Question

Michael is a 17-year-old high school football player who has recently been doing “two a day” practices in preparation for the upcoming season. He is in good physical condition at 5 feet 10 inches and 165 pounds. He is attempting to gain weight, so he has increased his intake of protein foods and estimates and eats approximately 3500 kcalories a day. One particularly hot afternoon, Michael is sweating profusely and begins to feel weak and has a difficult time keeping up with his usual practice routines. Noticing that his face is visibly flushed, his coach has him sit out of practice. Michael reports having eaten two peanut butter and jelly sandwiches, potato chips, and a can of soda for lunch about 2 hours before practice. He had a breakfast burrito with eggs and cheese for breakfast with a 12-ounce glass of orange juice.

1. Based on these signs of dehydration, what percentage of body fluid would you estimate Michael has lost?

2. Using his reported caloric intake, estimate Michael’s fluid needs?

3. Besides fruit juice and soda, what foods and beverages could help meet Michael’s fluid requirements?

4. What food groups appear to be deficient in Michael’s usual diet? What essential minerals are likely to be lacking as a result of his limited diet?

5. Explain how the kidneys help to maintain fluid balance.

Answer 1

Answer 1:

Based on the signs and symptoms of the patient the percentage of dehydration is = fluid loss of 1 - 5% of body weight

• fatigue (unable to keep up)
• Thirst
• Vague discomfort.

Other signs that a patient with 1 - 5%can have is

1. sleepiness
2. Palpitations
3. Nausea
4. Appetite suppression

Features of fluid loss of 6 - 10% of body weight

• Inability to walk
• Dry mouth due to lack of salivation
• Dizziness and headache
• Difficulty talking
• Difficulty breathing

Features of fluid loss of > 10% body weight is

• Deranged mental status
• Muscle cramps
• Swollen tongue
• Reduced vision
• Shrivelled skin
• Burning urination
• Numb skin

Answer 2:

Formula for calculating the fluid requirements based on caloric intake =

0.034 * daily caloric intake = recommended fluid intake in ounces

0.034 * 3400 kcal = 119 ounces = 3.5 ltrs.

Answer 3:

Other options available

1. Plain water
2. Koolaid
3. Coffee
4. Tea
5. LemoNade
6. Cola drinks

Answer: 4

All major food groups are covered in his diet

High Protein

Fats - peanut butter, cheese

Carbs - bread

Vitamins - peanut butter, cheese

Deficiency of mineral:-

The consumption of high amounts of protein causes acidification of urine. This, in turn, lead to loss of mineral through urine.

• Calcium - this can cause a bone weakness, cardiac arrhythmia.
• Magnesium - this can cause high blood pressure, arrhythmia, sudden cardiac death

Answer 5.

Kidney manages fluid in the following ways

1. Anti-diuretic hormone -
   1. Increase fluid loss causes increases osmolarity of blood.
   2. This stimulates the osmoreceptors in the hypothalamus (brain)
   3. This causes release of antidiuretic hormone
   4. This hormone prevents fluid loss by acting on the distal convoluted tube and collecting duct.
2. Aldosterone release
   1. Reduced blood volume stimulates the renin angiotensin system of the kidney
   2. This increases the levels of angiotensin II.
   3. Angiotensin II causes release of aldosterone.
   4. Aldosterone acts on the distal convoluted tubules and collecting duct to increase absorption of sodium.
   5. Absorption of sodium increase fluid absorption as well.