NBME 22 Glucose and sodium (NBME Answers)

NBME 22 Answers

nbme22/Block 2/Question#14 (reveal difficulty score)
A previously healthy 12-year-old boy is ...
Glucose and sodium 🔍 / 📺 / 🌳 / 📖
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submitted by ∗armymed88(49)

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Glucose is co-transported into enterocytes of SI via sodium

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toxoplasmabartonella That makes that glucose needs to be given with sodium. But, what about bicarb? Isn't the patient losing lots of bicarb from diarrhea? +4

pg32 Had the same debate. I knew glucose/sodium was the textbook answer for rehydration but also was wondering if we just ignore the bicarb loss in diarrhea...? +4

makinallkindzofgainz @pg32 - Sure, they are losing bicarb in the diarrhea, and yes this can effect pH, but it doesn't matter that much. You're not going to replace the bicarb for simple diarrhea in a stable, but hydrated previously healthy 12 year old. You're gonna give him some oral rehydration with a glucose/sodium-containing beverage. Don't overthink the question :) +2

makinallkindzofgainz *dehydrated +

baja_blast Here's a pic: https://www.researchgate.net/profile/Maciej_Malinowski2/publication/265193258/figure/fig1/AS:295989702348808@1447580852271/Model-of-the-secondary-active-glucose-absorption-by-the-enterocyte-Glucose-together-with.png +2

teepot123 salt and sugar, that's all the kid needs when ill simple +1

mtkilimanjaro Hm I put bicarb/K+ since thats lost in diarrhea, but I think the key thing in this Q is that its only 6 hours of acute diarrhea and nothing else. You would prob give bicarb and K+ in more "chronic" diarrhea over a few days or longer not just a few hours +1

specialist_jello ugh i overthought the question and changed my answer to bicarb/k +

an1 SGLT1 in the gut is a symporter. Glucose is needed to allow Na to enter, water will follow Na into the cell and reduce dehydration. Be sure to give a HYPOtonic ORS solution (more water than salt and sugar), otherwise solutes (move from low to high OSm will leave the tissues and enter the vasculature. +

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submitted by gunnersinchrome(6)

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Easiest way to think of this is that this is Gatorade. Sure everyone thinks that sports drinks have glucose for the energy (which is also true) but they also contain sugar because the Na/Glucose co-transporter in the small intestine helps drive electrolyte intake. Without glucose, you don’t pull in sodium nearly as efficiently in the gut and the first makers of the Gatorade formula at UF found that once they gave glucose and electrolytes instead of just water to the football team during practice, they didn’t get as dehydrated and their electrolyte balance was a lot more stable.

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usmleboy Gaaaaaatttoooraaddeeee! Water sucks! It really really sucks! +3

mumenrider4ever You're drinking the wrong water https://www.youtube.com/watch?v=7I2-14y6-jM +1

rockodude go gators, we made that shit +

username go dawgs +

skonys Any hydrohomies? My patient's will be getting straight RO water to the neck. None of that heretical devil-drink. +

chaosawaits @rockodude, if only FSU had made it; we'd all be drinking Seminole Fluid ;) +1

impostersyndromel1000 @chaosawaits underrated comment +

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submitted by ∗hello(429)

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The patient is dehydrated. Need to give water to rehydrate.

Water follows solute. If sodium is added to the solution, water will follow the sodium. Now, enterocyte uptake of sodium is mediated by Sodium-Glucose transporter. Hence, the solution needs to contain sodium and glucose in order to have the enterocytes take up the sodium.

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submitted by ∗beto(28)

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Glucose is co-transported into enterocytes of SI via sodium

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Glucose is co-transported into enterocytes of SI via sodium

+3/- beto(28)

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submitted by partybrockk(7)

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Kid probably had cholera -- giving Na+ and glucose takes advantage of sodium-glucose cotransporter thereby replenishing electrolytes and energy.

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hipster_do To add on to the diarrhea kid -- SGLT1 is the Na-glucose symporter and it facilitates movement of water into the enterocytes. Water loves to follow sodium around, I think sodium over other electrolytes purely because sodium is generally the highest concentration electrolyte. +1

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