A 68 year old man was in the hospital, in serious condition, recovering from a h

Question

A 68 year old man was in the hospital, in serious condition, recovering from a heart attack. He had just undergone balloon angioplasty to redilate his left coronary artery and was thus on an ‘npo’ diet (i.e. he is not allowed to have food or drink by mouth). He received fluid through an intravenous (IV) line. Late one night, a weary nurse who was on the 13th hour of a 14hour shift came into the patient's room to replace the empty IV bag with a new one. Misreading the physician's orders, the nurse hooked up a fresh bag of IV fluid that was "twicenormal" saline rather than "halfnormal" saline.

A) How much more salty was the IV fluid than what the patient was supposed to receive? i) the same amount of saltiness ii) 2 times as salty iii) 3 times iv) 4 times

B) Explain why you chose that answer in part A.

C) Most dissolved substances in the blood plasma can easily move out of the bloodstream and into the interstitial fluid (extracellular fluid) surrounding the cells. Will the nurse's mistake increase or decrease the "saltiness" of the interstitial fluid?

D) Given your knowledge of osmosis, will this cause the cells in the body to increase or decrease in size? Explain your answer.

E) Is the patient’s interstitial fluid isotonic, hypotonic, or hypertonic to the cells in his body? F) Explain why this is the case.

Explanation / Answer

A)Normal Saline concentration is 0.9% . so twice mormal saline is 0.9*2=1.8 and half normal saline is 0.9/2=0.45

So 3.6-0.45=3.15 times more salty .

C) Nurse by mistake increase the saltiness i.e concentation of interstitial fluid increases..

D) Osmosis is water movement from high slvent to low slvent concentration so RBC will shrink because water will flow out of the cell in to the extracellular fluid concentrating the intracellular fluid and diluting the extracellular fluid.

E) Patient interstitial fluid is hypertonic to the cells.

F)Because saltiness increases osmosis expressed as concentation as expressed as osomoles per litre.

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