A 49-year old male was rushed to the ER because of sudden loss of consciousness

Question

A 49-year old male was rushed to the ER because of sudden loss of consciousness (well, he was unconscious for 1 day, then his family brought him in). At the ER, he was unresponsive with shallow respiration. He was intubated and mechanically ventilated. The following are results from initial testing, leading to a diagnosis of metabolic acidosis: blood pH HCO3 ammonia liver enzymes (ALT, AST)elevated osmolar ga 6.8 (normal is 7.4 7 mEq (normal is 22-28) elevated elevated at +22 (normal is -10 to +10) After questioning the patient's family, they admitted that he had drank an unknown quantity of homemade wine. It would take another day to run the test for blood MeOH concentration (as this is an uncommon occurrence and therefore tests are not on-site), but the osmolar gap is a quick assay and gives a good indication that there are extra crystalloids in the blood stream. It measures the difference between calculated blood osmolality of the three major crystalloids: Na+, glucose, urea; and actual measured osmolarity of the blood. From a toxicological perspective, these extra crystalloids are usually EtOH, MeOH, methylene glycol, or isopropyl alcohol. The patient was given emergency hemodialysis to get rid of the extra crystalloids.

Explanation / Answer

GFR means flow rate of filtered fluid through kidney, GFR will be improved with plasma and ISF correction. Starling Forces govern the passive exchange of water between the capillary microcirculation and the interstitial fluid. These forces not only determine the directionality of net water movement between two different compartments but also determines the rate at which water exchange occurs.

If GFR imporves the starling force will also increases, both directly proportionate

Any osmotically active agent that is filtered by the glomerulus but not reabsorbed causes water to be retained in these segments and promotes a water diuresis. Such agents can be used to reduce intracranial pressure and to promote prompt removal of renal toxins. The prototypical osmotic diuretic is mannitol.

Mannitol is an osmotic diuretic that is metabolically inert in humans and occurs naturally, as a sugar or sugar alcohol, in fruits and vegetables. Mannitol elevates blood plasma osmolality, resulting in enhanced flow of water from tissues, including the brain and cerebrospinal fluid, into interstitial fluid and plasma.

Related Questions

Navigate

• Browse (All)
• Browse A
• Subjects

---

---

Integrity-first tutoring: explanations and feedback only — we do not complete graded work. Learn more.