Lecture 9 - Fluids, electrolytes, and pH

hi everybody dr mike here in this video i'm going to tell you exactly what the ph scale represents i've drawn the ph scale up here and you can see it goes from 0 to 14 or from 14 to 0 depending on how you look at it when we look at ph itself remember we've spoken about it in a previous video that p stands for the power of and h stands for hydrogen ion concentration so all we're measuring is the hydrogen ion concentration now usually when we measure other ions like the concentration of sodium ions or potassium ions we use molar as a unit of measurement but when we look at hydrogen ions the number is so small in regards to molar that we use ph instead now let me show you the conversion and why it's so important that we use ph and for you to understand it again remember that if something has a ph of 7 it's recognized as being neutral and an example of something with neutral ph is water anything with a ph from 7 to 0 we term acidic anything with a ph from 7 to 14 we term basic or alkaline all right next point is this because we want to have a look at what a ph of 7 represents when it comes to molar this is what we do a ph of 7 means that the hydrogen ion concentration is 10 to the negative 7 molar that's the hydrogen ion concentration all that means is this if i were to write down 1.0 it means i need to move that decimal point into the negative seven positions now if that just said ten to the seven i move that decimal point seven positions in the positive but it doesn't 10 to the negative seven so i move it one two three four five six seven and there's my decimal point which means there's now going to be a 0 0 0 0 0 0 here which means that our new concentration written in the form of molar in regards to hydrogen ion is 0.00001 molar of hydro9 that's what a ph of 7 actually means that number is so small that's why we don't write it down like that we write it as 7. now another important point if i want to write a ph of 8 in the form of molar it's 10 to the negative 8 molar which means we move that decimal point one extra position which now means which now means instead of being 0.00001 there's six zeroes there there's going to be seven zeros because we've moved at one more position so you could write it as zero point one two three four five six seven then one molar hydrogen ion concentration again if we were to keep doing this ten to the negative nine ten to the negative ten what we're going to find is one two three four five six seven it's going to be eight now for ten to the negative nine one two three four five six seven eight ten for the negative ten there's going to be nine one two three four five six seven eight nine what you can see is as we go from 7 up to 14 the concentration of hydrogen ions gets smaller look how small that number is that is a very very small number of in regards to molar hydrogen ion concentration but it also means as we move down in this direction the acidic direction we get more hydrogen ions and again as an example 10 to the negative 6 10 to the negative 5 10 to the negative 4 from 7 to 6 there's going to be one less or one fewer zeros here so move it back and it's going to be one two three four five so you can say zero point one two three four five and we can keep going right as you can see we keep going in the number gets bigger and bigger and bigger and bigger and what that means is this if you go from a ph of 7 to 6 you now have 10 times more hydrogen ions if you go from an 8 to a 9 you have 10 times fewer hydrogen ions this is a big shift so that means when we look at blood ph and blood ph being 7.35 to 7.45 you may go wow that's not very much but there is a huge difference between 7 and 8 right and you can see that this shift is actually a lot bigger than you'd actually think so we have quite a good buffering capacity however we can't go outside of this range so that's what the ph scale represents hi everybody dr mike here in this video i want to talk about buffers within the body buffers resist drastic changes in ph we know that our blood has a ph of between 7.35 and 7.45 that's worth putting up ph of 7.35 to 7.45 and if the blood ph goes below 7.35 it's becoming too acidic if it goes above it's becoming too alkalinic that means that the concentration of hydrogen ions which dictates the ph is either going to be too much if it goes in this direction too many hydrogen ions or not enough hydrogen ions if it goes in this direction so what happens in the body is if we don't have enough hydrogen ions we need to make more if we do have too many hydrogen ions we need to reduce it and this is what buffers do they resist these drastic changes in ph all right so for example i want to talk about a quick buffer and a buffer that looks like this h2co3 what this is called is carbonic acid and you should know that the definition of an acid is anything that can donate a hydrogen ion so that means that this carbonic acid can give us a hydrogen ion now if it does give us a hydrogen ion what are we left with if we take one hydrogen out of this we're left with one hydrogen one carbon and three oxygen which is hco3 and because we stole a positive from this it's left with a negative and this is called bicarbonate ion bicarbonate ion and this is our hydrogen ion again it's the concentration of the hydrogen ion that dictates the ph so what we've got here is this a weak acid which donates a small number of hydrogen ions and leaves us with a weak base now the definition of a base is something that can mop up hydrogen ions it can bind to hydrogen ions which means if that can bind to that this is a reversible equation and so this can also go in this direction now what we have here is a very simplistic buffer system where if we don't have enough hydrogen ions the weak acid will split apart release hydrogen ions if we've got too many it will bind to bicarbonate and go in that direction now our body utilizes this reaction but with the addition of some other parts for example carbon dioxide and water if you bind carbon dioxide on water have a look there's one carbon there's the one carbon two plus one oxygen is three oxygen two hydrogen two hydrogen if you bind carbon dioxide with water you get carbonic acid so let's write these down just for completion sake carbon dioxide and water all right and that can split itself apart to produce these two so that's reversible as well what we've now drawn up here is something called the bicarbonate buffering system and this is one of the most important biological buffers that we have now let me talk about it in regards to how it actually works all right this end of the equation deals with the lungs this end of the equation deals with predominantly the kidneys now this is important because when we look at imbalances in regards to ph we can say if something's wrong here it could be metabolic or kidney caused if something's wrong here then it could be respiratory cause and this is going to be the basis of respiratory versus metabolic acidosis or alkalosis right that's for another lecture but let's think about like this let's just say we do not have enough hydrogen ions in the body if we don't have enough hydrogen ions the ph is going up right so remember it's a reverse logarithmic equation have a look at my previous video about calculating ph right we don't have enough hydrogen ions how do we create more let's have a look carbon dioxide this is a byproduct of respiration breathe in oxygen our mitochondria utilize that oxygen and it produces atp water and carbon dioxide and we don't like carbon dioxide we want to breathe it out but in order to go from the cells to our lungs to breathe out it has to go in our bloodstream so when carbon dioxide hops in our bloodstream most of our blood streams water inevitably all our carbon dioxide is going to be binding to that water and it will be producing carbonic acid but because carbonic acid is a weak acid hates itself splits itself apart and produces hydrogen ions which means one way we can increase the concentration of hydrogen ions in our body is through the accumulation of co2 how can we accumulate co2 i'll show you hold your breath if you're holding your breath you're not breathing out and this is what happens some individuals who do not have a high enough concentration of hydrogen ions in their blood they may be holding their breath a little bit their breathing will be different let's think of it flipped what if we have too many hydrogen ions well if we have too many the bicarbonate will mop it up and produce carbonic acid which will then split up and produce water and carbon dioxide so if we are acidic