Osmolarity in action Case Study: A nineteen-year old arrived at the Emergency Ro

Question

Osmolarity in action Case Study:

A nineteen-year old arrived at the Emergency Room in a comatose state, with seizure-like activity, two hours after drinking a quart of soy sauce. (His sodium blood levels were 196 mmols/L – normal is 135-145 mmols/L)

A.) What did ingesting that much salt do to the water levels in the different fluid compartments of the body (ICF vs ECF)? Justify/explain why you answered the way you did.

B.) He survived without permanent neurological damage due to the I.V. infusion of 6 Liters of fluid (D5W) over 30 minutes. Why was this emergency procedure able to help the patient recover?

C.) After D5W was administered, the blood glucose was triple normal values. Why was D5W used in the IV and not pure water?

Explanation / Answer

A). Excess salt intake cause hypernatremia thus it increase Osmolarity of ECF. This will pull water from ICF therefore ICF volume would decrease and ECF volume will increase.

B). D5W or 5% dextrose act as osmotic diuretic therefore cause diuresis. So there is rapid water and sodium loss from kidney in the form of urine. This treat hypernatremia and normalize blood Osmolarity. As D5W also has water so it will restore ICF and ECF volume disbalance.

C). If normal water is given then it will treat hypernatremia but blood volume will increase too much which will put too much pressure on heart (as patient already has volume overload due to hypervolumic hypernatremia and water will only treat hypernatremia but D5W treat both components) and there will be no diuresis like when D5W is given.

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