Wiper Fluid

A 15 year old male presents after ingesting windshield wiper fluid to get high. Explain what will happen to the following:

  1. Osmolarity
  2. Sodium levels
  3. Oncotic pressure
    A windshield wiper solution helps improve driving visibility but is highly toxic if ingested, inhaled, or contacted to the skin (Fałkowska et al., 2018; Purohit, 2018). Typically, 30%-50% of windshield solutions contain methanol, which can poison humans and pets (Purohit, 2018). Ingesting the washer fluid can lead to stomach upset, vomiting, and late symptoms such as dizziness, lethargy, and confusion. In addition, prompt emergency treatment is crucial to prevent severe outcomes like permanent blindness, coma, or even death, especially with children (ADAM Inc, 2023).
    According to the review of Ashurst and Nappe (2019), consuming windshield wiper fluid containing methanol elevates serum osmolarity. Methanol is rapidly absorbed in the gastrointestinal tract and rapidly distributed throughout the total body water compartment. Formic acid, which is the product when the liver metabolizes methanol, is what causes metabolic acidosis. Also, formic acid makes an osmotically active ion, resulting in a higher osmolarity. The byproduct of methanol metabolism is an increase in the hydrogen ions in the blood, which decreases the pH and makes the osmolarity increase (Fakowska et al., 2018). This is measured using the osmolar gap equation, which considers the concentrations of sodium, blood urea nitrogen, glucose, and ethanol in the serum (Ashurst & Nappe, 2019).

Sodium Levels
As a result of acidosis, sodium ions move from the extracellular fluid to the intracellular fluid, resulting in hyponatremia. Conversely, hypernatremia results from the free water loss brought on by an osmotic shift from the intravascular to the intracellular compartment. Moreover, methanol toxicity causes symptoms like vomiting and diarrhea, which aggravate the condition of dehydration and fluid deficiency. These pathological changes heighten the susceptibility to hypernatremia (Ashurst & Nappe, 2019). According to Fałkowska et al. (2018), methanol toxicity causes kidney damage, which can further affect electrolyte imbalance, including sodium.

Oncotic Pressure
Methanol toxicity causes a metabolic imbalance that affects osmotic pressure in the body, including oncotic pressure. In severe cases, fluid and electrolyte loss is the primary cause of decreased oncotic pressure, which can result in edema (Ashurst & Nappe, 2019). Fałkowska et al. (2018) further explained that kidney failure increases the loss of albumin in the urine, thus further decreasing the oncotic pressure.

ADAM Inc. (2023, January 2). Poison – Windshield washer fluid. Ssl.adam.com. https://ssl.adam.com/content.aspx?productid=617&pid=1&gid=002803&site=makatimed.adam.com&login=MAKA1603
Ashurst, J. V., & Nappe, T. M. (2019, March 15). Methanol toxicity. Nih.gov; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK482121/
Fałkowska, U., Radzka, A., Sławiński, A., Ryczkowski, A., Neścior, M., & Tchórz, M. (2018). Fatal methanol poisoning due to massive windshield screen washer fluid ingestion – case report. Zenodo, 8(9), 996–1001. https://doi.org/10.5281/zenodo.1419724
Purohit, M. (2018, February 28). First aid for windshield washer fluid poisoning. DoveMed. https://www.dovemed.com/healthy-living/first-aid/first-aid-windshield-washer-fluid-poisoning/

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