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BIOL 3324 Human Physiology - BIOL3324_Lecture20
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00:01 okay. It looks like everything is and rolling. Let's make sure everything
00:06 , works. Okay. So what we're gonna do is we're gonna
00:10 on with the renal system or the system, which everywhere you want to
00:15 it, Um, and what we're do? Well, let me just
00:18 you what we talked about right was first looked at the process of
00:22 We said making urine requires three processes , absorption and secretion. We start
00:28 with the process of filtration. Filtration basically taking the plasma, pushing it
00:34 , uh, the capital re walls Bowman's capsule. And we have 125
00:40 of stuff, most of it we want to get rid of. Most
00:43 we want to keep. So now process has to do with re
00:48 What do we want to keep? right. This is what What?
00:51 re absorption absorption processes. So it's , meaning that it's specifically pulling things
00:58 in alright. It primarily occurs in proximal convoluted tubules. Alright, So
01:05 occurs right there. Bowman's capsule right at the glamorous Dulles and then that
01:10 first region is primarily where most of re absorption is taking place.
01:17 the statement next is basically, look, if you need it,
01:21 going to reabsorb it. If you really want need it, you're not
01:24 reabsorb it. So it's pretty right? We're kind of getting that
01:28 and really what we're looking at if you remember, the fill treat
01:31 said is just the stuff. It's the plasma that indiscriminately pulled things
01:36 and the only thing that you've left on the plasma proteins. So what
01:39 looking at are just those things that left over the in that plasmas that
01:44 we would refer to as the pill . And so what we're gonna do
01:47 we're gonna use one of two Were either using trans solar transport,
01:51 we're moving things through the cells or gonna move things in between the cells
01:54 get things done. And the thing re absorption, it's actually incredibly easy
01:59 we've already learned the principles that drive . All right now, I asked
02:04 , I said, you guys remember rules of high school politics, and
02:07 guys all stared at me like I like going? I don't know.
02:11 I'm just gonna remind you. we had the cool kid and really
02:15 the cool girl and the boyfriend, ? You know, you knew who
02:19 were. Everyone saw them in They walked around the the high school
02:23 the time holding hands. Maybe they their hands in the back pockets.
02:27 . You know what I'm talking Can you can picture them now?
02:30 at your school. You had this and circling around them. You didn't
02:34 them in your school. Their their around them. They have their their
02:39 , right? You have the you know that that kind of hangs
02:44 . It's like the it's in the zone to the girl. You
02:48 he's the one that's trying to weasel , but he knows he can't do
02:52 because, you know, really, boyfriend's gonna kick his butt. So
02:55 just kind of sits on the side is always there to hear what her
02:59 are and stuff like that in the that somehow he'll be able to replace
03:03 gonna happen. And then you have the other friends I'd like to hang
03:06 with the with the guy who wants wherever he goes. They go wherever
03:11 goes. He goes also, Now you're getting the picture. Every
03:16 school movie they've ever made has this . And when we talked about the
03:23 of water and salt, that's what described, and that's what we're going
03:28 see here. The rules are very . Wherever sodium goes, water follows
03:33 why osmotic considerations, right? So we move, sodium water is gonna
03:39 . What happens is when water it's going to drive other things to
03:44 with it. So all you gotta is which direction is sodium going all
03:49 ? And that's really what we're looking . And it's just gonna use one
03:52 these two methods to do so. sodium absorption is our starting point,
03:58 so sodium has some unique characteristics with . Most of the sodium that's gonna
04:05 reabsorbed is do is done. So in the proximal convoluted tubules and loop
04:10 handling, we're gonna deal with handling little bit, but you can see
04:13 grand portion of the of the sodium being reabsorbed in the front end but
04:20 the back end, alright, The convoluted tubules about 8% of sodium is
04:26 regulated. So you can think about this. The majority of the sodium
04:29 going back into your body and a rate. But on the back
04:36 depending upon my need, I'm gonna either reabsorb or I'm gonna or I'm
04:40 discreet. Okay, now put that perspective. If most of your sodium
04:46 being restored in the proximal convoluted to a would you expect to happen with
04:52 , it's gonna follow. Remember, start off 125 mils of fluid sodium
04:58 being driven back into the body so is naturally gonna follow. That's why
05:03 go down to that one mil. , so that's really what's kind of
05:07 on here. So when we talk that top that that first value the
05:12 convoluted too. But you can see got a note there. It plays
05:14 pivotal role in glucose amino acid chlorine in your re absorption. So
05:20 sodium goes, water follows, wherever goes, everything else follows. That's
05:26 easy. Check marks. We could on to secretion. Basically all
05:33 that part that takes place in the of Henle and we're gonna talk about
05:37 deals with the varying urine concentration The idea that my urine could be
05:42 , really watery or really, really . We're going to see how it
05:47 that role there, but still, a constant rate, it's only down
05:50 at the end in the distal, tubules where we're gonna be concerned with
05:55 own state of dehydration or hydration. we dehydrated, we pull salt into
06:02 bodies so that water will follow to of maintain as much hydration as we
06:08 , given our state. But when over hydrated, then we're just gonna
06:13 the salt to be pumped out. is gonna follow, and it allows
06:17 to make, you know, get of excess water so that we can
06:20 ourselves back to a normal state of . You see, we got
06:25 so it's on Lee. A small that is being regulated. Now I'm
06:29 look at my two pharmacists, future . The drugs that we give is
06:35 affect this last little bit right All right, so we're talking about
06:40 RBS when you're talking about your when you're talking about a So all
06:44 things that regulate blood pressure, what really doing is you're regulating SCF
06:51 And when you regulate CCF volume re blood pressure, that's what all those
06:55 effect is. How we're dealing with on the back end. I'm gonna
07:00 about that just a second. So just kind of run through all these
07:05 . So here I'm just trying to you How do we move sodium
07:08 Well, we've got sodium transporters, ? So that's sodium glucose transport of
07:13 sodium amino acid transporters. We've got exchangers. We've got sodium channels.
