A 50-year-old man is hospitalized because of sever congestive heart failure. He

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A 50-year-old man is hospitalized because of sever congestive heart failure. He has edema of the lower extremities. His exertional tolerance is limited by dyspnea and weakness. On the day of admission the following physical and laboratory values are found: Weight = 80 kg *Blood pressure = 110/85 mm Hg *Heart rate = 95/min *Plasma Na+ concentration = 138 mEq/L *Plasma K+ concentration = 4.5 mEg/L Plasma renin concentration = 30 units/L (normal, 2-10) Urinary aldosterone = 90 micrograms/24 hours (normal, 6-16). *Hematocrit = 0.45 or 45% Clearance of PAH and inulin was measured by infusing these compounds intravenously, maintaining a steady plasm concentration of 2 mg/100 ml for PAH and 1 mg/100 ml for inulin. Renal excretin of PAH was 8 mg/min and of inulin was 0.8 mg/min. The patient was confined to bed and treated with digitalis. On the 5th day the following values were obtained. Weight = 75 kg *Blood pressure = 115/82 mm Hg * Heart rate = 87/min *Hematocrit = 0.50 or 50% *Plasma Na+ concentration = 140 mEq/L *Plasma K+ concentration = 4.5 mEq/L Plasma rening concentration = 20 units/L Urinary aldosterone = 45 micrograms / 24 hours Clearance of PAH and inulin was again determined. Plasma PAH = 2 mg/100 ml Urine PAH = 9 mg/min Plasma inulin = 1 mg/100 ml Urine inulin = 1.0 mg/min. Questions: 1. The loss of weight over the 5 day treatment period is most likely due to loss of body Blank 1 not to burning body Blank 2 . 2. Calculate glomerular filtration rate on the: -day of admission = Blank 3 and the units are Blank 4 -day 5 of treatment = Blank 5 with the same units as above. Glomerular filtration rate is equal to Blank 6 clearance. 2. Patients with CHF usually have Blank 7 stroke volume and pulse pressure at rest, and abnormally Blank 8 stroke volume and cardiac output during exercise. Arterial Blank 9 are sensitive to both pulse pressure and MAP. Part of the response of this reflex system being diminished with CHF is Blank 10 sympathetic nervsous activity to the kidney. This Blank 11 renal blood flow and GFR, reducing the filtered load of sodium. Either the decreased presure in the renal afferent arteriole because of decreased blood flow, or the decrease in filtered load of sodium causes the release of Blank 12 causing the plasma concentration (30 units/L) to exceed the normal levels. This enzyme catalzyes the formation of angiotensin Blank 13 (Use Roman numeral) from Blank 14 . The angiotensin-converting enzyme (ACE) generates angiotensin Blank 15 (Roman numerals again) that stimulates the release of Blank 16 from the adrenal cortex. This explains the fluid retention the presented as generalized Blank 17 of the subcutaneous tissues due to increased sodium resorption at the Blank 18 tubules of the nephrons. 3. Digitalis diuresis is dependent upon - (a) improvement in the general circulation, through which accumulated tissue fluid passes into the blood to make hydremic plethora, and (b) improvement in the kidney circulation. It is not due to a direct Blank 19 of the drug upon the kidney cells. Consequently the marked Blank 20 lasts only until the excess of fluid in the body brought about by venous stagnation is removed.

A 50-yAar-old pital he haart tai HA has the low On the d than frlinwing phy boratory fund VW ht 80 Blond si24.hn intising th teady plann 2 following a chtanad. Veight "Blood Pr Heart rate a N tration ALU mEqvi. "Hlasma K roan tration 4.5 mE concentration 20 Unnary alsORtarona 15 mierograms hours. Clearance of PNH P/NH 2 NH-9 mgtmin Pl 100 m U Questi The los the 5 day treatm period most likely due to of bod burning tha -day nf Admi te glom stroke wolumc and pulse pressure at rest, and abncrmally 2. Patients with CHF stroke volume and cardiac cutput during to both and MAP Part ot th al blnod tow And GFR filtera being di ity the kidney raduring th arteriole beca of d eased blood Mow, or e decrease leled lead of so aueee he release plasma co unitel to exceed the normal evels. This enzyme calalzyes the ormation Use Roman Causing verting enzyme (ACE generate rais again) that stimulates th from the adrenal cxplains the fluid retention the presente the suhtuta dua to At th tubules of th nenhrans. 3. Digitalis di is dapandant upan -(a) improvament in tha genaralcirculatinn through which arcumulated issues 1uin parses into tha bined in make hydr plethora, and (by improv ulati of the drug quently the mark last the body brought out by

Explanation / Answer

Answer 1.

1. The loss of weight over the 5 day treatment period is most likely due to loss of body water not to burning body Blank 2 .(Some misprint is there in this sentence)

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