and our ph is too low because we have too many hydrogen ions we end up producing more carbon dioxide which means the patient may breathe more so the respiration can be an indication of the blood ph and you can also see if we don't have enough hydrogen ions it goes in this direction if we have too many it goes in this and this is the bicarbonate buffering system hi everyone a lot of health students have issues with looking at acidosis or alkalosis this is determining whether the blood is acidic or basic compared to its normal blood ph now there's different types of acidosis and alkalosis you can have respiratory or you can have metabolic now what i want to talk to you about today is what makes one respiratory based acidosis alkalosis or metabolic based acidosis alkalosis so like i said before your blood ph needs to sit between the range of 7.35 and 7.45 that's the range that needs to sit within if it goes below this particular range acidosis if it goes above this particular range alkalosis that's the first point next point is when we measure ph the h simply stands for hydrogen ions that's all we are measuring in this case but when we do bloods to have a look when you get medical professionals taking blood to have a look at whether somebody has acidosis alkalosis they don't just look for the ph they also look for some other factors to tell it whether it's respiratory or metabolic let's take a look alright first thing is you must know this equation the equation is that when you breathe you produce carbon dioxide this carbon dioxide will inevitably get into your blood and blood is filled with water so when carbon dioxide mixes with water it produces something the thing it produces is called carbonic acid which is h2 there's the h2 c from there o3 because there's two there and one there now carbonic acid hates itself and splits itself apart and it produces these two things it produces bicarbonate ion and it produces hydrogen ions again when we measure ph we're just measuring this so if somebody has acidosis it means that the quantity or concentration of this is going up right if they've got alkalosis the concentration of this is going down now think of this on a seesaw if you increase carbon dioxide this goes up and everything falls in this direction producing more acid so the more carbon dioxide the more acidic the more acidic it means it's going down in this direction and the person has acidosis usually the body is very good at compensating and it will bind with that and roll back down in this direction and you'll breathe that carbon dioxide out all right let's talk about acidosis alkalosis different types when we look at respiratory based acidosis alkalosis it's looking at this end of the equation when we look at metabolic it's looking at this end of the equation now when somebody has respiratory acidosis what happens is it's respiratory based something to do with breathing carbon dioxide is the only thing here that we truly breathe we do breathe out a little bit of water but mainly carbon dioxide right so if somebody has respiratory acidosis the carbon dioxide levels must be increasing respiratory acidosis increase carbon dioxide because this means it bonds with the water produces carbonic acid splits apart and produces hydrogen ions this is acidic that's respiratory acidosis so what happens with the ph it goes down dropping down in this direction all right that's respiratory acidosis what about respiratory alkalosis well it's going in the opposite direction so in respiratory alkalosis we're not producing enough co2 so it's not binding with water it's not creating carbonic acid and we're not producing enough hydrogen ions which means we've just got an over abundance of bicarbonate comparatively and it becomes more acidic so it's a drop in co2 which results in an increase in the ph this is respiratory acidosis respiratory alkalosis what about metabolic metabolic acidosis metabolic acidosis is referring to what's happening here now think about it metabolic acidosis can happen either if you increase the amount of hydrogen ions or if you decrease the amount of bicarbonate because bicarbonate binds to hydrogen to mop it up and get rid of it so if that's gone you're just left with a whole bunch of free hydrogen ions so when you do the bloods to check for this in metabolic acidosis what you'll find is a drop in bicarbonate this again is if it's uncompensated and an increase and a drop sorry in the ph because it's acidosis so it's going down in metabolic alkalosis what's happening is it's producing too many bicarbonate ions or again it could be the fact there's not enough hydrogen ions maybe one or the other but what we do know is that in alkalosis there's more bicarbonate ions if it's uncompensated and what happens is the ph goes up as well so this is just a very quick run through of what happens in respiratory based acidosis alkalosis and metabolic based acidosis alkalosis so let's have a quick look at how the blood in our body moving through into the kidneys gets filtered and ultimately forms urine so we're going to have a look at urine formation so a couple of things you need to go through the previous videos and understand what a nephron is and understand how the blood supply gets to the nephron and how that blood supply starts to become filtered okay so just as a very quick recap we're going to go through some functional anatomy and we're going to name different aspects of this nephron so remember this is the functional unit of the kidney this is the filtration unit is the nephron and what you can see is a blood supply coming through now this blood supply isn't here to give this nephron oxygen this blood supply is coming in because here is a capillary bed now remember this capillary bed is called the glomerulus remember glomerulus means bowl of yarn so you've got a blood vessel coming in that branches into this glomerulus capillary bed and this is where filtration happens and remember the tubules here of the nephron contain what's just been filtered from this blood and so this is called filtrate and if this filtrate remains in the nephron all the way through it comes out as urine okay so urine formation has to do with this filtration process here okay and what's happening to this filtrate all the way through the nephron that's what we're going to discuss today but before we begin let's label some things so that you know exactly where we are so first thing is that we have blood coming into or towards this nephron remember this is called the afferent arteriole and afrin arterial comes down into a capillary bed which we call the glomerulus the glomerulus then continues down into not a vein remember but an artery another arteriole which would call the efferent arteriole and you can see that the efferent arterial continues and it basically hugs all the tubules of the nephron and we call this peritubular capillaries okay why does this capillary bed here hug the tubules of the nephron because remember what gets filtered into the nephron doesn't necessarily stain the nephron 99 of this filtrate that gets into the nephron actually gets thrown back into the blood and it gets thrown back into this peritubular network okay so that's labeling the blood supply let's label the nephron now i'm not going to write the labels down because i'll have to rub them out but what you can see is the first part here we call the glomerular capsule okay so that's the glomerular capsule looks like a little pacman the first portion of the tubule closest to the capsule is called the proximal convoluted tubule proximal because it's closest to convoluted because usually you'll see it as these squiggly wavy lines but i've just drawn it here straight for simplicity's sake so proximal convoluted tubing you've got the loop of henle also known as the nephron loop which is made up of the thin descending loop of henle and the thick ascending loop of henle then you have the distal convoluted tubule and then you have the collecting duct okay now when it comes to urine formation what you're going to find is a couple of things that urine formation is actually equal to a couple of things your information is equal to glomerular filtration what that means is remember our ultimate goal is urine formation here so we're going to talk about how we can get from here to here firstly we need to start off with glomerular filtration let's write that as number one so you know from previous videos that as the blood comes through that there is a relatively high pressure here the glomerulus that now remember that at most capillary beds the pressure's around about 30 20 to 30 millimeters of