07:18 a variety of different ways that we sodium from that Phil trait into the
07:24 and then from the cell, it's move downstream into the extra cellular fluid
07:29 then be moved out it back into plaza. All right, so we
07:33 an upstream and then we have a water. Follow salt. That's all
07:42 says right? Wherever sodium goes, follows. All right, now there
07:47 some hormonal control. That's again, at that back end. Alright,
07:51 so we'll deal with that in just moment. But for the most
07:53 wherever sodium goes, water is gonna . All right now, sodium or
07:57 , the water moves through Aqua So if you're going through the
08:00 you're gonna have an aqua foreign. it's also small enough to actually pass
08:04 the tight junctions, so they're not in the sense that they allow for
08:09 nous. It's just that water is of moving between the cells, so
08:12 uses both trans cellular and Paris cellular to move with the salt.
08:23 Is that that BFF, right? the guy that's trying to,
08:30 out, out thrown the water. is a positive ion. Chlorine is
08:36 negative ion. If you see the right, so wherever showed him
08:41 chlorine is gonna follow. How can help you? That's really what's going
08:46 . So the fast you absorb sodium factor stub. Gloria. Potassium.
08:54 , well, potassium is gonna follow because of the osmotic considerations. As
09:01 move more water out of the fill that creates an environment that is less
09:06 . So potassium goes where there's more . That's why we have that
09:12 We're going to see a little bit with the Inter collected cells.
09:16 I don't think we even talk about , but I'm gonna pointed out
09:18 So remember, we talked about the cells, Remember? What they do
09:21 they move acid or they move Remember that all your base. All
09:25 base. I'm sorry. Only a people know what that is. The
09:32 cells. What did they dio? one? Disaster base. Asset.
09:36 right, so what they use is use an exchanger. I'll trade you
09:40 proton for potassium. So that's how reabsorb Potassium comes in. Proton goes
09:49 , that's all. The little pictures you up there. Glucose cries.
09:55 transporter with sodium. So ever sodium , glucose follows amino acids. Same
10:05 as glucose use co transporter. Where goes, amino acids follow. And
10:15 , we got the weird ones. right, so if you're not familiar
10:19 the way that your body gets rid nitrogenous waste is in one of three
10:23 . All right, so you got area, which is basically protein breakdown
10:26 acid, which is nucleic acid breakdown , which is skeletal muscle breakdown of
10:32 All right, so these were just forms of nitrogenous waste. What I
10:38 to focus on is Yuria. There's because if you look at your really
10:43 it's kind of the same same pathway . All right, so your area
10:48 like your friend that you tell jokes that takes a little bit of time
10:53 get it right. You know which I'm talking about? You, you
10:57 ? So you're thinking of somebody right You're going? Yeah, that's that
11:00 , right? They're the slow Alright, So when water goes,
11:07 is gonna follow, right? And going to do so for osmotic
11:12 The difference is, is that Yuria moving slower. And so what?
11:19 don't need to know these percentiles, ? But you can see, like
11:21 the proximal convoluted tubules. 50% of ria Yuria that's in the field.
11:26 gets reabsorbed. All right. And you get down to the net.
11:30 loop. And what happens is you out Yuria again said I don't want
11:33 stuff. So now you have the of your you want to get rid
11:37 is now back in the tube you're , all right, I'm getting rid
11:40 it. And then it's like, , no, I'm gonna go back
11:42 of the tubular again in a very way. So it's about 50% that's
11:47 reabsorbed back in. So you're on getting rid of about half of the
11:51 . That's already, you know that trying to get rid off. All
11:54 , so this is constant battle of to get out. So what?
11:57 telling you that you have a lot Yuria in your body? Not a
12:01 thing. Excess urea is a bad . That's why you want to get
12:04 of it. So the rate at we're getting rid of it is a
12:06 bit slower than what we'd normally We're gonna use this reabsorbed urea to
12:11 us establish that osmotic radiant that we about on Thursday, which we're gonna
12:16 some time talking about here. All , so the idea here is that
12:20 still being reabsorbed, and it's also secreted. But the grand scheme of
12:26 about half of the area that we trying to get rid of gets reabsorbed
12:30 to the body just because of osmotic , all right. Still getting rid
12:37 it, but not as much as like to. So far, so
12:43 . With three absorption. Wherever sodium , water follows. Wherever water
12:47 the rest of it goes or they sodium. One of the two things
12:50 pretty pretty basic. Alright, So we're doing is removing with re
12:57 We're moving things back in the things that we want to keep.
13:00 I kind of ran over. Do want to keep glucose in your
13:03 Do you want to put it Keep it. Do you wanna do
13:06 wanna p out amino acid or you to keep him? Keep him
13:11 Let's get rid of the stuff we need. Like the Yuria, the
13:14 acid. That's the nitrogenous material we to get rid of, Right?
13:19 we want to keep these things in body. So purposes is to put
13:22 in the body. That body wants keep secretion, on the other
13:26 is the opposite. Here. What doing is we're saying, look,
13:30 rate of filtration or the act of doesn't get rid of the stuff.
13:35 wanna get rid of enough fast So what I want to do is
13:38 want to selectively take materials out of plasma, transported across the walls of
13:45 tubules and put it into the fill . Alright, So where is re
13:50 is putting things you want back into body. Secretion is taking things out
13:53 the body and putting it into your in an active fashion. Okay,
13:58 the process of filtration very, very process of re absorption while it uses
14:04 mechanisms, it is also dependent upon active mechanisms of using energy to move
14:12 so that the other things could All right, so these air two
14:17 of secretion we're gonna we're gonna kind do this, uh, using the
14:22 ones and look at some more complex . So, for example, we
14:25 about protons, right? If you too much acid in your body,
14:27 body wants to get rid of those protons to reduce the acidity of the
14:32 ? And so there's mechanisms through these type A cells that are found in
14:38 proximal well founded, the dissed on collecting ducks on what they do is
14:43 basically pump out the Patasse or pump the protons while returning something back in
14:49 body because you're usually using an exchange . Now this only works if you
14:55 an acidic system. If you have basic system, you're not gonna want
14:59 pump out acids. Instead, you to get rid of the by carbon
15:04 Alright. So by carbon, it then be the mechanisms discretion if
15:08 your body's, is leaning towards the side. Potassium is primarily reabsorbed in
15:15 proximal tubules, which is what we four or five slides ago. But
15:21 the distal tubules, weaken secrete out to maintain the proper concentration of potassium
15:28 the body. So if you end with too much potassium, you don't
15:31 to sit there in the body. want to get rid of it.
