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4/15/16

The Hot Tub Mystery:

Part I:
1. The paramedics noted that the temperature of the water in the hot tub was unusually
high, the couple had been dead for some time, and that there were empty bottles of wine
besides the pool.
2. The investigators should ask the maid why the water was so unusually hot and what
time she discovered the couple.
3. Physiological effects that should be considered in this situation include the following:

Mr. Underhill had been taking Lasix, a diuretic, possibly to treat a preexisting

condition pertaining to the heart, liver, kidney, or blood pressure.

The water was very hot, specifically much hotter than normal internal body

temperature.
The couple had been drinking a large amount of alcohol.

4. Possible physiological effects that possibly led to their death include:

The couple may be experiencing occupational stress, which often results in

conditions which include chronic high blood pressure.

The drug Lasix is a diuretic, so it causes the kidney to excess water and sodium
from the blood stream, which might lead to dehydration for Mr. Underhill, who is

already sweating from the heat of the pool.

Hot tubs would increase external body temperature, leading to a high internal

body temperature of vital organs.

Alcohol is a vasodilator, which can cause the capillaries beneath the skin to
expand, further accelerating effects of the water temperature on the internal
temperatures of the couple.

Further, in large quantities alcohol acts as a vasoconstrictor, thereby directing

blood flow away from the skin and would increase the couples core

temperatures.
Alcohol is also classified as a depressant drug which leads to an impairment of
judgement, lightheadedness, unconsciousness, coma, or even death in large
amounts.

5. The couple was experiencing some combination of all of these effects, so it is possible
that their drinking led to a lack of judgement, the hot water led to a dangerous increase
in body temperature due to prolonged exposure, ultimately causing them to lose
consciousness due to excessive alcohol consumption of dehydration. The actual cause of
death for Mr. Underhill might have caused by dehydration, given the effects of Lasix and
high heat of the water.

Part II:
1. Given the side effects of Lasix, it is possible that Mr. Uphill died as a result of
dehydration alone. Otherwise, it may also be the case that both lost consciousness, or
the ability to leave the tub, as the result of dehydration. Since the temperature of the
pool was 115 degrees, which is much greater than a normal internal temperature of 98.1
degrees, and the alcohol caused their internal temperature to increase at an accelerated
rate, the couple was also sweating and thus becoming further dehydrated.
2. Given that the maid noted that Mr.Uphill had been using the bathroom a a lot since
his visit with the doctor, it is likely that he was only recently prescribed Lasix (a
diuretic), which would require him to drink sufficient water to offset the water loss that

he is experiencing due to the effects of the drug. He would be the most likely to have
experienced dehydration first.
3. The Blood Alcohol Level is a measurement of the amount of alcohol found in the
blood, but an individuals weight must be taken into account when determining safe and
unsafe blood alcohol levels.
4. Since Alcohol is typically a vasodilator, which would cause blood vessels to dilate and
an overall decrease in blood pressure and increased blood flow. As a result, we would
expect that a larger volume of blood will be passed through capillaries in the skin.
Alcohol is also effects inhibitory and excitatory neurotransmitters, glutamate and GABA,
causing an overall impairment of motor control.
5. Alcohol is metabolized at a rate of 1 ounce per hour.
6. For a 160lb man, a .20% BAL would signify legal intoxication (greater than .08%
BAL), but is not high enough to lead to alcohol poisoning (.4% BAL). For a 120lb
woman, a .20% BAL would signify legal intoxication (greater than .054% BAL), but is
not high enough to lead to alcohol poisoning (.35% BAL). However, for both, these levels
may lead to unconsciousness.

Part III:
1. Naturally, the body undergoes fluxuations in regular blood pressure, but this is
regulated by the dilation and constriction of the blood vessels, primarily through the
release of hormones.
2. Lasix is a diuretic, so it causes the kidneys to prevent the absorption of salt into the
blood, this excess salt and water is excreted through the urine. This decrease of salt in
the blood would lead to a decrease in overall blood volume, and therefore a decrease in

blood pressure. Since Alcohol is typically a vasodilator, it would cause blood vessels to
dilate and a further decrease in blood pressure and increased blood flow. Note that the
opposite effect is observed when alcohol is consumed in very large amounts.
3. In order to reverse the decreasing blood pressure, the body would attempt to cool its
core temperature by increasing blood pressure. The couple inhibited this process by
consuming more of a vasodilator.
4. If the couple had been found unconscious, first they would have to be resuscitated,
given a vasoconstrictor that would increase blood pressure, cooled down, and given
plenty of fluids.

Essay:
Given the circumstances, dangerously high internal temperatures and high blood
alcohol levels, Renee would inform the detective of the following physiological
information:
The vasodilation caused by the consumption of alcohol increases the diameter of
blood vessels, which increases the volume of blood that can pass through a vessel. This
dilation of blood vessels decreases the amount of venous return to the heart. Also, this
increased diameter of blood vessels and increased volume allows for less of the blood to
come in contact with the walls of the vessels. So a larger volume of blood is allowed to
pass through a vessel without obstruction, characterizing a decrease in peripheral
resistance. This increased blood flow is explained by an immediate increase in heart
rate, which is what allows for more blood to pass through the vessels.
The decreased blood pressure, caused by an increased vessel diameter, is
detected by baroreceptors, where an action potential is sent to the brain.

Neurotransmitters are released from the brain which prompt the adrenal gland to
release hormones such as epinephrine, which act as vasoconstrictors.
As alcohol consumption increases, the drug begins to act as a vasoconstrictor
which does exactly the opposite: increased peripheral resistance, decreased blood flow
and decreased heart rate.
Additionally, since the couple had been gradually increasing their external and
internal temperatures, the body would attempt to attempt to lower internal temperature
by redirecting blood flow away from the heart by triggering the release of vasodilators by
the pituitary gland, to allow for more blood flow towards the peripherals. Again, the
dilation of blood vessels decreases the venous return, and therefore the filling of the
heart. Just as before, this process of vasodilation decreases blood pressure, increases
heart rate, and decreases peripheral resistance, but continues with prolonged exposure
to such hot water. Also, an increase in heart rate is caused by a decrease in filling volume
and increase stroke volume and end diastolic volume. With an increased heart rate, wed
also observe increased cardiac output.
Specifically, in the case of Mr.Underhill, who was taking the diuretic drug Lasix,
the lack of salt in the blood supply would lead to a decrease in blood viscosity.
Additionally, the drug was causing him to become increasingly dehydrated and likely to
fall unconscious.
For both of the Underhills this redirecting of blood flow towards the peripherals
means a decrease in blood supply to the visceral organs, which includes the kidneys. The
decrease in blood supply leads to a decrease in functioning of the kidneys. Given the
state of their kidneys when drinking, Underhills would become more quickly inebriated
since they would metabolize the excess alcohol in the blood supply at an impaired rate.

They likely fell unconscious as a result, causing them to fall into the pool where they
drowned.