A 70 year old man was brought to the emergency room by his son with complaints o
ID: 178009 • Letter: A
Question
A 70 year old man was brought to the emergency room by his son with complaints of 3 week history of restlessness, confusion, fatigue, dyspnea, orthopnea, paroxysmal nocturnal dyspnea, and pedal edema. According to his past medical history, he has hypertension, diabetes mellitus and is being treated for them. He suffered a myocardial infarction 1 year ago and had stent placement in the left coronary artery. On current examination, this patient has a pitting edema of his lower limbs, a soft murmur is heard while auscultating his heart and bilateral crackles are heard while auscultating his lungs. The attending physician concludes that the patient is suffering from Heart failure. Physical exam findings: Lab findings Blood pressure 105/60 mm Hg Hemoglobin: 13mg/dl Pulse rare: 110/min W.B.C count: 8, 500/microliter Pitting pedal edema Platelets: 350,000/microliter Heart murmur heard Lung Crackles heard Serum electrolytes: Patient Values Normal Range Sodium 130 mEq/L (136 - 146 mEq/L) Potassium 4.8 mEq/L (3.5 - 5 0 mEq/L) Calcium 9 mg/dl (8-10 mg/dl) Phosphorous 4 mg/dl (3.0 - 4.5 mg/dl) What is the action of ADH? Where does it act and describe it's mechanism of action. Why is the serum sodium low in this patient. Explain? How does the nervous system respond to the altered blood flow? Explain in detail all the steps in a flow chart.Explanation / Answer
ADH is antidiuretic hormone. It retains water in the body by reducing its loss through urine. It reduces the formation of urine in the kidney.
The ADH binds to receptors in the collecting ducts of the kidney.This promotes water reabsorption. This hormone stimulates insertion of aquaporins into the membranes of kidney tubules which in turn stimulates water reabsorption.
High concentration of this hormone causes constriction of arterioles causing increase in arterial pressure.
Low level of serum sodium indicates hyponatremia. High levels of anti diuretic hormone results in the body retaining more water. This leads to hyponatremia.
The sympathetic nervous system functions through two distinct neural systems that affect blood pressure-one affects blood vessels by causing them to constrict, whereas the other system increases pumping of the heart along with vasodilation of blood vessels.
Through the vagal nerve, the parasympathetic nervous system influences the heart. It slows down heart rate.
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