15:34 that's what you're gonna do, all . And you can do the same
15:37 from any other molecules as well. right, Now what I wanna do
15:41 I wanna look at the potassium for moment. All right, so this
15:45 something we already know. Potassium levels already high in the plasma,
15:49 there. Low inside. Uh, there. It wanted to fuse into
15:53 interstitial fluid. Alright, so that's it naturally goes and what I want
15:58 to. I want you to focus this picture down on the bottom.
16:00 me find my little pin here. is the thing. I want you
16:07 focus on down here so you can this. All right, So what
16:10 have is we have potassium out here this interstitial fluid, All right?
16:15 , what it's gonna do is we're take advantage of sodium potassium pump.
16:19 do we need a sodium potassium Right, to keep low concentrations.
16:25 , excuse me. Low concentrations of sodium on the inside of the
16:31 Right. So what this is gonna is gonna drive sodium in this
16:36 But it also means that I'm gonna pumping lots of potassium into a
16:41 All right, so now what are gonna do if you want? At
16:44 point, the potassium is gonna become great that nothing is gonna be able
16:47 happen. So potassium needs to leave cell, and it has two
16:53 First choice. If we have high is to go out through a channel
16:58 to the interstitial fluid. And so what do I have is I have
17:01 nice simple cycle, right where it keeps going in this direction.
17:07 So I could just pump sodium in , because I'm just allowing the potassium
17:11 to sell, leak its way pump it back in like its way
17:14 , so on and so forth. the other thing that I could do
17:18 like a move potassium outward. All . And when I do that,
17:23 have channels that allowed toe leak or I can exchange them. And
17:31 I'm using, there is a potassium exchange. So what's the chlorine going
17:37 dio? Is it gonna be all and sad? No. Remember,
17:41 have sodium, so it's gonna follow . So this is one way that
17:45 can move sodium in. Now. way that we adjust or modify potassium
17:52 is based on need, right? if you have mawr potassium, you're
17:56 need to have a mechanism that increases way that you could secrete this.
18:01 the hormone that regulates this is Austrian. So what is Aldo Austrian
18:09 well. Simply put what it It says. Alright, tubular
18:12 I want you to make mawr sodium pumps, and I want you to
18:16 Mawr potassium channels. I want you insert them into the membrane. And
18:20 what ends up happening is I start mawr potassium into the cell, and
18:26 more potassium leaks out in response to increase in l'd Austrian. Now,
18:31 I put more potassium or sodium potassium into a membrane, what's gonna happen
18:37 regard to the sodium? The potassium going into the cell, and I
18:46 more of these in. That's more , but what's gonna happen to the
18:51 flow out? You're gonna get more to move out of the cell and
18:54 the body. And when I have sodium, move into the body.
18:58 follows? Water. So what does Austrian do? This is not a
19:05 question. It's something that you're gonna toe tattoo to your body's later.
19:11 , no. What is going to is if you're putting more water into
19:17 body, it's increasing water volume in body so that be blood volume.
19:24 if you increase blood volume. What you do with blood? Pressure
19:28 It increases cell. Dos trone is mechanism not only to increase potassium
19:35 but to increase sodium absorption so that could increase blood volume so I could
19:42 blood pressure. Okay, that's the of Valdosta Rhone. Alright, So
19:47 has two functions here and this is this little picture tries to show.
19:51 says, look, when the potassium in the plasma get really, really
19:55 , put these in. And so get rid of more potassium. But
19:58 the same time, I also lower excretion. When I lower sodium
20:04 that means I lower water excretion. hold on the water more. So
20:11 this pattern of secretion make sense? do I want us to creep
20:21 So it's not so salty inside. , back. It s 02 of
20:26 guys gave me answers on salon and let's make it simpler if I'm secrete
20:31 potassium, why am I secrete ing So yeah, sodium leave outside.
20:39 being too confusing. Say it not water. You're gonna think I'm
20:46 to trick you. I'm not trying trick you. What do they have
20:50 your time? No, you guys made. Why am I secreted?
20:55 ? Because I have too much So start with the simple work to
21:02 complex. All right, that's how do it. Why do I want
21:06 reabsorb sodium? Because there's a Grady that favorite sodium absorption. That's that's
21:12 , that's the answer, right? what does that lead to? That's
21:17 you say, Oh, that's when bringing in more water, bringing up
21:20 pressure. Liatti Yada, yada, . So when you see secretion,
21:25 , the term secretion means something I'm to get rid of. So why
21:29 I secreted? I'm putting things from body into the fill trait. Why
21:32 I secreted? Potassium? Because there's much potassium. Why am I secrete
21:37 protons? There's too many protons. am I secreted bicarbonate? Because there's
21:41 much bicarbonate. Depending upon your your state may not be that you
21:46 too much potassium. If there's not potassium discreet, you don't secrete it
21:51 that kind of makes sense. that's kind of the key thing
21:55 Now I'm gonna kick it up a to make it more confusing to
22:01 Not really. It's actually pretty All right. This is also the
22:06 your body gets rid of in our not inorganic but organic ions that your
22:12 doesn't need. All right. The here is that you have all sorts
22:16 metabolic activity that's taking place We're talking proteins were talking about complex,
22:22 molecules in general that are broken down metabolites that need to be getting rid
22:28 , all right. And sometimes they're big to be filtered. Sometimes they
22:32 takes. There's just so much of . It just takes a long time
22:34 get rid of them. And so have these specific carrier molecules that can
22:40 these specific ions and can bind to and grab them and bring them across
22:47 membrane to get rid of them. , for you pharmacists, this is
22:52 that you're gonna be paying a lot attention to. All right? It
22:56 to do with the question of how can I get rid of something what
22:59 refer to as plasma clearance, which talk about briefly in just a
23:04 All right, but the idea here that every chemical compound. It goes
23:07 . Our body is removed from our at a specific rate. Okay?
23:13 the reason it's removed a specific rate because it takes advantage of or it
23:18 take advantage of these types of Alright, so different organic compounds have
23:25 carriers that can recognize them, which your body has a lot of these
23:29 sitting in inside inside the tubules of kidneys. So this is advantageous.
23:37 right, so let's think of something don't want hanging around in your body
23:40 a long period of time. Anyone ever eaten poppy seed muffins? Aren't
23:46 awesome? Have you taken a drug today after eating poppy seed muffins?
23:50 . Why? Why wouldn't you take drug test after Poppy Seed muffin
23:58 You're going to speak up a little because poppy seeds are the plant.
