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In the case study, it was found that Jane who was a marathon runner, decreased her fluid volumes and lost weight. She felt a few complications such as light-headedness, unsteadiness, and lethargy. Therefore, she was admitted to the hospital, and tests were conducted. She showed very low blood pressure, dark urine, and high specific gravity in urine, acidic urine. She also had dark circles under her eyes and dry lips. She had reduced her fluid intake, this affected her fluid output volume because she is experiencing low fluid output. In this essay, the case study will be discussed with reference to body functions and regulatory mechanisms including respiration, exchange of gases, autonomic nervous system (ANS), glucose homeostasis, the role of the kidneys in maintaining fluid balance, discussion bout urinalysis of Jane, the effect of blood pressure changes on kidney functions, renin-angiotensin-aldosterone system, blood transfusion issues, and calcium deficiency affecting blood clots.
During running, Jane will experience the relaxation of the diaphragm, contraction of the pleural cavity occurs during exhalation during a run. This involves exertion of pressure on the lungs and the pressure inside the chest cavity becomes less negative. As per Boyle's law, the pressure and volume are inversely proportional; so as the pressure inside the chest cavity increases the volume decreases (Martinez et al., 2020). With this action, the air is pushed out into the airway tracts and the chest cavity returns to its smaller size of reduced volume and increased pressure. All these changes are occurring in Jane’s chest cavity to achieve exhalation during the long run. Moreover, According to Knudsen et al. (2018), at the exchange point of gases, it is found that the air entering the lungs reaches the alveoli that are surrounded by the blood capillaries. At this point, the partial pressure of oxygen is high in Jane’s lungs and low in pulmonary blood capillaries and vice-versa for carbon-dioxide, so, the gases travel from high pressure to region of low pressure. Hence, the oxygen crosses the air-blood barrier and ensures blood capillaries and circulated to Jane’s body; whereas, the CO₂ from the pulmonary blood crosses the barrier to enter the alveoli and is pushed out of her lungs. Furthermore, the rate of gas exchange and depth of breathing increase with exercise; this is because during exercise more physical activity occurs, and demands oxygen increase. A large number of cells in the body need oxygen and high CO₂ of the blood needs to be removed therefore, the rate of gas exchange increases (Knudsen et al., 2018).
During Jane’s run, the sympathetic response of ANS will get activated. The sympathetic part during running gets activated; this results in increasing the cardiac output, respiratory rate, heart rate, and blood pressure (Sheng et al., 2018). All these activities are required to meet up with the increased oxygen and glucose demand of the body during exercise or running. At this time of exercise or running, Jane’s body requires more glucose and oxygen to compensate for the demand. Moreover, the autonomic nervous system of Jane will stimulate glycogenolysis of glycogen into glucose in her blood; therefore, glucagon hormone is released in the blood (Carnagarin et al., 2018). This results in the stimulation of the sympathetic nervous system for high glucose content of the blood and inhibits the release of insulin from the beta cells of Jane’s pancreas. So, during this time, glucagon is more active to convert the stored glycogen to glucose (Carnagarin et al., 2018).
In this case study, it is found that the patient decreased the intake of fluid and her fluid output is also low. This shows that her body fluid input and output balance might be disturbed but the body tries to maintain the balance. When the water volume inside the body is low, the kidney stimulates the release of the anti-diuretic hormone (ADH). This hormone stimulates the water reabsorption to occur by allowing the insertion of water channels in the cell membranes that line collecting ducts (Perrier et al., 2020). Moreover, the dark and acidic urine indicated that Jane’s body is dehydrated and shows that Jane is at risk of not maintaining homeostatic fluid mechanisms. According to Perrier et al. (2020), urine analysis is a clinical urine test in which there is an examination of particulate matter, organisms, crystals, casts, cells, solutes, and other physical properties of the urine. In this case study, this test is of great significance because the examination of the color, cellular bodies, and the specific gravity of the urine give information about dehydration for other homeostatic fluid mechanisms of the body. A specific gravity (SG) of more than 1.010 indicated severe dehydration (Pérez‐Accino et al., 2020). In this case study, Jane had an SG of 1.035. This shows that less blood flows towards the kidneys and they are unable to function normally.