mercury so what's that mean there's a hydrostatic pressure are pushed behind the blood pushing stuff out of the capillaries at the tissues of your body but once you get here to the kidneys this capillary bed is different and the push is greater it's 50 millimeters of mercury okay so you have this very strong push pushing substances within the blood plasma through okay now remember proteins do not go through and cells do not go through why well cells are too big so white blood cells red blood cells and platelets they're all too big to move through this filtration membrane or i should say filtration membranes proteins well the proteins are actually small enough to get through but there is a negative charge at this filtration membrane and remember proteins are negatively charged and like charges repel each other so in a healthy filtration membrane proteins are repelled and stay in the blood okay first thing so filtration now of the blood that comes down through into here what you'll find is so think about cardiac output right so your heart will contract and relax contract and relax and as it does this it pushes out blood right so every time it contracts it pulls it pushes out around about 70 ml of blood from one ventricle so left ventricle squirt 70 mls of blood and it does that about 72 times a minute so if it squirts out 70 mils in one go times 72 in a minute that gives you around about five liters a minute so your heart pushes out from one ventricle five liters a minute that's the cardiac output now that five liters a minute goes to the whole body right so only a fraction of that's going to get to the kidneys twenty percent of that will get to the kidneys what's twenty percent of five liters one liter so one liter of blood goes to the kidneys every minute now that one liter of blood is made up of all these different components it's made up of cells it's made up of proteins it's made up of blood plasma and so forth what gets filtered only plasma right because the cells and proteins don't go through so of that one liter what you'll find is sixty percent of it is plasma so what's sixty percent on one liter 600 mils so you have 600 mils of blood plasma that's coming through that can be filtered now of this how much of that 600 ml actually goes through 20 percent okay so 20 percent of the 600 ml gets filtered through how what's 20 percent of 600 it's 120 ml see every minute every minute in here you have 120 mils being filtered through so that means you create 120 mls of filtrate every minute in both both your kidneys together so not one nephron this is representing of both your kidneys okay so 120 ml a minute is what your kidney creates a filtrate now think about that 120 mils a minute now let's do some very quick maths how many minutes are there in an hour 60 minutes in an hour okay how many hours are there in a day 24 so 60 times 24 is 1440 minutes okay you have 1440 minutes in a day all right and you have 120 mils per minute being made so 120 times 1440 and this is something that i wrote down before is 172 800 mils per day your kidneys create 172 800 mils of filtrate per day that is nearly that's approximately 175 liters a day but you know that of this 100 that this 175 liters you know pa you know p out 175 liters a day you actually pay out around about 1.7 liters per day it's only one percent so of everything that you filter through you only pay out one percent so let's just say here 175 liters per day or by the time it gets to here it's only 1.7 liters a day so what does that mean that means of everything you've filtered 99 of it 99 of it goes back into your blood back into your body okay so that means that in order to create urine we need to add something else to this equation we said urine formation is equal to glomerular filtration which is 120 ml per minute minus tubular reabsorption right so this is that's the tubules and it's going back into the body so it's reabsorption not absorption because you've already absorbed this stuff before in the grt you're reabsorbing it back into the body okay so this is step two tubular reabsorption so let's just leave this a bit better here step one filtration and this is step two tubular reabsorption so tubular absorption you've got all these tubes you've got the proximal convoluted tubule you've got the lipo henley you got the distal convoluted tubule you've got the collecting duct in actual fact it happens all throughout okay so if you have a look here you'd find that at the proximal convoluted tubule 65 of what's just been filtered goes back into the body at the proximal convoluted tubule 65 percent okay at the loop of henle what you'll find is that 15 goes back into the body okay so what's that so far 70 80 80 okay here at the distal convoluted tubule you'll find that another 15 gets reabsorbed back into the body that's 95 and here at the collecting ducts four to five percent that equals 99 to 100 okay because remember 99 of what just got filtered goes back into the body 65 of it happens here at the proximal convoluted tubule 15 happens at loop of henle 15 happens at the distal convoluted tubule and 4 to 5 happen at the collecting ducts now the great thing is your body can alter this so it's not always going to be 65 15 15 and 4 to 5 if you want to reabsorb more this percentage can go up if you want to reabsorb less it can go down and vice versa with all these okay so for example if you want to reabsorb more water you can release adh antidiuretic hormone which makes you reabsorb more water here at the collecting ducts if you want to reabsorb more sodium into your body you can release aldosterone and this can tell the prox or the distal convoluted tubules to reabsorb more sodium okay so urine formation is equal to glomerular filtration minus tubular reabsorption so let me just wipe this off so i've got more room so does that make sense why it's minus because remember 120 mils per minute here but we need to minus what's going back 99 so now we have 1.2 mils coming through right 120 mils take one percent of that is 1.2 mils because that 99 has gone back so now we only have by the time we reach here we only have 1.2 mils per minute which is 1.7 liters a day okay coming through at 1.2 liters a day now that's not the end of it because your nephron can actually take some stuff from the blood and not just give substances to the blood it can receive substances from the blood and this is called this is number three and this is called tubular secretion now why is it called secretion is because it's secreting substances from the blood into the tubule people get confused about reabsorption secretion and so forth whatever is in the tube you need to remember is essentially being outside the body this is what's going to be peed out if it stays in the tube so if it goes from the blood into into this tubule it's secretion and this is number three tubular secretion and again this can happen at different stages or different parts of the nephron okay but usually it's not a huge amount okay not a huge amount so what can we see we can see when it comes to urine formation it's made up of three different components glomerular filtration which is about 120 ml a minute tubular reabsorption throwing back 99 of all that stuff back into the body okay and tubular secretion throwing out some stuff this stuff is going to be for example urea for example this is urea can be thrown back into the tubules to be excreted or to be paid out so this is your information hi everybody dr mike here in this video we're going to take a look at urinalysis now urinalysis is a cheap fast and cost-effective diagnostic tool to have a look at what should or should not be present in the urine and can be a great indicator for disease or disorder so let's go through what we can check in a urinalysis one by one so first thing is let's have a look at color so color is something you can obviously just take and look at it can be something that's clear or it can be cloudy or anything in between it could be colorless or it could be amber for example and anything in between now what can change the color of our urine can be anything from food to drugs for example it could be the presence of blood what about from clear to cloudy it could be the presence of proteins or anything dissolved in the urine or maybe an indication of an infection so just by looking at the urine can give you a great indication as to what may be going on specific gravity this is the first test that we can actually perform using the urinalysis or the dipstick for example and specific gravity is simply looking at the concentration of the urine it's looking at the stuff in