24:04 rise to the plant. The which produces those exogenous opiates that we
24:11 convert into heroin. Right? farmers do well, opium farmers
24:17 All right, so you can imagine put the population in your body,
24:22 body goes through and says, chemicals, chop, chop,
24:25 chop, chop and all of a . Now you've got metabolites that look
24:28 you've been abusing heroin or any other of opiate, right? So is
24:34 something you want circulating in your No, right. I mean,
24:37 body says this isn't supposed to be . I need to get rid of
24:40 . Let's say you have 10 of . All right now, let's say
24:43 process of filtration allows you to get of half of those off. Whatever
24:49 amount is, half there's that basically able to filter out half for every
24:53 it passes through a glimmer aerialist. your first time the blood comes through
24:57 it takes about five minutes for the . Come through. All right,
25:00 get you. Start with 10. move yourself down to five. But
25:03 the blood travels through your body for minutes, comes back in the next
25:06 around, you could get rid of , which is really hard to do
25:10 you can't rid of a half so can imagine, and then the next
25:12 around it's even less and even You just keep having it and having
25:16 and having it, you'd never get of it. Right? But what
25:19 mechanism like this? What this allows to do is it says alright,
25:23 could get rid of half here. if I have the right receptors,
25:26 channels, I congrats up extra ones get rid of it so I could
25:30 rid of whatever the metabolite is at faster rate that I normally would.
25:35 kind of makes sense. So in little model, let's pretend we have
25:38 receptors that recognize So the first five through now you got five passing in
25:43 tubules and this Just remember this is the tubules, right? And it
25:47 , Oh, I have five I could grab the other five.
25:50 you basically remove all of the metabolites one go. It's a quick way
25:54 get rid of stuff. We don't to even talk about drugs. We
25:57 talk about hormones and other signaling molecules you need moved out of your body
26:02 they could be harmful to how your regulating things. All right, that's
26:10 all it does. Now, these gonna be localized to the proximal proximal
26:15 . Alright, they are not subjected physiological adjustment. In other words,
26:19 that means is they're not regulated in sense of like, oh,
26:23 let's increase the number of decrease the of depending upon need. They're just
26:29 , right? So they're playing that of secretion. So I'm gonna
26:36 Does that make sense? The eight in the class No. Six people
26:40 the class got one to head Three of us kind of like
26:45 I don't know, going to the head, not the I'm not gonna
26:55 commit to nodding my head, but gonna let you know that I do
26:58 you up there at the front. , people online. Does this make
27:03 ? Give a thumbs up in the or happy face or kitty cat pooping
27:08 whatever the emoji is that's nearest to mouse button. I have one
27:21 Yeah, Cemal straight that that, know, the honest answer there is
27:31 it could probably Kern both of Like I said, the it's the
27:36 here is that your textbook has actually between the convoluted in the straight,
27:41 typically most other textbooks just refer to as a proximal tubules or collectively as
27:47 proximal convoluted tubules. And so, to be clear on the exam,
27:51 not gonna make you distinguish between convoluted straight. I just I just referred
27:56 as I the proximal tubular, convoluted. All right? Yeah,
28:01 the idea here is that it's occurring the front end. It's not occurring
28:04 the back end. That back would distal correct? Uh huh. All
28:12 , So with that in mind, we're gonna go deal with what your
28:16 does when you go. Makes you in a cup. Everyone here is
28:19 in a cup. Yea, we're . All right. I guess you
28:25 that to kids, too, But probably less fun. Not that it's
28:29 being an adult. I mean, nothing Where is going in there?
28:31 pee in the cup. It's like just peed 10 minutes ago.
28:34 how am I gonna do this? right, we'll talk about how you
28:38 do it later. Yeah, we fun in this class. This is
28:43 telling you, the residents class about , pooping and producing really reproducing.
28:48 right, so what we're doing here What we're looking at is how do
28:53 look at your kidney function and we the GF are to do so
28:58 What they could do is they can this this molecule. It's called
29:02 not insulin. Even though it looks I misspelled insulin, it's called
29:06 It's a large sugar pro or not , but this is large sugar chain
29:12 found in plants. You don't need know what it is. I'm not
29:15 ask you what anyone is, but you see it, just okay and
29:18 they do is they put it into body. Now you don't do this
29:21 you when you regularly go to the . But if they're now like really
29:24 to regulate or trying to figure it , they put that in you,
29:28 then this in Yulin is freely meaning it passes through filtration. But
29:34 neither absorbed, so it's never It stays in the fill trade,
29:38 it's not secreted. So it basically a measure of your filtration rate,
29:43 so they can look at what's what the concentration of your urine. So
29:47 pee out of 100 mils. they look at the concentration annual in
29:51 urine. They look at the concentration plasma. They look at the volume
29:54 urine that you have so 100 And they say, Okay, we
29:57 figure out GF are using this simple . You don't have to do
30:01 I'm not gonna ask you to memorize equation, Okay, But this is
30:05 the this is. This is like the standard. Now what they may
30:11 is they may do some checks. know they'll have you pee in the
30:15 and they'll do some measures based on creatinine levels. All right, so
30:21 stuff that they could do mathematically to out what your how how good your
30:26 , they're working. But this is gold standard. So if you have
30:29 low gi fr because we know what normal G fr should look like if
30:33 G f R is low, that's That's an indicator that there is a
30:37 in kidney function. Alright, so f. R is used to determine
30:44 function. That's the key. Take from this and they can calculate that
30:52 other way that we could do this we can look at how your kidneys
30:55 . Looking at renal plasma clearance. , this is a complex idea that
31:00 can all screw up and I'm probably to screw it up. Just trying
31:02 explain to you what we're looking at the volume of plasma cleared of a
31:08 per minute. All right, we're asking how much substance is cleared.
31:12 asking how much volume is being passed we clear this substance out.
31:18 E, I don't know why they this as a measure, but it
31:22 the way they do it. So basically says it takes 50 leaders for
31:27 to clear this stuff out rather than much time does it take to remove
31:31 amount of substance? Alright, Every has its own plasma clearance value.
31:40 . You know this because you all taken, uh, headache medicines.
31:46 ? All right. So let's let's at the primary medicines that you take
31:50 a headache. You have ibuprofen, ? What's another one that you can
31:57 acetaminophen? That what you was You're saying? See if you whisper
32:02 can't hear you title, which is . Okay, that's good.
32:07 What else? Aspirin. Good. else? Approximately that. Is that
32:14 leave? That's a leave. An approximate Advil is ibuprofen. So
32:20 got the four majors. Alright, can't think of any other e.
