HOT TUB CASE STUDY (Autopsy Report)

Introductionwhat happened - from the case study:Roma and Clint went into hot tub with some wine. After the night, they were found dead. Before going into the hot tub, Clint took his Lasix medication. The temperature of the hot tub was higher than it should be. BAL of the couple was 0.20. Roma weighted 120lb; Clint weighted 160lb. Time of death estimated at 2AM in the morning. There was a therapeutic (fair amount) level of Lasix in Clint’s blood, but none in Roma’s blood.

TemperatureHot tub temperature can be no more than 104-106 degree Fahrenheit (40-41 degree Celsius)more than 104-106 (40-41) can lead to heat stroke, heart attack nausea, stroke, brain damage, other illness and death, even in healthy adults. They might drown..

AlcoholAlcohol while in hot tub is very dangerous- The heat from the spa accelerates the effects of the alcohol and can lead to unconsciousness.- alcohol dehydrates the body, as does sweating in a hot tub--cause light-headedness, dizziness, nausea, heart palpation, confusion, weakness and even coma and death.- Drinking alcohol can cause dizziness, which can be aggravated by the high temperature of a hot tub. dizziness may cause you to fall..and drown- the depressant effect of alcohol intake in combination with the high temperature of a hot tub can cause you to fall asleep or pass out.---drowning- the heat of a hot tub expands your blood vessels (lowers blood pressure) and increases your body temperature (cause you to sweat--dehydration), as does drinking alcohol. combining them can result in unconsciousness or even a stroke or a heart attack

hinders production of ADH (antidiurectic hormone) from the hypothalamuso ADH regulate the osmotic pressure of the body fluids by causing an increase

in water reabsorbtiono HOWEVER: the decrease in ADH makes the nephron impermeable to water

→ no regulation of water means no osmotic pressure → person becomes increasingly thirsty

Due to dehydration, as a behavioural response and more fluid excretion through urine

thrust would mean more consumption of alcohol, which would only decrease ADH levels in the body. → water inside the body is not reabsorbed

Medication

Lasix is loop diuretic(water pill) called Furosemide that prevents your body from absorbing too much salt, allowing the salt to be excreted as urine

with the comboniation of alcohol may cause orthostatic hypotension (sudden decrease of blood pressure in the body)

o may lead to syncope or fainting due to the lack of blood being pumped to the brain (this usually occurs due to stress, heat, or a diuretic medication, like Lasix)

o Clint’s blood pressure was low, and he was in very hot water and was fatigued from stress

o orthostatic hypotension may have occurred due to the decrease in blood volume which was due to the Lasix, and because of his dehydration.

o Used for:

o treating hypertension o fluid retention (edema - fluid isn’t removed from body) - in ppl /w congestive

heart failure, liver disease, or a kidney disorder such as nephoric syndrome. Function of removing excess fluid from body:

o the diuretic induces the kidneys to increase the amount of salts (ex. K and Na) being filtered out of the blood into urine

o as the salts are filtered out of the blood by the kidneys, water is also drawn out

Effects on body:o removal of fluid decreases blood volume, and thereby lowers the blood

pressureo the lower blood pressure results less oxygen and nutrients to be delivered to

the tissues o feeling thirsty and hot (heavy sweating) on hot or dry skino feeling light-headed or short of breath,trouble concentrating, dizziness,

blurred visiono nausea o sudden numbness or weakness, especially on one side o can cause dehydration very easily

CAUTION: o one should not drink alcohol while taking Lasix because alcohol’s effects may

be made worse dizziness/light headedness may become worse

- Alcohol is a Many psychotherapeutic and CNS-active agents (e.g., anxiolytics, sedatives, hypnotics, antidepressants, antipsychotics, opioids, alcohol, muscle relaxants) exhibit hypotensive effects - This drug may make you dizzy or cause blurred vision. Do not drive, use machinery, or do any activity that requires alertness or clear vision until you are sure you can perform such activities safely. Limit alcoholic beverages.Severe sweating, diarrhea, or vomiting can increase the risk of dehydration. Report prolonged diarrhea or vomiting to your doctor. Follow your doctor's instructions about the amount of fluids you can drink.

Stress

Triggers the body’s response to perceive threat or danger The body reacts by releasing hormones: adrenalin and cortisol

speed heart rate slow digestion pushes blood flow to major muscle groups

there is an increase in blood volume and blood pressure Brain identifies stressful situation→the hypothalamus sends releasing hormone to

the anterior lobe of pituitary→stimulates secretion of ACTH (adrenaline) → blood carries it → adrenal cortex → secretes mineralocorticoids & glucocorticoid (among them is cortisol) → target cells in liver and muscle→ cortisol incre levels of amino acids in the blood in an attempt to help the body recover from stress → the amino acids are converted into glucose by the liver → raises the blood sugar

o secretion of aldosterone (a mineralocoticoid) → increases sodium reabsorbtion which moves more water out of nephron

therefore, helps maintain body fluid levels HOWEVER, since no ADH (anti-diuretic hormone) is being secreted,

there is no reabsorbtion in the kidneys, thus, the body fluid levels are not regulated  ← no adh because of alcohol.. so who cares xD****LMAO SUCH wiinneerr-_______- <------ i don’t think we need this... like all this hormone stuff

thats what i said haejo ahahaha : D

Far more serious is hypovolemic shock , a life-threatening complication of dehydration. It occurs when low blood volume causes a sudden drop in blood pressure and a reduction in the amount of oxygen reaching your tissues. If untreated, severe hypovolemic shock can cause death within a few minutes or hours. this is correct*** good job

