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QW14-December 2024

Question 1: Select each option to validate with explanations

image

“I discovered, that the saline solution which I had used had not been prepared with distilled water, but with pipe water supplied by the New River Water Company. As this water contains minute traces of various inorganic substances, I at once tested the action of saline solution made with distilled water and I found that I did not get the effects described in the paper referred to. It is obvious therefore, that the effects I had obtained are due to some of the inorganic constituents of the pipe water”
These were the words of Sydney Ringer, a British clinician and physiologist, is recognised for formulating the 'Ringer's solution,' which facilitated the maintenance of isolated frog heart contractions, ultimately contributing to the creation of an isotonic solution utilised in medical research.

Question: Which particular inorganic compound referred to here had the most profound impact in maintaining the frog heart contractions?
😭

Wrong Answer:A. Sodium

😭

Wrong Answer:B. Potassium

😉

Right Answer: C. Calcium

Explanation: Ringer investigated the impact of electrolytes on cardiac and smooth muscles—the effects of various inorganic salts on cardiac function. Ringer's solution was discovered by chance when a lab assistant mistakenly used tap water instead of distilled water during frog heart experiments. Ringer noticed that the tests with tap water yielded different results, leading him to conclude that the presence of inorganic substances in tap water was responsible for the variation.
Ringer examined various solutions with differing concentrations of salts and assessed their impact on sustaining contractions in isolated frog hearts. He observed that saline failed to sustain contractions, whether administered alone or in conjunction with potassium chloride and sodium bicarbonate. Calcium addition sustained contractions; nevertheless, the calcium concentration required proper proportionality to potassium.
This demonstrated that many electrolytes possess antagonistic properties relative to those in other groups. The study indicated that specific quantities and ratios of sodium, potassium, chloride, and calcium are vital for protoplasmic activity. The Ringer's solution was formulated from this research; it enabled tissues and organisms to survive outside of blood for experimental purposes. Furthermore, Ringer's solution paved the way for advancements in biobanking and cryopreservation techniques, allowing for the long-term storage of viable tissues for future research and therapeutic applications.

Clinical Pearls: Composition of RL

Ringer's solution, also known as Ringer's lactate solution or simply lactated Ringer's, is a type of isotonic fluid commonly used for intravenous hydration and electrolyte balance.
Its composition typically includes:
1. Sodium chloride (NaCl): 130 mEq/L
2. Sodium lactate: 28 mEq/L
3. Potassium chloride (KCl): 4 mEq/L
4. Calcium chloride (CaCl2): 3 mEq/L
5. Water for Injection: To bring the solution to the desired volume
These components closely mimic the body's plasma, making Ringer's solution suitable for various clinical uses, including fluid resuscitation, electrolyte replenishment, and maintaining acid-base balance.

😭

Wrong Answer: D. Magnesium



Reference:

1. Sternbach G. Sydney Ringer: water supplied by the New River Water Company. J Emerg Med. 1988 Jan-Feb;6(1):71-4. doi: 10.1016/0736-4679(88)90254-5. PMID: 3283218.
2. Miller DJ. Sydney Ringer; physiological saline, calcium and the contraction of the heart. J Physiol. 2004 Mar 16;555(Pt 3):585-7. doi: 10.1113/jphysiol.2004.060731. Epub 2004 Jan 23. PMID: 14742734; PMCID: PMC1664856.
3. Panchal V, Sivasubramanian BP, Samala Venkata V. Crystalloid Solutions in Hospital: A Review of Existing Literature. Cureus. 2023 May 23;15(5):e39411. doi: 10.7759/cureus.39411. PMID: 37362468; PMCID: PMC10287545.
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