32:24 mean, we could go coding and can start getting into some really fun
32:27 . But generally speaking, the stuff you can go buy over the
32:30 we just label them aspirin, Tylenol and, um, approximate.
32:36 for a leave, I'm not gonna naproxen. I'm gonna get it wrong
32:39 time I say it. All How much time has to pass between
32:44 first film before we could take a pill? Six hours, 68
32:50 68 ibuprofen. So I'm picking on pharmacy. The because your farm text
32:56 right? I mean, yeah. how what's the timeframe between each
33:02 We're looking at roughly what, 250 . So it six hours right,
33:14 six hours. Acetaminophen. Four Go and take a look at your
33:24 . I know I'm picking on YouTube you guys, you're around the stuff
33:29 the time. Even though you're just stuff in bottles and dealing with people
33:32 me. All right. Who could really irritating when I drive up to
33:36 CBS? Where's my stuff? You I'm talking about Yeah. See?
33:45 right, let's say you have a , all right? This is not
33:51 advice. Do not listen. My advice. I'm not a physician.
33:55 not telling you what to do. is what our physician told us what
33:59 do when we had a child who a fever. Right? You take
34:03 ibuprofen or acetaminophen, and what happens is that fever goes away for about
34:07 hours, maybe three hours, and it comes back up. And you
34:11 give the child the drug because they cleared their body. You don't wanna
34:16 up toxic levels. In fact, is it for acetaminophen? If you
34:19 over 4000 mg in 24 hours, like toxic levels that will destroy your
34:24 and then make your head explode, then your body will lose out like
34:27 big sludge or something. Yeah. about it? Ibuprofen. What's what
34:32 the levels? You know, I remember. True. 200 mg.
34:39 mg in a 24 hour period. , I've been prescribed way more than
34:45 . Yeah, but it it works the kidneys. So, um,
34:49 anyway, so I know. So do you deal with this? You
34:52 a screaming child. It's two o'clock the morning. What do you
34:58 Yes, because they have different but similar types of of physical,
35:06 , you know or not how they with symptoms. That's what I'm looking
35:11 . I guess you can alternate right? So you can take a
35:16 , and in three hours you could ibuprofen, and then three hours
35:20 you give a Tylenol because you're now of the range that you that you
35:24 use. Remember I said it was , four hours and then three hours
35:27 , given ibuprofen And so you've actually the ibuprofen to clear and so
35:32 So on and so on. Because different drugs and they act in different
35:37 , but have the same results. can alternate them. Do not listen
35:42 me about which ones you could Talk to your physician's. I'm absolving
35:46 of you overdosing on something that you stupidly chance. Now everything you put
35:53 your body has a plasma clearance. is my favorite one Vitamin C.
35:57 the max amount of vitamin C you take in a day? Anyone
36:03 3000 mg. Before it starts breaking up, it starts causing damage to
36:10 . Everything has it, and the we know what's This? Plasma clearance
36:14 about 3000 mg. So those wonderful tasting tablets that tastes like Tang,
36:20 know, like tang sweethearts don't pop like candy. Well, you do
36:24 you get to 3000 mg and stop up. That's the idea.
36:29 so what the plasma clearance does, allows you to show you how that
36:35 is moved out. All right different things have different types of plasma
36:40 , as you mentioned. And so have these three models here. If
36:44 substance is filtered, all right, obviously it's going to kill kidney.
36:49 being filtered, but it's not nor is it secreted. It's
36:54 Clearance is equivalent to the GF are in. Yellen is an example of
37:00 of those types of substances, right put in your body. It can
37:03 be filtered. It can't be reabsorbed can't be secreted, so it's a
37:06 indicator of G F R. If substance is filtered and reabsorbed, but
37:13 not secreted, then it's plasma clearance some point lower than the GF
37:18 Now. We have something like Glucose is 100% reabsorbed, so it
37:24 in our bodies. All right, you have something like Yuria well,
37:31 we said it's the slow cousin. only partially reabsorb, but its rate
37:36 excretion is lower than it's the plasma rate. Alright for the G
37:44 I should say the GF far enough clearance. And lastly, these were
37:48 ones that were that I'm just kind describing here. Substances filtered and it's
37:53 . But it's not reabsorb than its clearance is greater than the G.
37:57 . All right, so these would the drugs protons. The idea is
38:01 I'm not re absorbing protons in the . I could get plenty of protons
38:04 my body. I don't need to absorb it. I'm I'm making
38:08 so I'm going to clear them faster I'm filtering on. That's what the
38:13 what the plasma clearances and why this important is primarily for the pharmacists who
38:17 to look at drugs and say you You can only take this so many
38:22 . And really what they're doing is this is the plasma clearance rate from
38:26 is where you really actually probably So, so far so good.
38:33 you understand the principle here? The plasma clearances, its representation of
38:38 quickly remove it from the body. let's jump into some anatomy real
38:44 All right? The urinary bladder. job. The job of that is
38:49 score urine until make tuition, make being the fancy word for peeing.
38:55 right, what do we say? always making your We're making urine at
38:58 rate of about one mill per There are four layers. All hollow
39:05 have these four layers. I'm not ask you what the four layers
39:07 but you see that if you see award mucosa, that's the epithelium,
39:12 sub layer followed by muscle, followed a protective layer on the outside,
39:16 is the advent issue. All if you look at the structure this
39:20 is from an an anatomy text, can see it has this little region
39:23 sits down on the bottom. I'm circle it here in the full
39:26 and it stays there in the empty . It's called the Try Gone,
39:31 basically it's the lowest point in the , where the urethra exits from the
39:35 . So it always ensures that the point is whether you read there's gonna
39:39 all right. It helps maintain the . There are parasympathetic fibers that are
39:46 to stimulate contraction, which will look in just a moment. The
39:53 we said, is the tube between bladder in the bathroom. When we
39:57 introduced you that all right, they're muscle that helps to propel urine through
40:02 elimination. But for the most it's the pressure on the bladder that's
40:06 . But we've all gotten to the end of API. And what do
40:08 do when I'm talking, not talking the guys about shaking? I'm talking
40:12 that. We all do it. all do that kind of that's squeezed
40:15 kind of get that last little bit . That would be the skeletal muscle
40:19 trying to push that stuff out so very, very short you,
40:25 Its sole purpose is to get your out of the bladder and males both
40:33 and semen. Okay? Not at same time. That's a bad
40:38 Okay, Urine from the bladder. then we're gonna see later in
40:42 How the, um the vast difference to the re thrace so it can
40:49 as a point of ejaculate. Now Fink. Cher's here that help control
40:55 the urine is gonna flow. We the internal urethral sphincter. Alright,
41:01 gonna be right up there. It's of the wall of the bladder.
