I. THE CASE STUDY: Hyperventilation, hypertension and a strong urge to pee -- A true case study in the making!
I've had a strong urge to pee lately. More specifically, I've had intense, acute bouts of urinary urgency that last from between 2 and 30 seconds and then fade with or without voiding. I'm also experiencing polyuria (excess urine formation). This urinary urge is strongly associated with daytime apneic episodes (breath holding). Often these episodes come about after short bouts of self-induced hyperventilation (several to a dozen breaths). I have several cardiovascular responses that occur concurrent with these other effects. I experience bradycardia (slow heart rate), yet my blood pressure is very high. I have intense peripheral vasoconstriction (constriction of blood vessels in my skin and limbs). It likely that my blood pressure during the apneic episodes is above 200/150 mmHg, and possibly much, much higher with systolic pressures over 300mmHg and diastolic pressures over 200 mmHg. (note: hypertension is often defined as systolic pressure generally over 140mmHg and diastolic over 90 mmHg). I'm also experiencing fluctuations in my blood pH, with a brief period of slight alkalosis (high pH) followed by a slow progression into slight acidosis (low pH).
Using the information above, answer the following questions:
- How could peripheral vasoconstriction lead to a) the hypertension reported and b) the bradycardia reported?
- Explain how my alkalosis develops.
- Explain what may be the cause of my slight acidosis.
- Using your answers from #1 and other information provided, explain why I'm making so much urine. Why might the urine be so dilute? (note: there are several mechanisms that you should come up with in answering this question)