Case+Study+1+-+Osmosis PDF

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Lab case study for bio 350 with Mark Thomas...

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Case Study 1: Agony and Ecstasy In 2002, a 20-year-old woman, Brittany, was brought to the emergency room at Harbor-UCLA Medical Center after having taken multiple tablets of ecstasy (3,4-methylenedioxymethamphetamine [MDMA]) and consuming large quantities of water while dancing at a party the night before. She did not report any symptoms upon returning home after the party. In the morning, however, she was found by her friends rolling her head, clearly confused and acting very delirious. Aside from these behavioral symptoms, the patient seemed otherwise healthy, with no medical or surgical history. She was not taking any medications and was a college student of good standing. Upon admission to the emergency room, the nurse on call was made aware of the MDMA and water consumption that occurred the night before. To further diagnose the patient, the nurse ordered an immediate urinalysis and blood test. While waiting for the test results, the nurse checked her medical references to find out as much as she could about how MDMA can affect the body. Knowing that the prevalence of MDMA usage has increased significantly over the last few years in college students, she used this opportunity to further her understanding of the drug. The nurse found that MDMA is a synthetic, psychoactive drug chemically similar to the stimulant methamphetamine and the hallucinogen mescaline. MDMA acts as both a stimulant and psychedelic. It produces energizing effects, distorts both physical and cognitive sensations and can impair memory. Additionally, she found that MDMA can affect a neurons ability to use the chemical serotonin, which plays an important role in regulating mood, aggression, sexual activity, sleep and sensitivity to pain. She also found that MDMA can have an effect on blood pressure, pulse rate, body temperature, water balance, blood sugar as well as vision. The nurse asked the individuals who brought the woman into the emergency room if she was acting unusual the night before, while on MDMA. They reported that she had drank an excessive amount of water and that she seemed very thirsty. She also was reported to be dancing for a long period of time the night before. The nurse thought for a minute, and knew that drinking a lot of water should induce a large amount of diluted urine. However, when Brittany’s bloodwork and urinalysis results returned, they suggested the opposite, that Brittany had extremely concentrated urine. These results suggested that Brittany was retaining water and therefore may be subject to an osmotic imbalance. The nurse thought to herself that perhaps the excessive amount of dancing that Brittany participated in the night before, caused an excess release of the antidiuretic hormone (ADH, also known as vasopressin), which is often released as a result from rigorous physical activity. This phenomenon is often observed in marathon runners, helping to prevent dehydration. However, the nurse remembered reading that MDMA can also trigger inappropriate secretion of ADH, independent from the degree of activity, leading to inappropriate water retention. This would suggest that MDMA can act as an anti-diuretic, forcing the kidneys to make concentrated urine, preventing the patient from getting rid of excess water. Brittany’s Test Results Item and Measure Heart Rate (beats/min) Blood Pressure (mmHg) Temperature Glucose (mg/dl) Sodium- Na+ (mM/L) Potassium – K+(mM/L) Chloride – Cl- (mM/L) O2 (mmHg) CO2 (mM/L)

Normal 60-100 90/50 – 140/90 98.6 60-109 135-146 3.5 to 5.5 95-109 80-100 22-32

Brittany 90 135/87 100.2 72 115 2.9 88 93 24

Case Study #1: Agony and Ecstasy (10 pts) Names: Marina Oehler, BeahCruz, Carmen Rodriguez, Danielle Christenson Lab Section: ________210__________________

Due Date:_______3-3-2020__________________

Given the above case and Brittany’s test results associated with it, answer the following questions in regards to osmosis and diffusion.

Case Study Questions: Prior Knowledge/Background Questions: 1. Describe the process of osmosis. (i.e. what is it, and how does it work). Diagrams are appropriate and acceptable.

Done

2. Describe the process of diffusion. (i.e. what is it and how does it work). Diagrams are appropriate and acceptable. Done 3. What are the differences and similarities between osmosis and diffusion? Use the Venn diagram below. Done

Questions Regarding the Case Above: 4. What is causing Brittany’s illness (based on the test results and what you now know about MDMA)? Brittany's illness is caused by an osmotic imbalance. You are able to observe this by looking at the hormone vasopressin which was released from her body, which is a diuretic hormone then causing her to release excess water from the body. This then caused her to drink excess water then resulted in the imbalance of sodium, potassium and chloride from the above test results

5. Given what you know about MDMA acting as an antidiuretic, what effects would this have on electrolyte concentration? The MDMA is an anti-diuretic which means her body is retaining excess water, which then causes the water to electrolyte balance to become distured by the high water retention. The electrolyte concentration then would be lower than normal.

6. If Brittany’s cells have an inside concentration of 300mosM solute, and 250mosM of solute outside of the cell, diagram the movement of molecules in regards to the principles of osmosis (use arrows to show the movement of water). This movement of water would cause the cells to ( shrink / swell ).

7. How would you suggest treating Brittany, quickly and effectively? To treat Brittany quickly and effectively, she should go through a detox. In addition, it has been proven that if a patient goes through a cognitive behavioral intervention to modify the way they think and behave, it can help in recovery, but this is usually done when MDMA is an addiction. If Brittany is doing this as a one-time thing, then a detox would be the best solution. To be more specific: We would give her a diaretic or normal saline (hypertonic), until she becomes normalized and comes back to equilibrium. Another thing would be to get her on oxygen therapy to manage her oxygen via a mask of some type, to again, bring her to desired parameters. To treat her temperature we would give her an ice bath. If the core temperature cannot be brought down then we would evaluate for serotonin syndrome which then can be treated with benzo.

8. How would your treatment fix Brittany’s symptoms? (Diagram how your treatment would modify electrolyte concentration to return to normal) It would fix her urine imbalance and cause her cells to become unswollen (isotonic). Also she wouldn't be dehydrated anymore

9. From this case study, you now know that MDMA can act as an anti-diuretic hormone, and how it can affect electrolyte concentrations within the body. Now, describe how a diuretic hormone would affect electrolyte concentrations. A diuretic hormone may cause an electrolyte imbalance as you are secreted an excessive amount of water, sodium and potassium out of your body. Some examples include: Hyponatremia, too little sodium, hypernatremia, toomuch sodium, and hypokalemia, too little potassium.

10. How would you treat symptoms that would arise due to excessive amounts of diuretic hormones? Since ADH tells our kidneys how much water to conserve, diuretics is just the opposite. It works with the kidneys to eliminate water and electrolytes which has a direct correlation to cardiovascular and renal disorders. Thus, if a patient were to experience excessive urination from the excessive amounts of diuretic hormones, the best way to treat this via change in medications or your diet. In regards to diet, it would be best to cut out any caffeinated drinks and any saly foods to hopefully decrease urine output. Some other things to avoid would be herbs, green and black tea, and other natural diuretics. Sometimes colder environments may even cause excessive urination....