41:05 ? It's smooth muscle. Which is we say it's not a true
41:08 because skeletal muscle plays a role in as a true sphincter. So when
41:14 bladder is relaxed, this thing is held type. But as the bladder
41:22 , what happens is that muscle also , right? And so now you
41:27 pressure driving, wanting to drive the out from that sphincter. Does the
41:32 come at this point? The answer no. All right. Do you
41:41 you control when you go, P . Do you control Everyone should know
41:47 heads. I mean, I'm not if you have issues. But for
41:50 most part, the answer is Right? And the reason is because
41:55 have the external, your ritual which is made of skeletal muscle.
42:00 right, so let's say you drink two gallons of water or juice or
42:05 like that in your bladder fills But you're in the middle of an
42:08 . Do you start going? You sit there and you start doing
42:11 in your power to keep yourself from right. You start doing your little
42:15 dance and, you know, trying think of things that aren't watery.
42:19 right, You know what I'm talking . And then you run to the
42:21 , and then you struggle with getting pants off, right? But you
42:27 control it. All right? That's skeletal muscle. Alright, once you
42:33 that and come on, let's let's face, we've all done this where
42:37 had to pee, right? And like you finally get to the
42:40 And what do you do? Uh . Right. You relax. You
42:45 your skeletal muscle, and that's what urine to flow out. Now what
42:51 it is contracted state is there are neurons that constantly signaling it for it
42:56 contract. So, Mick tuition is urination, voiding the bladder. So
43:04 so forth, backing up because I a question. Mhm. I hope
43:13 . Uh huh. No, I believe that they do. So,
43:16 example, in pregnant women, you you do a great deal of
43:23 of of some of the muscles, that can damage muscle so that it
43:28 become, you know, looser so you do have some incontinent. You
43:34 get incontinence as you age, but not necessarily a function of aging,
43:40 due to other things as well. I'm not going to say yes,
43:46 will happen. It's that, there's a potential for it to
43:50 And I don't know if it's just function of age or other things.
43:54 what I wanna do is I wanna at these two reflexes that are responsible
43:59 P. All right. All First is the storage reflects. All
44:04 , so this is when you were up the bladder. Alright, So
44:07 dealing with two different systems. The and somatic autonomic remember? Says
44:11 is involuntarily controlled somatic is voluntarily All right, so here's the
44:17 We're gonna get sympathetic stimulation. What is doing is it causes relaxation of
44:22 muscles that make up the wall of bladder. So as urine goes into
44:27 bladder because, remember, urine is in the kidney travels down the ureter
44:32 to the bladder, it's gonna cause bladder to fill up as those as
44:36 muscle feels. That pressure that causes relax, ation of the of those
44:42 , All right, simultaneously. What trying to do is we're trying to
44:50 the internal. But as you expand the bladder that that muscle,
44:56 become stretching, it is no longer to serve as a sphincter. All
45:01 , now, the somatic stimulation deals that external urethral sphincter. All
45:06 In other words, what it's saying , as a bladder fills, even
45:10 the internal sphincter relaxes, if I hold on to that smooth or if
45:15 can contract that skeletal muscle, nothing gonna pass out through the urethra.
45:20 right. But that leads us, , is we get to the point
45:23 the bladder is full. All so this is after the bladders
45:28 And this is where the MC tradition takes place. All right, There
45:32 basically four steps when you get to 200 or 300 mills. Alright,
45:37 pressure receptors inside the bladder send a to the ponds and say it's time
45:41 pee. The signal comes back down says through the parasympathetic fibers, begin
45:48 the muscles. Remember, sympathetic is the muscles to relax. Parasympathetic causes
45:52 muscles to contract. And so what do is you start squeezing on the
45:57 . What do we call that? , urge. Right When you need
46:01 pee, do you feel like you to pee, right? You feel
46:05 on your bladder. It's because you're the pressure on the bladder. And
46:09 it says it's time to pee. right, so we're going to cause
46:14 muscles to contract and that internally, sphincter to relax. All right,
46:20 to let it loose. But you're the middle of an exam and you
46:23 10 people on either side of You can't get up to pee.
46:26 not gonna pee in your chair, , so you can ignore it.
46:31 you have control over your skeletal muscle over the externally ritual sphincter. So
46:37 you ever noticed that if you ignore need to go the bathroom, it
46:39 of goes away after a couple of , right? And so then,
46:43 every 100 or 200 maybe even on top in 300 mills, you're gonna
46:48 that urge again and again and again again. All right. And so
46:53 idea here is that it's basically telling time to go. It's time to
46:56 . Time to go when it gets the point where the bladder can be
47:02 . So it basically doubles in That's when you don't have control
47:07 All right, Now, I know don't want to tell me this
47:10 but do you have that friend who's too much and then peed themselves?
47:14 you seen that now? Okay. very fortunate. Remember my generation little
47:19 different than yours. I had friends would get stinking blackout drunk. All
47:24 . And this is in New and they pass out and then wet
47:29 it be themselves, right? It's the body is processing, producing urine
47:35 There's nothing saying Control it and basically takes over. In other words,
47:41 it's a matter of will. All ? So you can try to challenge
47:46 . I'm not gonna pee today. gonna be a point where your body
47:49 gonna say, Yeah, no, gonna go ahead and p and you're
47:53 of luck. All right. So autonomic will take over and overcome the
48:01 . Alright, This one right I also want to point out you
48:05 avoid without this reflects. All So you can make yourself p.
48:10 all done it, right? I'm going to the doctor's office,
48:15 Said go pee in the cup. you just peed 10 minutes ago.
48:17 you still put a couple drops in cup? Yes, you can.
48:21 you could make yourself P if that work for if you never tried
48:25 remember when you go on out out your parents when you're younger and they'd
48:30 go pee, go to the bathroom now and go pee. But I
48:34 need to. Gopi Gopi. And go into the bathroom And what do
48:37 do? You peed is what you right? Because you can force
48:44 Basically, all you gotta do is the pressure on the bladder to initiate
48:48 response. Alright, We could Could literally squeeze each one of
48:53 Just squeeze you produce enough pressure on bladder and make your peak.
