Consider the plasma fluid and Na disturbance in this patient. Suggest a hormone/

Question

Consider the plasma fluid and Na disturbance in this patient. Suggest a hormone/peptide that may be acting in order to maintain water homeostasis. Explain its stimulus and mechanism of action (with a diagram if you wish)

Two years after the initial appointment the man presents at the hospital. He has been vomiting for two days following a fishing trip and has reported large amounts of bloodin vomit (suspected gastroesophageal variceal bleeding). He now weighs 102kg and presented with low blood pressure onadmission. Use the results from blood and urine analysis below for the rest of the calculations. Plasma Urine Result 126 mmol/L 133-143 6.4 mmol/L 3.6-4.6 12 mmol/L 24-32 93 mmol/L 98-108 15 mmol/L 3.0-7.0 30 mmH 200umol/L 60-120 Reference Range Result 3+ Positive Reference Range Dipstick Protein Blood Albumin/Creatinine 0.41g/g

Explanation / Answer

Due to gastroesophageal varices bleeding his blood pressure dropped

By observing the sodium levels in the urine which is 14mmol/L

Plasma sodium levels must be maintained between 135-145mmol/L.

Main factor determining the plasma sodium concentration is Hormone Vasopressin.

Normal urine creatine levels should range between 3-8 mmol/L which is nearly normal.

Albumin/Creatin ratio is too high nearly 410 mg indicates albuminuria

Vasopressin is a peptide hormone synthesized by hypothalamus and

secreted by Pituitary which is required to mainatin water homeostasis.

Mechanism of action of hormone Vasopressin

It prevents water loss from kidneys, reduces urine output

Hypothalamus ------posterior Pituitary----- ADH------Constriction of blood vessels and Renal reabsorption-------------- Increased arterial pressure and Blood volume.

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