Normal blood pressure is 120/80 mmHg and the mean arterial pressure should be in the range of 70- 100 mmHg (Di Daniele et al., 2016); however, in this case, study, Jane had a very low blood pressure of 87/58 mm Hg. It is found that during low mean arterial pressure, the blood vessels widen, cardiac output decreases, and less blood is circulated to the major body organs (Di Daniele et al., 2016). If the kidneys do not receive an adequate amount of blood then they will not be able to filter the blood and might also stop working. The nephrons in the kidney are supplied with a high volume of volume at high pressure; if changes in blood pressure occur then the vessels get damaged and their lumen either gets wider or narrower and this affects kidney functions (Rocco et al., 2020). However, this condition in Jane can be controlled to great extent by her body mechanism of activation of the renin-angiotensin-aldosterone system (RAAS). This system converts the angiotensinogen into its active form which later acts on the kidney to stimulate the aldosterone secretion – its secretion increases the water and salt reabsorption in the body, this increased blood volume, and blood pressure; acts on the hypothalamus for anti-diuretic hormone (ADH) secretion – it stimulates kidneys for water conservation, this results in a high concentration of water that increases blood volume and blood pressure; causes vasoconstriction of the blood vessels that increases blood pressure (Almeida et al., 2020). All these factors result in increasing the low blood pressure to maintain the normal functioning of the kidneys and help in the maintenance of Jane’s blood pressure.
According to Roussel et al. (2020), it is found that blood-matching during transfusion is of great significance because if the wrong blood is transfused then it can impact the health of the patient negatively. A patient with O negative can only receive blood from an O negative blood donor. If Jane who has O negative blood group is transfused with A positive blood group; then a major serious health issue can arise known as hemolytic transfusion reaction. In this reaction, due to incompatible transfusion of the blood type, the recipient’s immune system will get activated and then Jane might have suffered from the following consequences: sickness, kidneys failure, skin reactions, cell destructions, shock and die might also occur in severe and uncontrolled situations. Moreover, calcium is also found to help in blood clotting as well and it is a clotting factor IV in form of calcium ions. The deficiency of calcium thrombin formation is inhibited in Jane and thrombin is involved in clot formation (Cheng et al., 2019). Without calcium, loose strands of fibrin will not get converted to tight clot fibrin and platelet aggregation will also get negatively affected due to calcium deficiency in Jane’s case (Cheng et al., 2019).
It is concluded that due to poor intake of water of other fluid the fluid-electrolyte balance is disturbed. This might result in some issues with symptoms such as dark urine, unexpected cells in the urine, changes in blood pressure, and a high specific gravity of the urine. Moreover, it is found that if the individual is running or doing exercise then the autonomic nervous system will get activated and the body blood volume will be maintained. ANS results in increasing the blood volume and glucose; this will help in helping the body to meet with the high oxygen and glucose demands. It was also concluded that blood matching is necessary to prevent issues such as skin reactions, kidney failure, unexpected bad reactions, and a high amount of cell damage. Furthermore, it was found that calcium is a very important factor for blood clotting, and without its presence body clotting factors cannot perform their pathways.
Almeida, L. F., Tofteng, S. S., Madsen, K., & Jensen, B. L. (2020).Role of the renin–angiotensin system in kidney development and programming of adult blood pressure. Clinical Science, 134(6), 641-656.https://doi.org/10.1038/ejcn.2016.269
Carnagarin, R., Matthews, V. B., Herat, L. Y., Ho, J. K., & Schlaich, M. P. (2018). Autonomic regulation of glucose homeostasis: A specific role for sympathetic nervous system activation. Current Diabetes Reports, 18(11), 107.https://doi.org/10.1007/s11892-018-1069-2
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Pérez‐Accino, J., FeoBernabe, L., Manzanilla, E. G., &Puig, J. (2020).The utility of combined urine dipstick analysis and specific gravity measurement to determine feline proteinuria. Journal of Small Animal Practice, 61(9), 541-546.https://doi.org/10.1053/j.ajkd.2017.08.021
Perrier, E. T., Bottin, J. H., Vecchio, M., & Lemetais, G. (2017). Criterion values for urine-specific gravity and urine color representing adequate water intake in healthy adults. European Journal of Clinical Nutrition, 71(4), 561-563.https://doi.org/10.1111/jsap.13184
Rocco, M. V., Sink, K. M., Lovato, L. C., Wolfgram, D. F., Wiegmann, T. B., Wall, B. M., & Lewis, C. E. (2018). Effects of intensive blood pressure treatment on acute kidney injury events in the Systolic Blood Pressure Intervention Trial (SPRINT). American Journal of Kidney Diseases, 71(3), 352-361.https://doi.org/10.1042/CS20190765
Roussel, A., Sage, E., Massard, G., Thomas, P. A., Castier, Y., Fadel, E., &Claustre, J. (2019).Impact of donor, recipient and matching on survival after high emergency lung transplantation in France. European Respiratory Journal, 54(5).https://doi.org/10.1183/13993003.00096-2019
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Sheng, Y., & Zhu, L. (2018).The crosstalk between autonomic nervous system and blood vessels. International Journal of Physiology, Pathophysiology and Pharmacology, 10(1), 17.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5871626/
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