the urine now specifically what it's looking at is something called the osmolality and the osmolality is that concentration of stuff in the urine so for example if i were to check the specific gravity of water it's going to be one because there's nothing in water it's just water itself so it's the reference point specific gravity of one anytime you put anything into that water so let's say we start to dissolve some ions or maybe some proteins or maybe some sugar or glucose for example it's going to increase the concentration of stuff in there or the osmolality now this is going to increase the specific gravity so if we take urine it's obviously not going to be a void of particulates or particles dissolved in it like water is so it's going to be a value greater than one what you're going to find is for urine the specific gravity is usually between 1.003 and 1.03 so what this indicates is that for example if something's above 1.03 it may be an indication of dehydration so more stuff dissolved in the urine itself or not enough fluid and so the relative proportion of stuff dissolved in is greater compared to the fluid if it's below 1.003 it's going to be an indication of hydration maybe an indication of over hydration what can specific gravity tell us well again apart from the relative hydration status it can be an indication of the presence of other things so for example if it's above 1.03 so looking as though dehydrated could be the presence of glucose in the urine so glycose or glucose urea which is an indication potentially of diabetes for example it could be an indication of something called syndrome of inappropriate anti-diuretic hormone what does that mean so anti-diuretic hormone anti-diuresis to stop urinating so adh anti-diuretic hormone pulls water back into the body so syndrome of inappropriate antidiuretic hormone means it's pulling too much water back into the body so the urine you produce is concentrated so they can be just two potential reasons glucosuria or syndrome of inappropriate adh can be an indication if the specific gravity is too high if it's too low for an example for example it could be an indication of something called diabetes insipidus now diabetes mellitus mellitus means sweet sweet like sugar because there's glucose or sugar in the urine diabetes insipidus it's not sweet there's no glucose in that urine it's actually a problem up in the brain with not enough antidiuretic hormone being produced so too much dilute urine is being produced and that could be an indication of a low specific gravity again they're all just indicators so ph ph is looking at the concentration of hydrogen ions and obviously looking at ph can be a great way of looking at whether there's any acid base imbalances so for example somebody can have respiratory or metabolic acidosis or alkalosis so that means too much or too little hydrogen ions respiratory based means it has to have something to do with the breathing so maybe if you're retaining too much carbon dioxide that turns to hydrogen ions and your blood becomes too acidic maybe you're breathing off or hyperventilating and you're getting rid of too much carbon dioxide that could be an indication of alkalosis okay so your ph starts to go up acidosis ph goes down alkalosis pairs goes up metabolic means there's something going on in the body usually at the kidneys and it's retaining too much hydrogen ions or getting rid of too much bicarbonate for example this can bear out in the ph test of the urinalysis but what you should know is what the normal ph is so for example the ph can vary from 4.5 to 8 so that's quite significant usually it's sitting for urine between 5.5 and 6.5 now what's that telling you it's telling you it's slightly acidic now you can change the acid base through food for example so ingesting proteins proteins are made up of amino acids right the acid portion gives you an indication when we break down proteins and amino acids we turn it into ammonia our body doesn't like handling ammonia so it turns it into urea that comes out in our urine and urea is acidic so if you have more proteins in your diet your urine will be more acidic now if the urine is more basic it could be an indication that there's bacteria present that eat up or split the urea so a uti could be an indication of an alkaline based or a basic urine because it's breaking up that urea but it could also be an indication of a number of other things like i said food for example so ph again just an indicator all right so glucose is small enough for our kidneys to filter remember there's a filtration membrane called the glomerulus so if i were to draw up the filtration unit of the kidney called the nephron there's different aspects of it so right here is where you actually filter the blood so the blood is going to come in turn into something called a glomerulus and then the blood is going to go out and if it's small enough it gets filtered through this sieve or this filtration membrane called the glomerular filtration membrane glucose is small enough to get filtered into this tube into this nephron and these tubules but what should normally happen is all the glucose that gets filtered should be thrown back into the blood of the body so what that means is anything that ends up at the other end of this tube that comes out in our urine so that means all the glucose that gets filtered actually gets thrown back into the body and doesn't come out in our urine so a urine shouldn't actually have glucose in it but if it does have glucose in it what can be it be an indication of so maybe somebody has ingested far too much sugar far too much glucose and the transport molecules that bring it back into the body are being overwhelmed and it can't bring it all back so there's an overload of glucose and it just carries out into the urine or it could be an indication of diabetes so remember diabetes is a problem with handling glucose so type 1 diabetes you don't produce the insulin type 2 you produce it it just doesn't really work and insulin is that key to tell the cells of the body like muscle cells for example and fat cells to take the glucose and bring it in from the blood but if that insulin isn't there or doesn't work the glucose stays in the blood and overwhelms this filtration and it comes out in the urine and as we know with diabetics wherever the glucose goes it pulls water with it that's osmotic that's an osmotic effect and it can lead to increase in urine production as well polyuria more urine being produced over time so glucose good indicator of diabetes ketones also a good indicator of diabetes but more specifically type 1 diabetes now why what is ketones so ketones usually aren't present in the urine ketones are an alternate energy source alternate from glucose that's our primary energy source ketones are an alternate energy source what happens is this glucose turns into energy through a process known as glycolysis glucose goes to pyruvate pyruvate jumps into the krebs cycle of the mitochondria that creates products that jump into the electron transport chain that produces about 36 odd atp molecules glucose can only do this if insulin is present if insulin is not present the body tries to make glucose it makes it from non-glucose-based sources like fats and proteins and what happens is all these fats come in get broken down and they start to back up and when they back up they go through an alternate pathway of energy source production and that's the pathway of ketones now so type 1 diabetics they have they produce zero insulin right no insulin that means no glucose being produced no glucose being utilized for energy so all these ketones being produced type 2 diabetics they do produce the insulin which means the glucose is undergoing whatever glucose gets into the cells is undergoing this glycolytic process so the ketone production will be minimal right so that's why type 1 diabetes producing ketones is a good indicator but ketones are also produced when somebody is on a very low carbohydrate diet so somebody could be producing ketones if they're not ingesting much glucose at all in the first place so their only option is to produce the ketones for energy take the fatty acids break it down to produce ketones all right blood now blood is probably not the right term to use here but what we're referring to in this test is actually it measures something called peroxidase activity and peroxidase activity is actually an indicator of hemoglobin myoglobin and erythrocyte function so hemoglobin myoglobin erythrocyte function that's actually what this aspect of the test picks up not just blood now hemoglobin carries