Question

Mr. X is a 33 year-old Hispanic male (Spanish speaking only) who presented to the ED with a compliant of muscle aches and just not feeling good. He is a construction worker and has been working outside in 100-105 f degree weather for the last 3 days. His past medical and surgical history is negative. His mom has diabetes and his father has hypertension. He does not take any prescription medications and denies any over the counter medications, herbal products or supplements. He has been experiencing an increased thirst and has noticed a decrease in his urine output. His urine has been tea color. Temperature is 98.6, heart rate 105, respiratory rate is 16, and BP is 110/70 mmHg, lying down and 90/60 mmHg standing. On exam he appears tired, has dry mucous membranes, and has generalized muscle tenderness. Otherwise his exam is normal. Lab values: Sodium: 150 meq/L Potassium: 5.5 meq/L Creatinine 2.5 meq/L BUN 70 mg/dl Osmolality 302 mOms/kg Hematocrit 54% Hemoglobin: 18 g/dL The clinical scenario is most consistent with which diagnosis? What data in the clinical scenario supports your diagnosis? What risk factor (s) led to this person’s diagnosis? 4. Describe the key pathophysiologic concepts of the diagnosis in question 1. To answer this question completely, you must answer all of the sub questions below using complete sentences. Each sub-question may be answered in 1-6 sentences a. What is the tonicity of this patient’s intravascular space? b. How has osmotic pressure been altered by this patient’s condition? c. what are the functions of aldosterone, antidiuretic hormone and natriuretic hormones in fluid balance? d.How has the secretion of aldosterone, antidiuretic hormone and natriuretic hormones been altered by this pathophysiology. e. How is hydrostatic pressure altered when blood pressure is low?

Answer 1

By observing the condition,present occupational history of working in the higher temperature for 3 days and nrml blood levels of na+and k+, but increasing levels of creatinine levels and Bun level mostly it indicates 'DEHYDRATION'.

Dehydration occurs when you use or lose more fluid than you take in, and your body doesn't have enough water and other fluids to carry out its normal functions.

Dehydration can occur if you don't drink enough water during hot weather — especially if you are exercising or working vigorously.

During dehydration creatinine level, Bun level elevates

It clearly indicates the dehydration diagnosis.

dry mouth, muscle soreness, tiredness are main symptoms of dehydration.

Risk factors:When it's hot and humid, your risk of dehydration and heat illness increases. That's because when the air is humid, sweat can't evaporate and cool you as quickly as it normally does, and this can lead to an increased body temperature and the need for more fluids.

Tonicity is a descriptive physiologic term that refers to the volume behavior of cells in a solution; cell volume tends to expand as body fluids become hypotonic or shrink as surrounding fluids become hypertonic. Hypertonicity of inter vascular spaces,

Since water passes from a region of lower to a region of higher osmotic pressure, water flows out of the cells into the extracellular fluid, tending to lower its osmotic pressure and increase its volume toward normal. As a result of the flow of water out of the cells, they become dehydrated..

Hydrostatic pressure refers to the pressure that any fluid in a confined space exerts. If fluid is in a container, there will be some pressure on the wall of that container.

The pressure that blood exerts in the capillaries is known as blood pressure.

ADH causes it to take up water, whereas aldosterone causes it to take up salt and, in turn, causes water to follow.

The atrial natriuretic hormone (ANP) is a cardiac hormone , antagonizing the salt and water retention due to aldosterone and AVP.