48:59 we're not going to do that, . Okay, Question from online This
49:05 , You think it Z So the is, does it when? When
49:12 pain comes from holding too long, think. And I'm just speaking,
49:17 just kind of looking at my own experience here. It's not the
49:20 really. The pain is in the . It's basically the muscles are have
49:25 in such a catatonic state their tetanus they've been kind of, you
49:30 fighting you. And so that's where pain comes from. That's my
49:36 Whether or not that's true. I , it's where you perceive it,
49:39 I don't think it's the kidneys. , because you're gonna pee. Let
49:44 just I'm gonna promise this to Okay? Your bladder is not gonna
49:49 to the point of rupturing. Your is gonna empty long before that
49:53 and you're not gonna have a choice the matter. All right, everyone's
50:01 to the bathroom. I'm looking at guys here where it's like that last
50:05 effort to please please get these pants before. And it's just like microseconds
50:12 . You know what I'm talking So everyone's laughing because it's like,
50:15 , it's happened. All right, right. So we've got about 30
50:19 here to deal with this last little . I know there was a lot
50:22 slides here, but remember, how just kind of boom, boom,
50:24 , boom boom. All right, last thing I want to deal with
50:27 regulating how the how the kidney regulates pressure through managing water, salt
50:36 All right, so first off um, conserve water. They know
50:42 to do that, But they cannot lost water. All right, so
50:46 what I said on on Thursday said moment that urine is made, it's
50:52 is what it is. It goes the bladder, as is. I
50:55 go to the bladder and say, , by the way, I'm
50:57 Now, let me go to the and let me pull extra water
51:00 You can't do that. All so the kidneys know how to conserve
51:04 while we're in a state of But once that water has been removed
51:08 the kidneys, it can't go back replace it. All right, So
51:13 do we get our water from? , we get it from food and
51:16 . All right, so just food actually has water in it.
51:20 why you don't always have to You may be short of water,
51:23 that's why you drink. But you necessarily have to drink if you're eating
51:27 because it's already there, unless you're something like beef jerky or something that
51:30 no water in it. All water is lost through the skin,
51:35 in the lungs. We've all seen when it gets cold, you breathe
51:38 you can see the water there. also urine, obviously is easy,
51:43 we don't always think about defecation. being, um, it's not just
51:48 waste. There's actually quite a bit water and that as well. What
51:53 your water gets too high? Body , he says. Let's get rid
51:56 water. That's kidney. Does it rid of, uh, the excess
52:00 while you're making I mean through the . Alright. But if water levels
52:05 too low, it just says hold . I'm not gonna let that water
52:09 . I'm going to pull it back the body to keep me hydrated.
52:15 , so that's what we're looking at how does the kidney do this?
52:20 what I want to remind you of that a similarity in the kidney?
52:24 ? Your body has this Osma Osma . General similarity as being 300 million
52:30 moles. Right? And I put two up here. What hyper tonic
52:34 high platonic are referencing relative to the clarity. So in order to remove
52:40 water, you need to have an that pulls water out of that
52:45 Right? So if I have excess inside the tube, you align Eden
52:49 around the tube. You'll that draws water out, right? What draws
52:55 ? Salt sodium. Right. So Yuria. Alright, so we're gonna
52:59 using these two things, but we're primarily focused on the sodium.
53:03 But what we're doing is we're creating environment that is hyper osmotic that draws
53:08 water towards it and if we look the kidneys. We said,
53:12 the cortex has a Osma clarity similar the rest of the body. But
53:15 was the medulla that had this weird int that went from about 300 to
53:20 1200 million Oz bowls. And that's the picture is trying to show
53:23 all right. And because we have Grady in, what we're gonna do
53:26 we're gonna drive the tube. You'll there. We're gonna use that environment
53:30 move water when it's necessary. All ? And so it's this Grady int
53:36 allows us to produce urine of varying and the concentrations air 100 to 1200
53:42 hospitals 100 means basically like water. means like thick, dense soup.
53:50 you're in soup, trying to make grossed to make you picture. Now
53:57 way this happens is through the loop Henle E. All right now we've
54:01 the loop of Henle Iate. We one that went really, really
54:04 We had one that didn't go so , right? So we're kind of
54:06 on the jokes of legendary nephew because easier to visualize. But this is
54:10 in the cortical. All right, called a counter current multiplier because the
54:15 flow reverses on itself and it does in two ways. You can see
54:20 the loop of Henle E. You see it goes down and then it
54:23 back up, right? So there's the one Luke. That's counter current
54:28 ones going up. One's going But then the bazaar ETA is counter
54:31 to that as well. So the director has blood flowing downward. And
54:37 the tube, you will. You Phil trait flowing upward. That's gonna
54:41 important in just a moment. That's current as well. You can see
54:45 on the other side. Look, flow is this way. And,
54:48 , the tubular flow is in the the descending direction. All right,
54:54 why it's called the multiplier is because we're gonna do, we're gonna look
54:58 the fluid, and it's going to its volume. It's constantly not it's
55:02 . Excuse me. It's concentration as goes through, all right. And
55:07 was, and the way that's a , because we're gonna be making exchange
55:11 the external environment and the internal environment right. So when you see those
55:17 , they're basically just describing the mechanism going on. I spend a lot
55:21 time talking about this mechanism, and may not even see a question on
55:24 test about the mechanism. It's just is the part. Remember I said
55:28 the kidneys hard. This is the part right here. And this is
55:31 most students, including myself, when sat in your seat, will do
55:34 . Put my fingers in my ears go la la la, la,
55:36 , la, la, la, What's on the test? But this
55:40 you how the kidney works. All , so here's the counter current mechanism
55:44 here. All right. You can it's the Jackson vegetarian Ephron. All
55:48 , you can see that we have going down and then returning on
55:52 going back up. All right. , what we're gonna do is we're
55:56 take advantage of the of the different of pumps that air found in the
56:03 as well as the different types of and where they're specifically located. And
56:09 because of their these these channels and pumps that allows us to move materials
56:14 the surrounding environment or back into the the tube. You'll that allows us
56:22 change what the water concentration is inside fluid, but also change the salt
56:32 out here so that it gets denser denser and denser as it as we're
56:37 far as solid is concerned, all , and then what the va's erected
56:42 . It allows us to ensure that maintained because it's also counter current as
56:47 . So here's Here's the characteristics that need to know. All right,
56:51 have the descending limb in the ace England, we could talk thickened
56:54 but I'm just gonna be real Let's just talk. Descending and
56:58 The descending limb is highly permeable. water all right, but it has
57:06 role in absorbing sodium. There no or carriers for sodium on the descending
57:11 , so water may Onley exit out the descending limb on the A,
57:19 limb what we have primarily in the regions. We have a pumps,
57:24 right, so we have a sodium that basically pumps up. Our sodium
57:28 chlorine follows in the lower regions, passive but the general gist of the
57:34 limb is we are actively moving sodium , but we lack mechanisms, forced
57:41 to move. And what do we about the relationship of sodium and
57:45 Wherever sodium goes, water follows. if I'm pumping salt out over
57:51 I need to balance it with Where do I Where do I get
57:54 water to balance it? It comes over here. And if water leaves
58:00 here, what happens to the concentration there? It increases. So I'm
58:08 Mawr and Mawr. I'm hyper And then what happens is because I'm
58:13 hyper osmotic when I get down to bottom in, that's going to drive
58:17 sodium out. So these two sides helping each other create an environment that
58:25 this Grady int all right Now, used to have a video on
58:32 I think I still do. You , you'll just have to check to
58:37 if there should come available today if there, all right? And
58:41 this is all it says is it this mechanism in action, alright?
