Type 1 diabetic injected insufficient insulin so her body can’t use glucose in blood. Blood glucose is 38 mM (normal value = 3.3-5.8 mM). To adjust osmolality, she increased urine output = dehydration. Should she be treated with water?
The answer is NO and my teacher said the following:
NO b/c water will dilute everything in body, and your gonna give insulin which will cause glucose to come out then all of the sudden not enough solutes in blood and it will come out of the blood = edema ; she would be given saline .9 soution of nacl = isotonic same osmality of blood; reason for this is because once you give insulin and glucose is taken up by cell, you wanan make sure everything is in the right compartments
This makes no sense to me at all. What does she mean it will dilute everything? Since she has polyuria Im thinking there are more solutes in her blood in comparison to water. Actually that's all I'm understanding here. To compensate would the cells release water? I'm confused.
I drew myself a picture and I think I may understand a little more. This is my new thinking. If you were to just give plain water then the water would be taken up by the cells b/c the solute:water ratio in the cells would be less than that in the blood so water would move from the blood to the cells. I'm thinking this because water must have left the cells to go into the blood at one point because the solute concentration must have been greater in the blood but once you add in the water it would more to the tissues because the tissues now have more solute than water. If you were to give saline, the water would remain in the blood stream because saline is a solute so since you added more solute you need more water so it'll stay in the blood. I don;t know much about the whole isotonic thing yet but this is kinda what I understand. It's stil kinda rough.
I understand that you are confused about the explanation given by your teacher regarding the treatment for dehydration in a type 1 diabetic patient. Let me break it down for you:
First, let's understand the situation. The type 1 diabetic injected insufficient insulin, which means the glucose in her blood cannot be used by the body effectively. As a result, her blood glucose level is high at 38 mM (normal range is 3.3-5.8 mM).
To adjust osmolality (the concentration of solutes in the blood), the patient increased urine output, leading to dehydration. Now, let's address your confusion about water being used as a treatment.
Your teacher mentioned that water will dilute everything in the body, which means it will lower the concentration of solutes, including glucose, in the blood. If you inject insulin and then give water, the insulin will cause glucose to be taken up by the cells, resulting in a sudden decrease in solutes in the blood. This can lead to edema because water will move from the blood vessels into the tissues, causing swelling.
To treat dehydration in this case, your teacher suggested administering a saline solution of NaCl (sodium chloride) at a concentration of 0.9%. This solution is isotonic, meaning it has the same osmolality as blood. By providing an isotonic solution, you ensure that the solute concentration in the blood remains balanced, preventing the movement of water out of the blood vessels and into the tissues.
Now, let's address your understanding of the situation. You correctly noted that the diabetic patient has polyuria, indicating increased urine output. This leads to a loss of water from the body, but it does not necessarily mean that there are more solutes in her blood in comparison to water. In fact, the high blood glucose level in this case indicates the presence of more solutes (glucose) in the blood.
In dehydration, the body loses both water and solutes. To compensate for the loss, cells may release water into the bloodstream to try to maintain the balance of solutes. However, this release of water is not sufficient to fully rehydrate the body, which is why additional fluids need to be administered.
To summarize, in the case of a type 1 diabetic patient with insufficient insulin and dehydration, water alone is not the recommended treatment because it can further dilute solutes in the blood and cause edema. Instead, an isotonic saline solution is suggested to maintain an appropriate balance of solutes and prevent complications.