A patient with chronic renal failure was in the hospital recovering from a heart
ID: 3516162 • Letter: A
Question
A patient with chronic renal failure was in the hospital recovering from a heart attack. He was being given fluid through an intervenous (IV) line. Late one night, a weary nurse replaced the empty IV bags with a bag containing “twice-normal” saline rather than the prescribed “half-normal” saline.
By morning, the patient had noticeable pitting edema in the sacral region and respiratory “rales” (wet-sounding crackles) at the base of each lung.
7. Did the nurse's mistake increase or decrease the "saltiness" of the interstitial fluid?
Given your knowledge of osmosis, will this cause the cells in the body to increase or decrease in size?
Explain your answer.
How would this increase in salt load affect the patient's blood-aldosterone level?
In your answer, explain the function of the hormone aldosterone.
What symptoms might result from hypernatremia ("high blood-sodium" level)?
Explanation / Answer
The nurse's mistake increase the saltiness of the interstitial fluid.
There are basically three types of osmosis which will cause the cells in the body to increase or decrease in size in many ways:
Hypertonic: when the concentration of solute is greater inside than outside the cells then then movement of solute occurs from outside to inside. So the size of cell increases.
Hypotonic: when the concentration of solute is greater outside then inside then movement occurs from inside to outside therefore size of cell decreases.
Isotonic: when there is no change in movement of solute from inside to outside then the size of cells remains same.
Decrease water will move the cell outside the body.
Decreased aldosterone level. The stretch receptor located in the atria of heart. If decreased blood pressure is detected the adrenal gland is stimulated by these stretch receptors to release aldosterone, which increases the sodium resorption from the urine, sweat and gut. This cause increased osmolarity in the extracellular fluid which will eventually return blood pressure towards normal.
The symptoms might result from hypernatremia is heart failure is associated with odema and difficulty in breathing. The extra may cause heart to fail.
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