oxygen around the body myoglobin carries oxygen in the muscle that's what the myers refer to erythrocyte is the red blood cell which obviously carries hemoglobin now generally speaking erythrocytes do not get filtered they're too big cells don't get filtered here at the glomerulus so if you've got erythrocytes present could be an indication that there's damage at this membrane or there's some sort of infection or some sort of damage to the tubules itself or something lower down lower down could be the ureters it could be the bladder it could be the urethra for example what about myoglobin and hemoglobin well they could be present they do get filtered right but usually they get reabsorbed back in so their presence in the urine is very low so again it's an over abundance that's going to lead to their presence in the urine overproduction so for example it could be somebody doing exercise so marathon runners or some somebody performing intense exercise may find that their hemoglobin globin levels in their urine goes up but it should be transient so it should obviously fix itself within 48 72 hours or it could be a crush injury so if something crushes the muscle it's going to release all this myoglobin and again that's going to come out in the urine so it could be an indicator of that but again could also be an indicator that there's damage to the filtration membrane itself or the nephrons or the tubules for example or something lower down so an infection could actually increase those numbers protein so the only types of proteins that can get filtered are proteins that are less than 20 000 daltons in size that's the molecular weight so anything that's smaller than that gets filtered at the glomerulus some proteins are greater than that some proteins are smaller some proteins that are smaller than that that get filtered include albumin and some globulins they're usually carrier molecules so sometimes they're going to be carrying insoluble substances and they get filtered through again a lot of it gets reabsorbed back into the body some of it does come out so what can increase the presence of protein well it can happen transiently or long term so transiently things like heart failure can do it increasing that pressure that's happening it could be damage to the glomerulus so glomerulonephritis can can cause this as well so that's usually a long-term cause so it could be short-term or long-term short-term heart failure exercise fever stress long-term usually some sort of nephropathy such as glomerulonephritis can increase the presence of proteins nitrites all right you usually should have zero nitrites in your urine you shouldn't have any at all you have nitrates but no nitrites but what happens is we can have the presence of bacteria and these bacteria can turn the nitrates with the a into nitrites with the eye and so the presence of nitrites tell you there is bacteria present which can be an indication of a urinary tract effect infection wherever that infection may be leukocytes white blood cells good indication of infection so this infection again could be a great indicator of uti but usually you'd need to do some sort of culture to say that bacteria is present for a uti if not no bacteria present could be just some type of itis right some sort of oops inflammatory response that's happening so it could be inflammation of the nephron itself of the kidney something of the ureter bladder urethra so this could also increase the amount of leukocytes present all right last one bilirubin and urabilinogen your red blood cells when they die they go to the spleen so you got red blood cells they go to the spleen the spleen breaks up hemoglobin and globin and the heme goes to the liver and the liver turns it into bilirubin that's the first thing bilirubin now bilirubin can be unconjugated or conjugated the liver conjugates it what that means is it makes it water-soluble so it can float around in the water of our body if it's water-soluble it can be filtered so some conjugated bilirubin can be present in the urine some what usually happens is this the liver that makes the bilirubin conjugates it and sends it to the bile right which is the gallbladder and the gallbladder releases it into the small intestines and so this can come out in our fecal material or it can get reabsorbed back to the liver all right now here's the thing when it's in the bowel as in the small intestines this is where it turns into urobilinogen bilinogen okay and again this can go to the liver for reabsorption so what is all this telling you this is all telling you that the presence of bilirubin and urobilinogen in the urine can be an indication that too many red blood cells are breaking down this is known as hemolysis it could be an indicator that liver is dysfunctional all right so some sort of hepatic disease or maybe some sort of hepatocellular disease or it can be an indication that there's a problem with the bile or bile ducts so the biliary system that's what it's telling you that's what it's an indicator of so this is a quick run through of urinalysis hi everybody dr mike here in this video we're going to take a look at body fluids and electrolytes so the first thing is if you take a 70 kilogram male such as myself and have a look at the composition of body fluid 65 percent of me will be water now this is going to change depending on an individual's body composition more fat less water less fat more water the older you are less water the younger you are more water so all these need to be taken into consideration when thinking about fluid balance for individuals now within this fluid we have things that are dissolved so for example we have ions now ions are when you take an electrolyte which is basically a salt so sodium chloride and when you put sodium chloride for example which is just salt right table salt for example you ingest it once it hits the fluids of your body it splits off and forms a positive sodium and a negative chloride together they balance each other's charge out now now they're called ions that's electrolyte these are now ions so if we look at the ion distribution within our body because they influence the movement of water and therefore influence where the water sits within the compartments of our body now the compartments of our body can be broken up into two particular compartments that is inside the cell that's one compartment the fluid that sits inside the cell is called intracellular fluid or icf so i can put in here this is intracellular fluid or it can be the fluid that sits outside the cell that we term extracellular fluid so that's going to be out here but also within the blood vessels so all the fluid within the blood vessels is recognized as being extracellular fluid now they're two separate compartments obviously so you've got intracellular fluid everything inside the cell extracellular fluid or the fluid outside the cell and the extracellular fluid compartment is broken up into two sub compartments what are these compartments it is the one the area that sits outside the cell in between the cells that is called the interstitium so interstitial fluid and the other one is inside the blood vessels and we call this intravascular now the intravascular fluid is basically blood plasma so this is how we break up body fluids within different compartments of the body now let's talk about ions and where they sit so firstly outside the cell you have large amounts of sodium chloride calcium and bicarbonate you can see you've got some are positive like sodium and calcium some are negative like chloride and bicarbonate inside the cell what you have is potassium you're going to have phosphate you're going to have magnesium and you're going to have negatively charged proteins again some of these are going to be positive like potassium and magnesium some of these are going to be negative like phosphate and proteins now as you can see you have different ions sitting in different compartments now there are going to be some potassium outside and phosphate and magnesium and some proteins outside and there's going to be some sodium chloride calcium bicarbonate inside but predominantly the most abundant positive ion that sits outside the cell is sodium the most abundant positive ion that sits inside the cell is potassium all right and you can see the others break up like this now the other important point is all the ions that sit outside the cell in the interstitial the extracellular fluid because extracellular fluid is both the interstitium and intravascular that means everything here is exchangeable with everything here so things can go back and forth they