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USMLE Step 1 Bits & Pieces High yield short focused points, monographs, charts, illustrations, tables, and other stuff related to the USMLE Step 1 Exam.


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  #1  
Old 10-03-2013
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Wink Physiology Review: Journey to Excellence (250+)

Topics about Body Fluid Compartment and Osmolarity:

1- What happened to a patient who has a HANGOVER/FEVER/Diabetes Insipidus/Sweating/Dehydrated in terms of ICF volume and Osmolarity and/or ECF volume and Osmolarity, Na+ concentration, Hct (Hematocrit)?

2- What happened to a patient who is Vomiting/bleeding/Diarrheic in terms of ICF volume and Osmolarity and/or ECF volume and Osmolarity Na+ concentration, Hct (Hematocrit)?

3- What happened to a patient who receive 0.3% or D5W (SIADH, drinking Tap or Distilled water) Saline in terms of ICF volume and Osmolarity and/or ECF volume and Osmolarity Na+ concentration, Hct (Hematocrit)?

4- What happened to a patient who received Normal saline (0.9 %) or Lactate Ringer in terms of ICF volume and Osmolarity and/or ECF volume and Osmolarity Na+ concentration, Hct (Hematocrit)?

5- What happened to a patient who has Adrenal Insufficiency in terms of ICF volume and Osmolarity and/or ECF volume and Osmolarity Na+ concentration, Hct (Hematocrit)?

6- What happened to a patient who has a Adrenal Excess/Taking salt tablets in terms of ICF volume and Osmolarity and/or ECF volume and Osmolarity Na+ concentration, Hct (Hematocrit)?
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  #2  
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Please refer to attached files for answers...
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  #3  
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Default Response #1

1- In a patient who has a hangover after alcohol intoxication or who is feverish and sweating, who has Diabetes Insipidus or Dehydrated, there will be a loss of HYPOTONIC FLUID which means the patient will loss more FLUID than SOLUTE. Therefore, the ECF (ExtraCellular Fluid) volume will eventually DECREASE, ECF Osmolarity will INCREASE because a little bit of SOLUTE were loss. The Na+ concentration will be HIGH (if Osmolarity is HIGH, Na+ is HIGH), Hct (Hematocrit) will be NORMAL (Why because ECF volume and ICF volume both are Decrease).


Recap:
Hangover/Fever/DI/Sweating ===> Loss Hypotonic Fluid===> ECF Vol decrease, ECF Osm increase ===>ICF vol decrease, ICF Osm increase===> Na+ [ ] increase, Hct Norma
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Default Response #2

Responses:

2- In a patient who is Vomiting, bleeding, Diarrheic there is a loss of ISOTONIC FLUID (ISO means EQUAL from Greek, so EQUAL amount of fluid and SOLUTE is loss). Therefore ECF Volume is DECREASE (Hematocrit will be HIGH), ECF Osmolarity STAYS THE SAME (Equal loss of fluid and solute), so NORMAL Na+. ICF Volume and Osmolarity will stays the same.


Recap:

In a patient Vomiting, Bleeding, Hemorrhagic, Diarrheic: ECV Volume Decrease & Hct increase; ECV Osm stays the same, Na+ stays the same; ECV Volume and Osmolarity stays the same.

Tricks: Whenever there is loss of BLOOD volume (Isotonic or Hypertonic, NOT HYPOTONIC), Hct will increases ( Vice Versa).
Na+ concentration depends on ECF Osmolarity (Directly proportional).
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Default Response # 3

Responses:

3- A patient who receive 0.3% or D5W (SIADH, drinking Tap or Distilled water) Saline will experience the following:
0.3% Saline is HYPOTONIC (Anything below 0.90% I mean 0.3 or 0.45 %). So there will be a GAIN of HYPOTONIC solution (Hypo from GREEK means LOW, so more FLUID with low SOLUTE). ECF Volume will INCREASE, ECF Osm will DECREASE (more Fluid for less Solute), Na+ [ ] will be DECREASE (LOW ECF Osmolarity, HYPONATREMIA). ICF volume will Increase (because of ECF Osm Decrease), ICF Osm will be Decrease (same Osm effect for both compartment). Hematocrit will be NORMAL.


Recap:

A patient who receive 0.3% or D5W (SIADH, drinking Tap or Distilled water) Saline will have ECF Volume INCREASE; ECF Osm Decrease, Na+ [ ] Decrease; ICF volume Increase (Low ECF Osm), ICF Osm Decrease; Hct NORMAL (Because ECF/ ICF Volume Increases).

Tricks: If ECF vol & ICF vol experience same change(decrease or increase both) Hct stays the same (NO CHANGE). This is seen in Loss or gain of HYPOTONIC fluids.
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Default Response #4

A patient who received Normal saline (0.9 %) or Lactate Ringer is receiving ISOTONIC solution, which means EQUAL amount of FLUID & SOLUTE. Therefore, ECF volume will INCREASE, ECF Osm STAYS THE SAME, Na+ [ ] STAYS THE SAME, ICF Vol & Osm Stays the SAME, Hct will be DECREASED.

Recap:

Infusion of Lactate Ringer or Normal Saline or 0.90 % Saline (308 Osm.) will have, Increase ECF Vol, Decrease Hct; Normal Osm, Normal Na+ [ ]; Normal ECF Vol & Osm.
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Default Response # 5

Responses:

5- A patient who has Adrenal Insufficiency will have LOW ALDOSTERONE (Aldosterone/Mineralocorticoid Deficiency), LOW Na+ (ECF Osm Decrease) Loss of ECF volume, ICF Osm Decrease, ICF Volume Increases, Hct Decreases.

Recap:

Adrenal Insuficiency ===> ECF Osm Decrease, Na+ [] Decrease; ECF Vol Decrease, Hct Increase, ICF Osm Decreases, ICF Volume Increase.
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Default Response # 6

A patient who has a Adrenal/ Mineralocorticoids Excess or Taking salt tablets will have Increase Na+ [], Increase ECF Osm; Increase ECF Volume, Decrease Hct, Increase ICF Osm, Decrease ICF Volume.

Tricks: It likes an infusion of Hypertonic fluid.
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thanks a lot! osmlarity, volume and hct is all clear but how do we determine what happens to rbc? i got pretty confused with them. when do they swell n shrink?
thanks!
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Old 10-27-2013
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why does the ICF volume and osmolarity stays the same can you explain please?
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