Other Info:

o Your body is trying to cool itself by sweating and if you replace that water with alcohol it isn't as diluted in your blood stream. Also the heat causes the blood vessels to dilate which increases blood flow and reduces the amount of time it takes to feel the effects of alcohol

o Alcohol is another major cause of dehydration. Drinking excessive alcohol leads to loss of water from the body. Dehydration is caused due to excessive urine production.

o Causes of low blood pressure (hypotension) Dehydration: when one becomes dehydrated, the body loses more

water than it takes in. Even mild dehyraton can cause weakness, dizziness and fatigue. Fever, vomiting, severe diarrhea, overuse of diuretics and strenuous exercise can all lead to dehydration

increase in water loss → blood solutes become more concentrated → incr. in blood’s osmotic pressure → water moves into the blood stream →cells in hypothalamus shrink →thus, a nerve message is sent to pituitary → signals the release of ADH →goes through blood stream →kidneys

o kidneys reabsorb more water: thus they produce a more concentrated urine prevents osmotic pressure of body fluid from increasing

Weight/Gender:

women have higher body fat, relative to their body size, so they are more affected by alcohol

women have less stomach enzyme - dehydrogenase, from the liver to metabolize alcohol than men

women absorb 30% more alcohol into bloodstream WEIGHT: In general, the less you weigh the more you will be affected by a given amount of alcohol.

alcohol has a high affinity for water. Basically one's blood alcohol concentration is a function of the total amount of alcohol in one's system divided by total body water. So for two individuals with similar body compositions and different weights, the larger individual will achieve lower alcohol concentrations than the smaller one if ingesting the same amount of alcohol.However, for people of the same weight, a well muscled individual will be less affected than someone with a higher percentage of fat since fatty tissue does not contain very much water and will not absorb very much alcohol.

In general, if a man and a woman of the same weight ingest the same amount of alcohol the woman will tend to achieve a higher alcohol concentration.  -> but since Roma weighs less than Clint, she will achieve even higher alcohol concentration.

OTHER INFO: Low Blood PressureLow blood pressure is commonly caused by drugs such as:

Alcohol Anti-anxiety medications Certain antidepressants Diuretics Heart medicines, including those used to treat high blood pressure and coronary

heart disease Medications used for surgery Painkillers

Symptoms may include: Blurry vision Confusion Dizziness Fainting (syncope) Light-headedness Sleepiness Weakness

ConclusionClint: DEHYDRATION, low blood pressure, unconsciousness

Clint was dehydrated from high temperature, because as the body tried to adjust to the external temperature (very hot), the body’s temperature increased.

o his body tried to get rid of heat = sweating = dehydrationo very high temp = vasodilation = low blood pressureo very high temp + low blood pressure = unconsciousness, dizziness

Lasix also contributed to his death; o because it is a diuretic, it required Clint to urinate moreo This caused excessive water loss for Clint → With sweating at high

temperature, this was not very goodo It is worsened by consuming alcohol (yep!) hehe <3o Lasix is also used for treating high blood pressure (lowers blood pressure). In

addition to vasodilation from hot temperature and consumption of alcohol, Clint’s low blood pressure has become more severe

o Also, being one of Lasix’s side effects, Lasix may have caused unconsciousness and light-headedness as well

Alcohol was another factor that contributed to their deaths; they were almost 2.5times more drunk than the legal level (0.20 compared to 0.08)

o As the couples were LOADED with alcohol, their blood pressure dropped, because alcohol is a depressant; this lead to low blood pressure, along with the low blood pressure resulted from hot tub and Lasix

o In addition, as more alcohol was consumed, their blood “thickened” -- meaning they had less water in their blood. To fulfill their thirst, they continued to drink more “liquid” -- hence alcohol. This further lead to the factors that contribute to their deaths.

As real estate agents, they were lately stressed:o

Roma:

Temperature: same as above Lasix: she was not on the medication, so the effect of Lasix does not apply to Roma Alcohol: same as above Stress: same as above Weight and Gender:

o Her weight: 120lbo because she was a female and had less mass than Clint, she was more

susceptible to all of these changes in her body. These factors affected her at a greater level than how it would have affected Clint. Even without the aid of Lasix, water loss (Dehydration) from high temperature, and decreased blood pressure from alcohol, __________ from stress were impacting enough to kill her.