10.28.13 kin 110 class notes- Location of heartbreak hill- Scenario: Cynthia lucero and bridget jones are in troubleo 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 Nauseao Bridget jones Light-headedness Fatigue Muscle weaknesso 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- Cynthiao Severe headacheo Confusiono Disorientationo Muscle cramping in both legs- Bridgeto Mild to moderate headacheo Still feels exhausted- Options:o Increases infustion rate of saline in Cynthia’s line, continue Bridget’s treatmento Oro Continue treatment in both patients- You decided to give both patients intravenous fluidso Cynthia Still not doing as well Increase fluid we are giving her?o Bridget Same state- Status updateo Cynthia Light headedness stopped Severe headacheo Bridget Mod. Headache Light headedness stopped- Continue treatment?- Cynthia is getting worseo Unbearable headacheo Confusiono Disorientationo Muscle cramping- Bridget Joneso Mild headacheo Still feels exhausted- By the time you get to her roomo Cynthia Seizures Heart rate is very high dies- Intern comes back from lab with resultso Bridget: Extremely high sodium High potassium Chloride is higho Cynthia: Very low electrolytes- Gina Kolatao Years telling athletes to drink a lot of water is a greater health risko 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 plasmao Extracellular fluid (plasma)o Intercellular fluido Extracellular fluid (tissue fluid) (interstitial fluid)- Watero Electrolytes: dissolved mineral saltso Sodiumo Chloride ^^ mainly extracellularo Potassiumo Phosphorus ^^ mainly intracellular- water lost from the body must be replace or you get dehydratedo part of the problem is high concentration of electrolytes (especially sodiumo high electrolytes disrupt heart rhythm, muscle contraction, blood pressure, and kidney function- Electrolyte content of blood =osmolarityo (number of molecules dissolved/unit of fluid)o osmolarity maintained in tight range 280 – 300 milliosmoles/liter- deviation from normal range:o electrolyte imbalanceo changes to blood osmolarity sensed by osmoreceptors- receptors sense changes in blood osmolarityo receptors in arteries sense changes in blood pressure and volume- As you sweat, you lose fluido 1. Blood more concentrated, osmolarity UPo 2. Plasma volume goes downo 3. Blood pressure goes down- release of hormone from pituitaryo ADH causes kidney to retain water- Hypothalamuso High osmolarityo Low BPo Low BV- pituitary- ADH- by reabsorbing more sodium, kidney retains water- helps conserve fluid and maintain…o osmolalityo blood volumeo blood pressure- overhydrated = low sodiumo hyponutremia- Why do people get hyponatremia if there is a system to regulate osmolarity?o Deals with high osmolarity i.e. dehydration and blood losso 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 troubleo Blood sodium too lowo Collapse & dieo 115 - several factors contribute to hyponatremiao 1. Relatively slowly > 4 hours to run race (walking)o 2. Drinking a LOT of fluido 3. Weight gain. Runners with hyponatremia >5 lbs during the race- replacing fluid losses is important and helps performanceo over replacing fluid can be dangerous- endurance formulao designed for needs of athletes during long, intense activityo endurance formula has nearly 2x sodium and 3x potassium of normal
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