Often large quantities of bicarbonate ions must be reabsorbed from the upper small intestine because large amounts of bicarbonate ions have been secreted into the duodenum in both pancreatic secretion and bile. The bicarbonate ion is absorbed in an indirect way as follows: When sodium ions are absorbed, moderate amounts of hydrogen ions are secreted into the lumen of the gut in exchange for some of the sodium. These hydrogen ions in turn combine with the bicarbonate ions to form carbonic acid (H2CO3), which then dissociates to form water and carbon dioxide. The water remains as part of the chyme in the intestines, but the carbon dioxide is readily absorbed into the blood and subsequently expired through the lungs. Thus, this is so-called "active absorption of bicarbonate ions." It is the same mechanism that occurs in the tubules of the kidneys.
Secretion of Bicarbonate Ions in the Ileum and Large Intestine—Simultaneous Absorption of Chloride Ions
The epithelial cells on the surfaces of the villi in the ileum as well as on all surfaces of the large intestine have a special capability of secreting bicarbonate ions in exchange for absorption of chloride ions. This is important because it provides alkaline bicarbonate ions that neutralize acid products formed by bacteria in the large intestine.
Extreme Secretion of Chloride Ions, Sodium Ions, and Water from the Large Intestine Epithelium in Some Types of Diarrhea. Deep in the spaces between the intestinal epithelial folds are immature epithelial cells that continually divide to form new epithelial cells. These in turn spread outward over the luminal surfaces of the intestines. While still in the deep folds, the epithelial cells secrete sodium chloride and water into the intestinal lumen. This secretion in turn is reabsorbed by the older epithelial cells outside the folds, thus providing flow of water for absorbing intestinal digestates.
The toxins of cholera and of some other types of diar-rheal bacteria can stimulate the fold secretion so greatly that this secretion often becomes much greater than can be reabsorbed, thus sometimes causing loss of 5 to 10 liters of water and sodium chloride as diarrhea each day. Within 1 to 5 days, many severely affected patients die from this loss of fluid alone.
Extreme diarrheal secretion is initiated by entry of a subunit of cholera toxin into the epithelial cells. This stimulates formation of excess cyclic adenosine monophosphate, which opens tremendous numbers of chloride channels, allowing chloride ions to flow rapidly from inside the cell into the intestinal crypts. In turn, this is believed to activate a sodium pump that pumps sodium ions into the crypts to go along with the chloride ions. Finally, all this extra sodium chloride causes extreme osmosis of water from the blood, thus providing rapid flow of fluid along with the salt. All this excess fluid washes away most of the bacteria and is of value in combating the disease, but too much of a good thing can be lethal because of serious dehydration of the whole body that might ensue. In most instances, the life of a cholera victim can be saved by administration of tremendous amounts of sodium chloride solution to make up for the loss.
Absorption of Other Ions. Calcium ions are actively absorbed into the blood especially from the duodenum, and the amount of calcium ion absorption is very exactly controlled to supply exactly the daily need of the body for calcium. One important factor controlling calcium absorption is parathyroid hormone secreted by the parathyroid glands, and another is vitamin D. Parathyroid hormone activates vitamin D, and the activated vitamin D in turn greatly enhances calcium absorption. These effects are discussed in Chapter 79.
Iron ions are also actively absorbed from the small intestine. The principles of iron absorption and regulation of its absorption in proportion to the body's need for iron, especially for the formation of hemoglobin, are discussed in Chapter 32.
Potassium, magnesium, phosphate, and probably still other ions can also be actively absorbed through the intestinal mucosa. In general, the monovalent ions are absorbed with ease and in great quantities. Conversely, bivalent ions are normally absorbed in only small amounts; for example, maximum absorption of calcium ions is only 1/50 as great as the normal absorption of sodium ions. Fortunately, only small quantities of the bivalent ions are normally required daily by the body.
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This ebook provides an introductory explanation of the workings of the human body, with an effort to draw connections between the body systems and explain their interdependencies. A framework for the book is homeostasis and how the body maintains balance within each system. This is intended as a first introduction to physiology for a college-level course.