are exchangeable and so whatever ions are outside are inside so that means sodium chloride calcium and bicarbonate in the same concentrations inside your bloodstream as they are floating around outside your cells so that means if you get something injected into your bloodstream it will then jump out of the bloodstream and float around outside your cells so if you get a saline bag which is just sodium and chloride injected in in high concentrations that's going to increase in the blood vessel that's going to move out and increase outside the cell and that's going to influence movement of water now the question is why does it influence movement of water because the concentrations here first of all are balanced now you may think well no they're not there's more sodium outside and more potassium inside more chloride outside more phosphate inside yes but if you add up the concentration of these things inside the cell and compare them to the concentration of things outside the cell it's the same concentration and we measure the concentration in something called milliosmoles and the concentration is around about 290 milliosmoles that means when i add up all the stuff dissolved outside the cell it's 290 milliosmoles when i add up all the stuff inside the cell it's 290 milligrams moles that is perfect how do we calculate this well we calculate it like this right you find out how much sodium you have and multiply it by two you find out how much potassium you have you multiply it by two you add how much glucose we have and add it to how much urea we have and then what you get is 290 milliosmoles how do we know well two times 135 millimoles per liter which is around about the amount of sodium we have plus two times potassium which is around about five millimoles per liter plus five millimoles per liter of glucose plus five millimoles per liter of urea what's that going to give us 2 times 135 is 170 plus 10 plus 5 plus 5 what's that 10 plus 10 equals 20 plus 170 is sorry 270 is 290. so we've got 290 milliosmols that also means if you increase the amount of sodium or glucose urea or potassium it's going to change that concentration now here's the other thing let's just say you do intravenously put in huge amounts of sodium you increase the amount of sodium inside the blood vessel so now we've got all this sodium what's going to happen well because whatever's in the blood vessel is exchangeable with what's outside all this sodium moves outside now we've got huge amounts of sodium sitting outside the blood vessel what that means you increase the amount of sodium here what happens to the concentration it goes up it's now no longer 290 milliosmoles outside it's 310 for example what's inside inside is still 290 milliosmoles the concentration has changed and the body hates it when there's a concentration difference from outside the cell compared to inside the cell water will move why won't these ions move because that's a fatty layer of the cell and the cell membrane or the fatty layer does not let anything through that is large or charged doesn't let it through so these ions stay in their compartments but the water must shift so if it's more concentrated outside than inside where does the water move to to dilute out that high concentration water is going to move from inside outside and what that means is this gets diluted so that starts to drop back down but this increases and goes up so that will probably go to 300 now and this will go up to 300 now it's balanced which is great but you still have too much ions in the body and this is where your kidneys come into play and pee it out okay so this is a really really important point when it comes to fluid balance and electrolytes sometimes you can lose these ions through sweat or exercise and that means this concentration drops this concentration drops something's going to happen what's that thing that happens is you need to ingest more salt you feel like eating salty foods what if only your fluid drops right what if you've got a container filled with stuff and you sweat and you sweat out more liquid than you do ions right so this volume of water drops down to here but the amount of iron stay relatively the same this is called dehydration the concentration goes up when the concentration goes up this same thing happens but it also goes to the hypothalamus and the hypothalamus tells you you're thirsty and you drink some water so this is a quick overview of body fluids and electrolytes hi everybody dr mike here in this video we're going to talk about dehydration now dehydration is defined by a loss of total body fluid now not all dehydration is the same today i'm going to talk about two different types of dehydration one that we call intracellular dehydration and one that we call extracellular dehydration first thing you need to be aware of which i've spoken about in previous videos is that if we have a cell and have a look at all the stuff inside the cell so this may be ions like sodium or potassium or magnesium or chloride or whatever it may be and look at its concentration inside the cell compare it to the concentration of all that stuff outside the cell what you're going to find is that the concentration normally is the same this concentration is 290 milliosmoles outside the cell 290 milliosmoles inside the cell that's the same now what that basically means is that water will be moving in that direction and that direction at around about the same rate which means there's no net shifting of fluid between the intracellular compartments and extracellular compartments now remember two thirds of your water is inside the cell one third of your water is sitting outside the cell okay when the concentration of stuff is the same inside compared to outside there's no overall net movement of fluid one way or the other however let's talk about intracellular dehydration let's just say that you do some exercise now when you exercise you obviously sweat and the reason why you sweat is because that fluid or water that's coming out of your skin is going to transfer heat away when a breeze goes past it takes heat away in actual fact about 580 kilocalories will be of heat will be taken away per kilogram of sweat how much do you sweat during exercise anywhere between 0.5 to 2 liters per hour depending on how intense you're exercising so exercise and sweat glands are a way to release this fluid these sweat glands predominantly are equine sweat glands and if you think about what is inside of it predominantly it's water right but there's also going to be some salts like sodium and chloride and magnesium and potassium and so forth now remember this in the base of these e-chrome glands right so you get the base of the gland and then it snakes its way up to the skin here where it's forming the sweat it's going to contain water and the sodium and potassium and chloride and magnesium and so forth right those ions now the concentration of those things inside the sweat gland when it's being made is the same as the concentration inside the cells okay when it starts to move its way up through the gland those substances start to get actively reabsorbed back into the body and by the time you sweat and the sweat goes onto your skin the concentration of those substances inside your sweat is less than the concentration of those substances inside your cell we call that a hypotonic solution now when it's the same concentration that's called an isotonic solution you've probably heard of that before with a gatorade all it's saying is that in that gatorade that water you have a whole bunch of salts in there that's at the same concentration as your blood or your cells okay hypo means it's less concentrated than your blood or your cells hyper means it's more concentrated than your blood or your cells got it now that means you do exercise you start to sweat like i said 0.5 or 2 liters per hour of this sweat which contains some salt but what you find is most of that salt gets thrown back into your body you end up sweating or releasing more water than you do all the substances dissolved in your water so basically what's happening is this you have a container and this container has water in it and some stuff dissolved in it when you do exercise you lose a whole bunch of water and only a few of these things but significant amounts of water have been lost now think about what that means if most of and this is happening from all the fluid outside the cells right so i'm pulling out some of this water and keeping most of these dissolved substances that means this fluid outside the cell becomes more concentrated all right and if it becomes more