1. There are two patients who enter the hospital, each with weak distal pulses,
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1. There are two patients who enter the hospital, each with weak distal pulses, elevated heart rate, and severe hypotension (i.e., low blood pressure). One patient is suffering from dehydration due to the water-borne disease cholera, whereas the second patient has been involved in a severe car accident Both have stabilized fluid/blood loss, yet standard emergency protocols differ for these two patients. Answer the questions below about each patient to gain insight into why rehydration and attempts to restore blood pressure differ for these two patients. (14 points) Both patients suffer from hypotension. Describe a control system engaged to restore blood pressure. Be sure to identify the typical components of a reflex and state whether blood pressure is homeostatically controlled by negative or positive feedback (5 points) a. b. Before medical intervention, predict each patient's blood osmolarity (i.e., isosmotic, hypoosmotic, or hypero smotic) (2 points) i. Cholera Patient with Dehydration ii. Car Accident Victim with Blood Loss Suppose the car accident victim lost 0.5 L of blood. Paramedics infuse 500 cc of 140 mM saline. Assuming that reference blood osmolarity is 300 mOsM, what happens to the patient's plasma osmolarity after infusion? (increase/decrease/no change)? (2 points) Assume the volume of the car accident victim's plasma (before the IV) was 2.5 L. Assume that there was complete mixing of the infusion with plasma, but no mixing with interstitial fluid. Calculate the patient's plasma osmolarity after the infusion mixed with her plasma but before any water enters her red blood cells. (3 points) c. d.Explanation / Answer
Ans. 1 - Cholera is a serious bacterial disease that usually causes severe diarrhea and dehydration.Cholera is caused by bacteria called Vibrio cholerae. When the bacteria attaches to the small intestine’s walls, your body begins to secrete large amounts of water that lead to diarrhea and rapid loss of fluids and salts. As given in question Case 1 has been diagnosed with cholera.
Common methods for treating cholera and bringing patient to insight.
These treatments add to the liquid in the body and re-hydrate it. They also help reduce the length of time of having diarrhea.
of critical importance to the proper management of cholera, is the hypotension when present is due to hypovolemia. in hypotensive adult patients initial fluid infusion is given rapidly (@ 50-100ml/min) untill a strong radial pulse has been restored. It suggests presence of Positive feedback mechanism.
In case 2 of patient with road accident - Sudden blood loss of moderate degree causes fall in blood pressure, which is compensated to certain extent by baroreceptor mediated rise in heart rate and vasoconstriction. In case of severe haemorrhage fall in blood pressure is accompanied by bradycardia indicating failure of baroreceptor mediated recovery in blood pressure. In such conditions partial recovery in the blood pressure with time is possible due to mechanisms other than baroreflex. As per studies, 20% blood loss is compensated by baroreflex while 35% blood loss is not accompanied by tachycardia so mechanisms other than the baroreflex, like increase in the vagal tone, contribute to the initial recovery in blood pressure and cardiac output. Therefore, in cases of blood loss, blood pressure is regained by Negetive feeback meachanism.
ANS. 2 - in case of cholera patient, blood osmolarity is obviously HYPO-OSMOTIC before medical intervention as their is fliud loss due to diarrhoea. In case of a accidental blood loss patient, blood osmolarity is normal or isoosmotic as there is only blood loss and not fluid loss specifically.
ANS. 3- as in the given case, 300mOsM is a normal blood osmolarity. when saline infusion is given there will be an increase in plasma osmolarity.
ANS. 4 - Proper answer to this question is unknown, apologies!
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