A. Billy, a neurotic fitness buff, decided to \"flush the toxins from his body\"

Question

A. Billy, a neurotic fitness buff, decided to "flush the toxins from his body" by drinking 10 liters of distilled water in 20 minutes. Billy weighed 154 pounds and appeared to be a normally hydrated, healthy young man before he started. Assume that he experienced some brain swelling as a result of rapidly drinking the water (water intoxication). Assuming that his osmolarity was normal prior to drinking the water, what was his osmolarity after he finished?

B. If you only had access to hypertonic sodium chloride solutions, how much 2.5% sodium chloride should you administer IV to return Billy's osmolarity to 300 mOsm/L.

Explanation / Answer

excessive consumption of water leads to intoxication in the brain,hyperhydration is always fatal and leads to electrolyte imbalance.drinking large quantity of water in short duration gives an overload on the renal functioning and also pushes the electrolytes from the brain.sodium levels drop too low.hyponatremia leads to weight gain as a result of hyper or over hydration.hyperhydration also leads to overexertion and heat stress,psychogenic polydipsia.fluids outside the cells has excessively low amount of solutes like sodium and other electrolytes,when compared to the inside cells causing the fluid to move in to the cells to balance its concentration.this leads to swelling of the cells,especially in the brain which leads to intracranial pressure increase.this causes headache,personality changes,behavioral changes,delirium,drowsiness,dyspnoea,muscle weakness and pain,cramps,nausea vomiting,thirst.if this prolongs it leads to bradycardia and the cells in the brain swell leading to cerebral edema.this also applies pressure on the brainstem leading CNS dysfunction.

his osmolarity increases to 5 times of the normal.giving diuretics to him will help .

strictly restricting the intake of fluids.

0.9% of sodium chloride injection contains 9g/l NACL,with an osmolarity of 308 mOsmol/L.which contains 154 mEq/L chloride.

2.5% sodium chloride contains 22.5g/l NACL with an osmolarity of 924 mOsmol/L.

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