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History: A 68-year-old man with chronic renal failure was in the hospital in serious condition recovering from a heart attack. He had just undergone "balloon angioplasty" to redilate his left coronary artery and was thus on an "NPO" diet (i.e., he was not allowed to have food or drink by mouth). He received fluid through an intravenous (IV) line. Late one night, a weary nurse who was on the 11th hour of a 12-hour shift came into the patient's room to replace the man's empty IV bag with a new one. Misreading the physician's orders, he hooked up a fresh bag of IV fluid that was "twice-normal" saline rather than "half-normal" saline (in other words, the patient started receiving a fluid that was four times saltier than it should have been). This mistake was not noticed until the following morning. At that time, the man had marked pitting edema around the sacral region and had inspiratory rales ("wet-sounding crackles") at the bases of the lungs on each side. He complained that it was difficult to breathe as well. Blood was drawn, revealing the following: Na+ 157 mEq/liter (Normal = 136-145 mEq/liter) K+ 4.7 mEq/liter (Normal = 3.5-5.0 mEq/liter) Cl- 101 mEq/liter (Normal = 96-106 mEq/liter) A chest x-ray revealed interstitial edema in the lungs. Questions: 1. Most dissolved substances in the blood plasma can easily move out of the bloodstream and into the interstitial fluid surrounding the cells. A. Will the nurse's mistake increase or decrease the "saltiness" of the interstitial fluid? B. Given your knowledge of osmosis, will this cause the cells in the body to increase or decrease in size? 2. Why does this patient have pitting edema and inspiratory rales? 3. How would this increase in salt load affect the patient's blood-aldosterone level? In your answer, explain the function of the hormone aldosterone. 4. Can you think of any other normal mechanisms that the body has to control salt and water balance? How might they react in this situation? 5. What symptoms might result from hypernatremia ("high blood-sodium" level)? 6. How is this patient's interstitial edema in the lungs affected by his already-weakened heart?

Name: historya 68 year old man with chronic renal failure was in the hospital in serious condition recovering from a heart attack he had just undergone balloon angioplasty to redilate his left cor 04723
Uploaded: 2022-09-08T01:03:59-08:00
Duration: 11 min 1 s
Channel: Patricia Claus
Description: historya 68 year old man with chronic renal failure was in the hospital in serious condition recovering from a heart attack he had just undergone balloon angioplasty to redilate his left cor 04723

Questions:
1. Most dissolved substances in the blood plasma can easily move out of the bloodstream and into the interstitial fluid surrounding the cells.
A. Will the nurse's mistake increase or decrease the "saltiness" of the interstitial fluid?
B. Given your knowledge of osmosis, will this cause the cells in the body to increase or decrease in size?
2. Why does this patient have pitting edema and inspiratory rales?
3. How would this increase in salt load affect the patient's blood-aldosterone level? In your answer, explain the function of the hormone aldosterone.
4. Can you think of any other normal mechanisms that the body has to control salt and water balance? How might they react in this situation?
5. What symptoms might result from hypernatremia ("high blood-sodium" level)?
6. How is this patient's interstitial edema in the lungs affected by his already-weakened heart?

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Biology for AP Courses

Julianne Zedalis, John Eggebrecht

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Solved by Expert Patricia Claus

09/08/2022

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A. The nurse's mistake will increase the "saltiness" of the interstitial fluid. This is because the high concentration of salt in the IV fluid will move from the bloodstream into the interstitial fluid, increasing its salt concentration. B. This will cause the Show more…

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History: A 68-year-old man with chronic renal failure was in the hospital in serious condition recovering from a heart attack. He had just undergone "balloon angioplasty" to redilate his left coronary artery and was thus on an "NPO" diet (i.e., he was not allowed to have food or drink by mouth). He received fluid through an intravenous (IV) line. Late one night, a weary nurse who was on the 11th hour of a 12-hour shift came into the patient's room to replace the man's empty IV bag with a new one. Misreading the physician's orders, he hooked up a fresh bag of IV fluid that was "twice-normal" saline rather than "half-normal" saline (in other words, the patient started receiving a fluid that was four times saltier than it should have been). This mistake was not noticed until the following morning. At that time, the man had marked pitting edema around the sacral region and had inspiratory rales ("wet-sounding crackles") at the bases of the lungs on each side. He complained that it was difficult to breathe as well. Blood was drawn, revealing the following: Na+ 157 mEq/liter (Normal = 136-145 mEq/liter) K+ 4.7 mEq/liter (Normal = 3.5-5.0 mEq/liter) Cl- 101 mEq/liter (Normal = 96-106 mEq/liter) A chest x-ray revealed interstitial edema in the lungs. Questions: 1. Most dissolved substances in the blood plasma can easily move out of the bloodstream and into the interstitial fluid surrounding the cells. A. Will the nurse's mistake increase or decrease the "saltiness" of the interstitial fluid? B. Given your knowledge of osmosis, will this cause the cells in the body to increase or decrease in size? 2. Why does this patient have pitting edema and inspiratory rales? 3. How would this increase in salt load affect the patient's blood-aldosterone level? In your answer, explain the function of the hormone aldosterone. 4. Can you think of any other normal mechanisms that the body has to control salt and water balance? How might they react in this situation? 5. What symptoms might result from hypernatremia ("high blood-sodium" level)? 6. How is this patient's interstitial edema in the lungs affected by his already-weakened heart?

