10 28 13 kin 110 class notes Location of heartbreak hill Scenario Cynthia lucero and bridget jones are in trouble o Minutes later both collapse and are rushed to MGH You are trained ER physician and take both cases Status upon arrival o Cynthia Lucero Lightheaded Fatigue Nausea o Bridget jones Light headedness Fatigue Muscle weakness o What next doctor Take blood and monitor patient rehydrate them Start an IV and give them a saline solution Take blood start an IV and give them saline You decided to give both patients fluids Cynthia o Severe headache o Confusion o Disorientation o Muscle cramping in both legs Bridget o Mild to moderate headache o Still feels exhausted Options o Increases infustion rate of saline in Cynthia s line continue Bridget s treatment o Or o Continue treatment in both patients You decided to give both patients intravenous fluids o Cynthia Still not doing as well Increase fluid we are giving her o Bridget Same state Status update o Cynthia Light headedness stopped Severe headache o Bridget Mod Headache Light headedness stopped Continue treatment Cynthia is getting worse o Unbearable headache o Confusion o Disorientation o Muscle cramping Bridget Jones o Mild headache o Still feels exhausted By the time you get to her room o Cynthia Seizures Heart rate is very high dies Intern comes back from lab with results o Bridget Extremely high sodium High potassium Chloride is high o Cynthia Very low electrolytes Gina Kolata o Years telling athletes to drink a lot of water is a greater health risk o Day or two before marathon drink too much and they could kill themselves Body fluid composed of intracellular and extracellular fluid ECF o Part of ECF is blood plasma o Extracellular fluid plasma o Intercellular fluid o Extracellular fluid tissue fluid interstitial fluid Water o Electrolytes dissolved mineral salts o Sodium o Chloride mainly extracellular o Potassium o Phosphorus mainly intracellular water lost from the body must be replace or you get dehydrated o part of the problem is high concentration of electrolytes especially sodium o high electrolytes disrupt heart rhythm muscle contraction blood pressure and kidney function Electrolyte content of blood osmolarity o number of molecules dissolved unit of fluid o osmolarity maintained in tight range 280 300 milliosmoles liter deviation from normal range o electrolyte imbalance o changes to blood osmolarity sensed by osmoreceptors receptors sense changes in blood osmolarity o receptors in arteries sense changes in blood pressure and volume As you sweat you lose fluid o 1 Blood more concentrated osmolarity UP o 2 Plasma volume goes down o 3 Blood pressure goes down release of hormone from pituitary o ADH causes kidney to retain water Hypothalamus o High osmolarity o Low BP o Low BV pituitary ADH by reabsorbing more sodium kidney retains water helps conserve fluid and maintain o osmolality o blood volume o blood pressure overhydrated low sodium o hyponutremia Why do people get hyponatremia if there is a system to regulate osmolarity o Deals with high osmolarity i e dehydration and blood loss o not sensitive to rapid decrease of blood sodium over hydration lowers blood sodium hyponatremia how much over hydration o Really have to overhydrate to get into trouble o Blood sodium too low o Collapse die o 115 several factors contribute to hyponatremia o 1 Relatively slowly 4 hours to run race walking o 2 Drinking a LOT of fluid o 3 Weight gain Runners with hyponatremia 5 lbs during the race replacing fluid losses is important and helps performance o over replacing fluid can be dangerous endurance formula o designed for needs of athletes during long intense activity o endurance formula has nearly 2x sodium and 3x potassium of normal gatorade
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