Question

Mr. Gutteman, a 70 year-old male, was brought to the emergency room in a comatose state and has yet to come out of it. It is obvious that he suffered severe head trauma – his scalp was badly lacerated and he has an impacted skull fracture. His initial lab tests of blood and urine were within normal limits. On the second day of his hospitalization, the aid reports that Mr. Gutteman is breathing irregularly, his skin is dry and lose, and that his urine reservoir was emptied several times during the day. The doctor has found that he is losing huge amounts of water in his urine (excessive fluid loss/low fluid retention) and the volume lost is being routinely replaced by IV fluid resuscitation. Questions What do you think is causing him to lose huge amounts of water in his urine? What hormone is there likely a dysfunction in, and where is this hormone produced? What is the normal function of this hormone, and why is the deficiency causing his excessive fluid loss? How would brain trauma and an impacted skull fracture cause this? (what is the link between the brain and hormone production)

          Mr. Gutteman, a 70 year-old male, was brought to the emergency room in a comatose state and has yet to come out of it. It is obvious that he suffered severe head trauma – his scalp was badly lacerated and he has an impacted skull fracture. His initial lab tests of blood and urine were within normal limits.
On the second day of his hospitalization, the aid reports that Mr. Gutteman is breathing irregularly, his skin is dry and lose, and that his urine reservoir was emptied several times during the day.
The doctor has found that he is losing huge amounts of water in his urine (excessive fluid loss/low fluid retention) and the volume lost is being routinely replaced by IV fluid resuscitation.
Questions
What do you think is causing him to lose huge amounts of water in his urine?
What hormone is there likely a dysfunction in, and where is this hormone produced?
What is the normal function of this hormone, and why is the deficiency causing his excessive fluid loss?
How would brain trauma and an impacted skull fracture cause this? (what is the link between the brain and hormone production)

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Added by Ashley C.

Biology for AP Courses

Julianne Zedalis, John Eggebrecht

Instant Answer

Solved by Expert Bryan Valdivia

04/11/2023

Step 1

- Mr. Gutteman is likely experiencing diabetes insipidus, a condition characterized by the excretion of large volumes of dilute urine due to a deficiency of antidiuretic hormone (ADH). Show more…

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Mr. Gutteman, a 70 year-old male, was brought to the emergency room in a comatose state and has yet to come out of it. It is obvious that he suffered severe head trauma – his scalp was badly lacerated and he has an impacted skull fracture. His initial lab tests of blood and urine were within normal limits. On the second day of his hospitalization, the aid reports that Mr. Gutteman is breathing irregularly, his skin is dry and lose, and that his urine reservoir was emptied several times during the day. The doctor has found that he is losing huge amounts of water in his urine (excessive fluid loss/low fluid retention) and the volume lost is being routinely replaced by IV fluid resuscitation. Questions What do you think is causing him to lose huge amounts of water in his urine? What hormone is there likely a dysfunction in, and where is this hormone produced? What is the normal function of this hormone, and why is the deficiency causing his excessive fluid loss? How would brain trauma and an impacted skull fracture cause this? (what is the link between the brain and hormone production)

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Transcript

00:01 Okay this question says, mr.

00:03 Gutmann, a 70 year old male was brought into the emergency room in a comatose state.

00:10 He has suffered a severe head trauma, his scalp was badly lacerated, and he has an impacted skull fracture.

00:17 His fracture was repaired.

00:18 On the second day of his hospitalization, the aid reports that mr.

00:22 Gutmann is breathing irregularly, his skin is dry and flaccid, and that she has emptied his urine several times during the day.

00:33 Mr.

00:33 Gutmann's blood and urine tests are negative for glucose and ketones.

00:38 He is found to be losing huge amounts of water and urine, and the colon lost is being routinely replaced via an iv line.

00:48 What is mr.

00:49 Gutmann's hormonal problem? so based on the information provided, this patient's symptoms suggest that he may be experiencing a condition called diabetes insipidus.

01:05 It occurs when there is, well in this case it is very likely to be a central problem, it means that there is not enough production of adh.

01:18 The function of adh is to absorb free water from the adrenal tubules back to the blood.

01:25 So if you don't have adh, then you're not going to be able to absorb water from the tubular fluid in the kidneys back to the blood, and hence the patient is going to be dehydrated and the patient is going to lose a lot of water in urine, and the urine is going to be diluted because of too much water in comparison with the solutes present in the urine.

01:45 So this is the condition that is affecting this patient.

01:48 Then it says, what is the lesion located? so diabetes insipidus can be both central or nephrogenic.

01:54 Nephrogenic is when the receptors on the kidneys are not working.

02:01 But in this case, as this patient has a history of suffering severe head trauma, then the problem is likely to be central.

02:14 It means that there was some damage to the brain that impaired the release of adh.

02:20 So one thing is central when there is an inaggregate release or particularly low release of low amounts or maybe no amounts of adh.

02:31 And another one is nephrogenic cause where the problem is not the levels of adh, but the receptors for adh...

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