Answer Happy

9. Should blood levels of ADH, aldosterone and angiotensin be
low, high or normal? Justify your answers with descriptions or
relevant detailed regulation diagrams.
Mr. Bilodeau, 66 years old, was taken by ambulance to the emergency room at about 2:00 a.m. This evening, he had gone to bed earlier than usual (around 8 p.m.), feeling particularly tired. Around 11:00 p.m., according to his wife, he was awakened by an intense chest discomfort, accompanied by nausea, strong diaphoresis and a fear of dying. For the past few days, he has been feeling worse: he admits to feeling tired, easily out of breath, and to having digestive problems and chest discomfort. The client is also a moderate smaker (about 10 cigarettes a day) and his father died of a heart attack at the age of 56. On arrival at the hospital, the following signs are noted. Table 1: Client's clinical signs at 2:00a.m. Clinical signs Observed values Blood pressure 82/55 mmHg Heart rate 125 beats/min. Respiratory rate 31 breaths/min Temperature 376 Arterial blood O2 saturation 84% Normal values 100-140/60-90 mm Hg 60-100 beats/min. 12-20 breaths/min 36-30°C 95-98% Mr. Bilodeau is pale, confused, and his hands and feet are cold. His breathing is marked by moist rales and his pulse is thready (barely perceptible). An electrocardiogram (ECG) and chest x-ray were quickly performed, leaving no doubt about the diagnosis. Mr. Bilodeau was suffering from acute pulmonary edema due to a myocardial infarction. Mr. Bilodeau is in intensive care and is receiving aspirin and thrombolytic therapy, among other things. He also requires intubation through an endotracheal tube and treatment with vasoactive amines (low dose dopamine and norepinephrine). In addition, he is maintained on a perfusion (isotonic solution). Finally, his blood pressure is closely monitored and medications are administered to reduce acute lung edema. Blood samples taken at 2:00 a.m. yield the following results. Cap mo, vagy Integration in Bolog (101-010-4) Table 2: Client's blood work at 2:00 am Normal values Observed values 146 mmol/l 4.0 mmol/l 109 mmol/l 6.2 mmol/l 11.4 mmol/l 135-145 mmol/l 3.5-5.0 mmol/l 98-108 mmol/l 3.0-6.5 mmol/l 3.6-6.2 mmol/l (fasting) Blood tests Natrem Kalemia Chloremia Uremia Blood glucose Musce enzymes Total CK1 (CPK) Troponinz Arterial gas Blood pH arterial pO2 arterial PCOZ HCO3 3528/1 3.8 mg <180/1 = 0.3 in 1 7.31 44 mmHg 44 mg 20 mmol/ 7,35-7,45 70-104 mmila 35-45 mmHg 21-26 mmol/l