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00:01 Hello, so we are going to discuss this question, basically talking about 68 -year -old man with chronic renal failure in a hospital recovering from a heart attack.

00:11 Basically, he was receiving half normal saline, but then through an honest mistake, he accidentally was receiving twice normal saline all night.

00:21 It was only discovered in the morning.

00:23 So when they noticed, he had marked pitting edema around the sacral region and inspiratory rails.

00:29 At the basis of each lungs, and it was difficult to breathe.

00:33 When they drew blood, they found that his sodium was elevated, but potassium and chloride were still elevated, but within normal levels.

00:39 And chest x -ray saw they had interstitial edema in the lungs.

00:45 First question is discussing the dissolved substances and blood plasma can move easily out of the bloodstream into the interstitial fluid surrounding the cells.

00:54 All right, so basically whatever's in the blood, those dissolved substances in the blood plasma go in between bloodstream, and the body cells.

01:03 So will the nurses mistake increase or decrease the saltiness? so he received something that was four times saltier than what he had before.

01:14 And so if he's receiving this in his iv directly in blood, then his body is going to be four times saltier as well.

01:25 So it's going to increase, increase.

01:34 Make sense? so increase saltiness.

01:38 And given the non -reasing.

01:38 And given the knowledge of osmosis, will the cells in the body increase or decrease? so if this cell was here before and all of a sudden it became this much saltier, is the water going to rush in or out? think about the cells wanting to be at equilibrium and it wants to be at a specific os monocity level.

02:02 So the water is going to rush in.

02:04 So if the water is rushing into the cell to try to make everything back to about the same level than it was before.

02:12 It's going to increase the cell size because there's more water in there than there used to be.

02:25 Next question is, why does this patient have pitting edema and inspiratory rails? this goes back to what the first two questions were leading us, because we're leading us too.

02:35 So if we see that he's receiving a solution that's saltier, saltier solution, increase water retention, what is the meaning of pitting edema.

02:54 Edema itself, it describes a retention of water.

02:58 So we're seeing pitting it edema because he's holding water because of the saltier solution, right? salterer solution, increased water retention, edema.

03:09 And we see the inspiratory rails because it's the same, the intratory rails, that equals edema in the lungs.

03:20 So we're seeing this because he has the saltier solution.

03:26 Increasing water retention that's resulting in edema throughout the entire body, especially in the sacral region where he's sitting, an inspiratory region, where he's breathing.

03:35 There's a lot of fluid dynamics and such in the lungs that relate to the heart as well.

03:41 So how would this increase in salt load affect the patient's blood aldosterone levels, explaining how aldosterone works.

03:49 All right.

03:50 So, aldosterone, an increase in the hormone aldosterone is used to, increase salt reabsorption into the body, into the bloodstream, right? so you increase aldosterone to grab back more of that salt that you want.

04:20 Helps to concentrate the urine.

04:22 So you have an increased salt load, therefore you probably are going to decrease, excuse me, the aldosterone levels.

04:34 Adosterone levels.

04:39 Levels.

04:40 You don't need more salt.

04:44 You don't need more salt, my friend.

04:46 We're good.

04:46 We're salt.

04:47 We're almost pure salt at this point.

04:50 Do you think of any other normal mechanisms that the body has to control salt and water balance? so another one that i can think of that's a big one that's also associated with kidneys is avh, anti -diuretic hormone.

05:04 An increase in this tends to promote the reabsorption of water.

05:16 Anti -diuretic, anti -diuretic increasing, promoting reabsorption of water to keep you from peeing.

05:24 Diaryetic.

05:25 Is peeing...

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