concentrated this may jump up to 310 milliosmoles for example now if it does what that now means is there's a concentration difference from outside the cell to inside the cell and your body hates it the only way your body can fix this is by shifting fluids between the set between inside the cell to outside the cell now water will try and balance this out and it does it by moving in one direction from inside the cell to outside the cell and so it slowly drops that to million miles and this concentration inside rises to around about 300 milliosmoles but think about what's happened through exercise and sweating water has been taken out of our cells and those cells begin to shrink when these cells shrink that means you get intracellular dehydration intracellular dehydration that's what it's called now when these cells start to dehydrate in the brain they specifically will do this to all the cells but they specifically will do it to cells in the hypothalamus hypothalamus picks up this change in concentration sends a signal down to the posterior portion of the hypothalamus so the posterior portion of the pituitary gland and tell it to release something called antidiuretic hormone adh adh as a hormone travels through the bloodstream goes down to the kidneys specifically goes to the nephrons i've spoken to you about the nephrons watch one of those videos if you don't know about them what adh does is it puts little holes in these tubules to tell the water that was going to turn into p to be thrown back into the blood adh increases water reabsorption and when that happens we replenish the volume of water outside pushes that water back inside all right so this is what happens in intracellular dehydration at the same time the hypothalamus will send signals to the cortex of your brain and tell you that you're thirsty and drink that means the response to intracellular dehydration will be a hormonal response adh and a behavioral response to drink now let's compare this to extracellular dehydration what's happening here is something different this is where your water loss outside your cells so again remember you're going to have a concentration of stuff outside the cell and inside the cell 290 milliosmoles 290 milliosmoles and now what happens in extracellular dehydration is the fluid outside the cells is being lost at the same concentration as what it is in outside the cell here so you're not just losing water like we were with intracellular dehydration mostly water you're losing water and the dissolved substances at the same concentration that they are here which means the whole fluid level drops but it still remains 290 milliosmoles think about it like this i've got that container with some particles in it let's say i've got one two three four five six seven eight nine ten particles and one liter ten particles per liter right per one liter let's now say i lose water and particles at the same rate so i go down to five particles five particles per half a liter five particles per half a liter is exactly the same as 10 particles per 1 liter it's still 290 milliosmoles which means there's no concentration difference from inside the cell to outside the cell is there going to be water moving out no so the cells remain hydrated but outside the cells we've lost our fluid volume i told you in a previous video that the extracellular fluid is the same as the blood fluid which means your blood volume drops if your blood volume drops your blood pressure drops if your blood pressure drops your tissues don't get the oxygen and nutrients it needs specifically here at the kidneys at the nephrons we need to filter remember 120 mls per minute of blood if your blood pressure and volume drops that drops you don't filter your blood properly your kidneys they're not happy with this so they release a hormone called renin specifically from here at the afron arterial renin is released renin does a whole bunch of things renin does a whole bunch of things to increase blood pressure i've done a video on ren and watch that increases the blood pressure it does it by going to the brain specifically the hypothalamus and releasing adh it also tells all the blood vessels to constrict if you constrict a hose the water backs up and the pressure increases perfect that's what we want as well it releases something called aldosterone aldosterone comes from the kidneys you've got the cap on the kidneys called the adrenal gland aldosterone is produced there is released goes to the distal convoluted tubule and the collecting ducts to reabsorb salt back into the body if salt is pulled back into the body water is pulled back into the body if water's pulled back into the body blood volume goes back up blood pressure goes back up and everything is sorted the renin angiotensin aldosterone system is a system that gets activated when our blood volume drops and our blood pressure drops and the whole purpose of it is to increase blood volume increase blood pressure so let's have a look and see how this system works if you have a look renin angiotensin aldosterone three different terms and they're released in that particular order so the first thing we need to talk about itself is renin now if you were to take the kidneys you should know that the filtration system is called the nephron and there's about 1 million nephrons per kidney now the majority of the nephron sits in the cortex of the kidney but the loop of henle and the collecting ducts sit within the renal pyramids also known as the medullary pyramids if we were to take a single nephron out and we were to stick it here what you'll find is that there's an afferent arteriole which is blood coming in and then it turns into a capillary network called the glomerulus then an efferent arteriole coming out now what you need to be aware of is that your kidneys need to filter about 120 milliliters of blood per minute or they need to create 120 milliliters of filtrate per minute that means when this blood comes in of this blood it needs to get filtered into this glomerular capsule and 120 milliliters of what's now called filtrate is produced per minute that means about 180 liters per day of filtrate is produced however of that 180 liters that we produce per day we don't pay out all of that 180 liters as i'm sure you're aware we p had only one percent of that 1.8 liters so that means 99 of what we filter at the glomerulus is thrown back into the body back into the bloodstream now this is important because the kidneys are basically weighing up exactly what we need what we don't need okay now this is why the kidneys must maintain this consistent what's called glomerular filtration rate of 120 ml per minute if your blood volume drops for example due to a bleed out to hemorrhage or due to some sort of peripheral vasodilation which may happen due to anaphylactic shock for example your blood pressure drops and your blood volume drops now that means that the kidneys at the glomerulus will not be able to filter that 120 milliliters per minute and this is a stimulus to release the first component of the renin angiotensin aldosterone system called renin now where is renin specifically released from well let's have a look in the afferent arterial the blood coming in there are some cells in the walls of the afrin arteriole now these cells are called juxtaglomerular cells also known as renin releasing granular cells so they're called juxta juxta glomerula cells also known as granular cells granular cells now these are the cells that actually release renin now renin is an enzyme okay it's not a hormone it's an enzyme and it's released by the granular cells of the afronaterial okay now what stimulates its release i told you a drop in blood volume drop in blood pressure but how does it know this well it knows this because as the blood that's coming in if the blood volume has dropped and therefore blood pressure has dropped these juxtaglomerular cells or glomerular granular cells are actually baroreceptors and they pick up that drop in blood pressure and then they release renin so the first way renin is released first way that renin is released is a drop in blood pressure in afferent arteriole that's the first way now there's another way that running can be released now think about this if the blood pressure is dropped and the blood volume has dropped that means the blood's moving through quite slowly with less of a force or push behind it so it comes through to the glomerulus gets filtered and now you've created filtrate here now think about it if the blood pressure is low blood volume is low this filtrate is going to move through slowly if it moves through slowly