produces hyperkalemia, and reduced hydrogen ion secretion produces metabolic acidosis.
- Lower arterial pressure activates the baroreceptor reflex and increases pulse rate.
- Orthostatic hypotension is a drop in blood pressure on standing, and the reflex increase in pulse rate is a compensatory response to reduced arterial pressure.
- Vomiting removes gastric hydrogen ion (H⁺), leaving bicarbonate ion (HCO₃⁻) in blood and causing metabolic alkalosis.
- Volume contraction activates the renin-angiotensin-aldosterone system, which increases bicarbonate reabsorption and can worsen the alkalosis.
- Potassium depletion commonly accompanies prolonged vomiting.
- Diarrhea removes bicarbonate-rich intestinal fluid and produces hyperchloremic metabolic acidosis.
- With intact renal function, increased ammonium ion (NH₄⁺) and phosphate-buffered acid excretion helps compensate for gastrointestinal bicarbonate loss.
- Vomiting tends to remove gastric acid and leave excess bicarbonate ion (HCO₃⁻) in blood, whereas diarrhea removes bicarbonate-rich intestinal fluid and can leave chloride ion (Cl⁻) relatively high.
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