Jacob is 45 years old and a keen cyclist. Every day he cycles to and from work about 25 km each way. For the past two weeks ambient temperature has exceeded 27°C, yet he kept cycling and one hot and sunny day he suddenly had an intense pain in his lower left side that radiated around his lower back. Upon arriving at the emergency room, the intensity of the pain was making him feel nauseous, and he was having problems sitting comfortably. Blood and urine samples were taken. His urine sample had a pinkish hue and upon analysis was found to have an osmolality of 1200 mOsm/l and contained small calcium oxalate crystals. Doctors suspected kidney stones as the source of the pain and ordered an abdominal CT. The diagnosis of kidney stones was confirmed as the CT scan showed a few stones of varying size in his left kidney. Jacob confirmed that he had a prolonged period of continuous exercise in very hot conditions and probably was not drinking enough water for proper hydration. He was given medication to help with the pain and instructed to drink lots of water to help pass the stones. Answer the following questions:
1. Explain the reason and mechanisms of increased osmolality of his urine.
2. What is the possible reason of his kidney stones formation?
3. How drinking the water would improve Jacob’s condition?