remember that at the proximal convoluted tubule this is where we reabsorb approximately 65 of all the stuff that gets thrown back into the body that includes sodium and then at the loop of henle around about 15 percent is thrown back at the loop of henle and the other portion that said the descending and ascending portions of the looper henley and then about five percent is thrown back at the distal convoluted tubule this is of sodium okay now if this filtrate is moving through slowly think about it there's more time for this salt to be pulled back into the body which means more sodium gets taken out of the tubules and thrown back into the body which means by the time we reach the distal convoluted tubule is there going to be less sodium or more sodium there's going to be less sodium this is the next trigger to release renin but how if we're in the distal convoluted tubule and these cells are here well there's a cell type in the distal convoluted tubule that measure concentration they're called macular densa cells macular densa cells they measure concentration so the chemoreceptors and what they do is there's actually you can see that the afrin arteriole is comes into close proximity with the distal convoluted tubule they're very close together in actual fact they're connected by connective tissue and this allows for a conversation to be had from the distal convoluted tubule to the afronateral specifically the macular densa cells to the granular cells and therefore when these macular densa cells pick up a drop in sodium in the distal convoluted tubule they tell the granular cells to release renin so what's the second reason why we release renin is a drop in sodium concentration in the distal convoluted tubule okay now there's a third thing that stimulates the release of renin and it it is direct innovation from the sympathetic nervous system that's the fatal flight system think about that in times of fight or flight we want to increase our blood pressure we want to increase our blood pressure why because it means our heart can deliver more blood to the muscles so we can fight or run away and so this is the third reason well the third way in which renin is released increased sympathetic nervous system innovation alright so the first thing you need to know is what triggers the release of renin three things one a drop in blood pressure which triggers the granular cells to directly release renin in the afro arteriole two a drop in sodium concentration in the distal convoluted tubule this is picked up by the macular denser cells which then speak to the granular cells to release renin and three the sympathetic nervous system directly innervates the granular cells to release renin so now we've spoken about how renin is released in the first instance we now need to talk about how the rest are released and how it actually increases blood volume increases blood pressure well let's move over to this part of the diagram now now what i've just said to you is that renin has been released from the kidneys now renin is released from the kidneys into the systemic circulation it's floating around now the liver produces and also stores many proteins as well and usually if it's something that's stored and inactive it has the suffix ogen on the end of it and what the liver produces and stores is something called angiotensinogen again another protein angiotensinogen angio's referring to blood vessels tension refers to pressure ogen tells you it's stored and inactive and what's going to happen angiotensinogen is released into the bloodstream and comes across renin which i said is an enzyme what does this enzyme do well renin chops off that ogen and creates something called angiotensin 1 i'm just going to write a t 1 angiotensin 1. what does angiotensin 1 do not too much it is a very slight vasoconstrictor but clinically doesn't really matter angiotensin 1 now is floating around now the thing is that angiotensin 1 as it floats around the bloodstream is inevitably going to get to the lungs now the lung produces the most amount of an enzyme called angiotensin converting enzyme let's write that down i'll write it down up here angiotensin converting enzyme a c e ace so it produces something called ace now think about what it does angiotensin converting enzyme it's going to convert angiotensin 1 into something called angiotensin ii now this is what we're interested in angiotensin ii angiotensin ii is what we're interested in what does it do a couple of things first thing is that angiotensin ii is a generalized vasoconstrictor it's predominantly going to strip constrict arterioles which means the blood is going to back up back up back up and increase blood pressure so when you have a generalized vasoconstrictor what is the ultimate outcome for a generalized vasoconstrictor it ends up increasing blood pressure what's the second thing that angiotensin ii does well angiotensin ii also goes to the efferent arteriole and when it gets to the efferent arterial remember arterioles when you hear the word arterial it's a small artery they have huge amounts of smooth muscle and so what angiotensin ii does is it goes to this smooth muscle that's wrapped around the efferent arteriole and it tells it to constrict what does that mean if these arterials are constricting blood is backing up into the glomerulus that increases filtration rate which is exactly what we wanted because the stimulus was a decreased filtration rate right when that decreased filtration rate happened we had all the sodium get thrown back into the body and the sodium levels were low that was the trigger now we've got negative feedback we've fixed it up there's going to be no more trigger there so the second thing that angiotensin ii does is it constricts the efferent arterial and what's the outcome for constricting the efferent arterial increasing glomerular filtration rate which also increases the sodium in the distal convoluted tubule okay what else does angiotensin 2 do angiotensin 2 will also travel importantly all the way to the adrenal glands specifically it's going to travel to the cortex of the adrenal gland and stimulate it to release something called aldosterone the last part of the renin angiotensin aldosterone system aldosterone now what does aldosterone do aldosterone travels to the distal convoluted tubule and it tells the distal convoluted tubule to take the sodium that's present and throw it back into the body now why would we want that if our blood volume is low and our blood pressure is low why would we want to throw more sodium back into the body well remember wherever sodium goes water follows therefore sodium back into the body sodium back into the blood water back into the blood increase blood volume that's the outcome so number three aldosterone from adrenal cortex and what's it do increases sodium reabsorption which ends up increasing blood volume which ends up increasing blood pressure what's the last thing that i want you to know that aldosterone angiotensin ii does well it travels to the hypothalamus now the hypothalamus is the master regulator of the endocrine system right and what that means is it endocrine system hypothalamus two pituitary glands anterior posterior the posterior pituitary gland has adh anti-diuretic hormone diuresis to urinate anti-diuresis to stop urinating so angiotensin ii tells adh antidiuretic hormone to be released into the body and this will travel to the distal convoluted tubule and the collecting ducts and tell them to reabsorb more water into the body reabsorb more water into the body that's what adh does this happens at the distal convoluted tubule in collecting ducts why more water again more blood volume more blood pressure so the last thing i want you to know that angiotensin ii does stimulates the release of antidiuretic hormone from the posterior pituitary gland and this resulted in what resulted in increased water reabsorption which increased blood volume which increased blood pressure there you go what was the stimulus stimulus was dropping blood volume dropping blood pressure what was the outcome when you stimulate renin angiotensin aldosterone system increasing blood volume increase in blood pressure hope that makes sense

Channel: Dr Matt & Dr Mike

Views: 8,605

Rating: 4.9170985 out of 5

Keywords: ph, fluids, electrolytes, water, balance, adh, hypothalamus, renin, angiotensin, aldosterone, system, blood, pressure, volume, sodium, na+, acid, base, bicarbonate, buffer, acidosis, alkalosis, intracellular, extracellular, osmosis, osmolality, osmolarity

Id: QnU7iAqyQlI

Length: 84min 52sec (5092 seconds)

Published: Tue Sep 01 2020