Urine acid-base compensation at simulated moderate altitude

Acute exposure to high altitude elicits respiratory alkalosis, and this is partially corrected by renal compensation. To determine the time course and magnitude of renal compensation during short-term moderate altitude exposure, we measured urine gas tensions and acid-base status in 48 healthy men and women at four levels of simulated altitude exposures. Each subject was exposed in pseudorandom order to simulated altitudes of 1780, 2085, 2455, and 2800 m. in a decompression chamber for 24 h, separated by 1 week at sea level. Fresh urine was collected anaerobically at sea level and after 6 and 24 h of each altitude exposure. Urine pH increased significantly (p < 0.01) after 6 h at all altitudes and returned to baseline values by 24 h at the lowest altitudes. In contrast, urine pH remained elevated at the highest altitudes. The mean value of urine HCO₃^- at sea level was 1.67 ± 0.25 mmol/L, increased significantly after 6 h at all altitudes, and then returned to near baseline after 24 h at three lower altitudes (1780, 2085, and 2455 m). However, it remained elevated at 2800 m. PCO₂ in urine was significantly increased after 6 h and returned to baseline after 24 h at all altitudes. These results suggest that (1) short-term low to moderate altitude exposure results in a marked HCO₃^- diuresis, which may be caused by inhibition of the secretion of renal tubular H⁺, and (2) renal HCO₃^- compensation was completed by 24 h at low to moderate altitude, but still incomplete at higher altitude.