Fluids/ Questions and case studies
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Questions[edit | edit source]
- What is the proportion (in % of whole body weight) of intracellular fluid on average in a healthy adult?
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- A – 60
- B – 40
- C – 25
- D – 15
- The physiological range of plasma osmolality is 275-295 mmol/kg. At what value of osmolality does antidiuretic hormone begin to be secreted?
- A – 295 mmol/kg
- B – 300 mmol/kg
- C – 278 mmol/kg
- D – 270 mmol/kg
- Which statements are incorrect?
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- A - Plasma Na+ concentration is not a measure of the body's Na+ content
- B - The level of plasma Na+ reflects the state (content) of Na+ in the whole organism
- C - Plasma Na+ concentration is a measure of the action of osmoregulatory mechanisms
- D - In patients with central diabetes insipidus, there is no increase in urine osmolality / plasma osmolality ratio above 50% after ADH administration
- What are the causes of K+ deficiency in the body when vomiting gastric juice?
- A - Extrarenal loss of K+ , which is contained in a relatively high concentration in acidic gastric juice
- B - Dehydration-induced K+ transfer from ECF to ICF
- C - Decreased circulating volume with consequent increase in aldosterone secretion and renal urinary K+ loss
- D - Alkalemia is accompanied by proportional hypokalemia
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Case studies[edit | edit source]
Patient in a diabetic coma[edit | edit source]
A 15-year-old girl is brought in a coma to the Department of Anesthesiology, Resuscitation and Intensive Medicine. She is a diabetic for 7 years, she takes insulin. She already had several bouts of hypoglycemia and ketoacidosis. She's been studying a lot for school lately and may have neglected some insulin injections.
Serum | Values | Blood | Values | Urine | Values |
urea | 5,8 mmol/l | pH | 7,11 | ketones | 3 |
creatinine | 122 μmol/l | pCO2 | 2,7 kPa | glucose | 3 |
Na+ | 148 mmol/l | pO2 | 12,7 kPa | ||
K+ | 5,8 mmol/l | glucose | 58,3 mmol/l | ||
Cl− | 87 mmol/l | HCO3− | 8 mmol/l | ||
lactate | 5 mmol/l | ||||
osmolality | 385 mmol/kg |
Questions:
- What is the diagnosis?
- Calculate the anion gap (AG), what is the cause of high AG?
- What is the significance of the increased osmolality?
- Why is chloride and bicarbonate reduced, what is the significance of "normal" sodium and increased potassium?
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Obese patient with severe hydration[edit | edit source]
A 86-year-old woman did not eat or drink fluids for 10 days due to a fever associated with a urinary tract infection and anorexia. Later, she did not eat or drink because she did not leave the bed due to weakness and because she lived alone. A neighbor-called doctor found her in a diseased state and considerable dehydration (dry tongue and mucous membranes, weak skin turgor, she was very thirsty and was breathing fast).
Serum | Values |
Na+ | 157 mmol/l |
K+ | 3.6 mmol/l |
Cl− | 121 mmol/l |
HCO3− | 26 mmol/l |
creatinine | 135 μmol/l |
urea | 19.5 mmol/kg |
Questions:
- What kind of indoor environment disorder is it?
- How is the water redistributed in the body of this patient?
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Patient with lung cancer[edit | edit source]
Fifty seven year old male with lung cancer (small cell carcinoma) was examined at check-up.
Serum | Values | Urine | Values |
---|---|---|---|
Na+ | 122 mmol/l | osmolality | 260 mmol/kg |
K+ | 2.8 mmol/l | ||
Cl- | 89 mmol/l | ||
HCO3- | 19 mmol/l | ||
osmolality | 255 mmol/kg | ||
creatinine | 76 μmol/l | ||
urea | 3.5 mmol/l |
Questions:
- How do you explain the results of electrolytes and osmolality
Answers [ hide ] | |
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Thirty two year old patient[edit | edit source]
She hasn't been feeling well for about 3 weeks prior to hospitalization. She started vomiting repeatedly about a week prior to hospitalization. She was dehydrated on admission. There was no evidence of hyperglycosuria or ketonuria in the urine.
Laboratory results
Serum | Values |
---|---|
Na+ | 120 mmol/l |
K+ | 5.9 mmol/l |
Cl- | 92 mmol/l |
HCO3- | 16 mmol/l |
creatinine | 145 μmol/l |
urea | 8.4 mmol/l |
Questions:
- Explain the possible cause of the pathological values.
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Heart disease patient treated with thiazide diuretics[edit | edit source]
A 74-year-old man with congestive heart failure was treated with thiazide diuretics and potassium salts. During the last check-up at, he stated that he felt weak and unbalanced when walking.
Laboratory results
Serum | Values |
---|---|
Na+ | 135 mmol/l |
K+ | 2.6 mmol/l |
Cl- | 92 mmol/l |
HCO3- | 28 mmol/l |
creatinine | 127 μmol/l |
urea | 8.4 mmol/l |
Questions:
- How do you evaluate these results?
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