Grandma's TUM-my Trouble
A Case Study in Renal Physiology and Acid-Base Balance
Nell Hodgson Woodruff School of Nursing
An elderly woman living independently with some help from her family is brought to the local emergency room because she is confused and vomiting. While her son suspects a stroke, a quick battery of laboratory tests indicates that her current problems are the result of impaired kidney function, an old-fashioned home remedy for ulcers, and her prescribed blood pressure medication. The combination of patient- and drug-related factors produces an acid-base disorder responsible for her confusion. This disorder further disrupts her kidney function. The case illustrates secretion and reabsorption processes in the kidney tubule which regulate plasma and urinary electrolytes (including calcium) and pH. The role of bicarbonate in maintaining systemic pH is emphasized. Interactions among the renal, respiratory and nervous systems in the regulation of systemic pH are also illustrated. Further, basic principles of pharmacotherapy and issues related to the appropriate use of medications are introduced. The case was developed for use in a physiology or human anatomy and physiology course, but it might be used in undergraduate nursing courses as well (e.g., pharmacology, pathophysiology).
- Identify the three processes that are involved with urine formation-filtration, reabsorption and secretion-and identify the places in the nephron where they happen.
- Outline the main mechanisms by which the kidney regulates pH in the body, and discuss the roles of specific transporters for H+ and HCO3- in pH regulation.
- Discuss the inter-related roles of the nervous system, the respiratory system and the renal system in regulation of pH in the body.
- Outline the mechanisms by which the kidney regulates plasma electrolyte concentrations, with special emphasis on plasma Ca++, including the pertinent hormones involved.
- Identify disturbances in plasma electrolytes and pH, given appropriate reference values.
- Identify possible causes of these disturbances
KeywordsAcid-base disorders; renal function; kidneys; kidney physiology; metabolic alkalosis; calcium regulation; Sippy regimen; bicarbonate
Educational LevelUndergraduate lower division, Undergraduate upper division, Graduate, Professional (degree program), Clinical education, Continuing education
Type / MethodsDirected, Discussion, Interrupted
Subject HeadingsPhysiology | Nursing | Biology (General) |