In which physiological state might you expect changes in protein binding due to increased blood volume?

Increased blood volume is most prominently associated with pregnancy. During this physiological state, a significant increase in plasma volume occurs, which can lead to changes in protein binding of drugs. This is because many medications bind to plasma proteins, such as albumin, and alterations in the concentration of these proteins or the overall volume of distribution in the bloodstream can influence the pharmacokinetics of drugs.

In pregnancy, the increase in blood volume can dilute the concentration of proteins in the blood, altering the binding capacity of drugs. This change can potentially affect the free (active) drug levels in the bloodstream, impacting efficacy and safety. Therefore, understanding how protein binding is altered during this unique state is crucial for optimizing pharmacotherapy in pregnant patients.

Other options represent conditions that may not cause a significant change in systemic blood volume or would likely produce different pharmacokinetic adaptations. For example, while coma and post-surgical recovery may involve other changes in drug metabolism and elimination, they do not typically lead to the same degree of increased blood volume seen in pregnancy. Dehydration, conversely, would likely result in decreased blood volume and could increase drug concentrations rather than reduce protein binding.