58:46 how the grading has actually created I'm gonna ask you how the great names
58:50 created in the sense of describe it me. I need you to understand
58:56 for what it does. This Grady is there because it allows us to
59:03 the urine mawr or less concentrated, upon our state of hydration. All
59:09 , so that's what all this this you is, just shows you step
59:13 step as the fluid flows down and up. What is going on in
59:18 little red squares are basically saying, at the concentrations and how they're getting
59:23 know, more and more concentrated that down. So let's look at the
59:30 . The fluid starts out with the mas Malaria's the rest of the
59:35 As it travels down and water it becomes four times more concentrated.
59:42 you get to the bottom of the , right, because water is
59:45 Why does water leave? Because sodium being pumped out on the other
59:50 right? And then as you travel up as a sodium leaves, the
59:58 that ends up in the distal tubules become more dilute. From your starting
60:05 , you're more dilute by threefold, basically the fill trade at this point
60:13 incredibly watery. So the starting point Phil Trade before it's made in the
60:19 . That last little step is that more watery. So this is when
60:23 say that the kidney has a very mechanism to produce a water, a
60:29 . This is why. And so is why we're able to get rid
60:33 water so easily because we have this in place to already create a Phil
60:39 that is bore watery than when it . And it is an active process
60:46 we have pumps that are playing the in doing that. All right,
60:53 let's Sam dehydrated. All right? , look, if I'm hydrated,
60:57 just goes out and I'm getting rid a fluid that has the same Osma
61:03 . But when I'm dehydrated, when body needs to hold on to the
61:08 , what I'm gonna do is I'm change the ability to for water to
61:17 through that wall. In other I'm changing the permeability of the collecting
61:22 . You'll So if I need water I put aqua porn's in the
61:28 well, water is gonna move where is a higher solute concentration. And
61:34 I don't need that water well, don't allow the aqua porn's to be
61:38 place so the urine just passes and that's how I make varying
61:45 It's all going to be dependent upon hormones to tell me whether or not
61:50 need to put aqua Porn's into That hormone is that suppressing or anti
61:55 hormone, the anti peeing hormone. doesn't keep you from paying. It
62:00 you from producing urine. Now the CTA. Its job is to
62:07 So over here this is hypothetical. imagine blood vessels that traveled through the
62:15 from the cortex and medulla. What happen is because these air capital Aries
62:20 would move out to the sodium where sodium is, but then the sodium
62:24 recognize that it would need to move . And so what you would do
62:28 you destroy the Grady int that you created. So what the Va's erect
62:34 is it runs side by side, in the opposite direction, so that
62:38 it does is it still picks up and still kicks out salt. But
62:43 , when you get back the other the reverse happens. So what you
62:47 is you just kind of redistributing where water and the salute goes so that
62:50 helps balance out that Grady int. right, so the idea is is
62:57 , normally, I don't have another for this. All right? So
63:00 , normally, water would be if is the decent limb, water would
63:04 coming out, right. Salt can't in, Salt comes out over
63:11 So what I'm gonna do is I'm balance it out by pushing water
63:15 But then salt gets picked up and over and then maybe gets kicked out
63:19 there and transported out. So it redistributes where the ions are,
63:25 to ensure that as salt and water that that Grady int that I've established
63:31 maintained. Anyone here work retail? you ever worked retail? All
63:38 You're I mean, you guys are behind the counter, but if you've
63:41 had to stock something right, e mean, I'm thinking of like that
63:45 the gap or something like that because picks up a piece of clothing,
63:47 with them and drops it someplace right? It doesn't leave the story
63:51 gets redistributed, and it really pisses off because you can't find anything.
63:56 what is the what of the people work retail? Dio pick that
64:00 Go re fold it, put it back where it belongs. And that's
64:03 what the Va Zarek to doing is is it's not moving things outside of
64:07 kidney. It's just delivering nutrients and . It's just redistributing the water and
64:13 to maintain the environment that was That's what the Va's director does.
64:23 let's take a look last little bit . We're gonna look at these hormone
64:28 . It's fun to say it that . Hormone ease If you've ever seen
64:31 big fat Greek wedding. That's how aunt says that the hormone ease all
64:36 , the hormones that suppressing alright, diuretic hormone, alright, what it
64:40 . It acts on the distal uh, convoluted tubules of collecting
64:45 Normally, these are impermeable to right, except when vasopressin is
64:51 what it does is it causes aqua to be made and inserted into the
64:57 . Normally, Aqua Porn's are gonna stored away internally on vesicles, and
65:03 when the vast president comes along and , Hey, move up to the
65:07 now You got a local porn so could move, uh, in and
65:10 based on the direction of the concentration int. So this is the effect
65:14 it happens. So this is uh, vasopressin. This is
65:19 So let's look at without first, would be a state of hydration.
65:23 fill trait that comes through is 300 Cosmos gets out here the distal convoluted
65:27 , 120 oz. Moles, no porn's. So the fluid that leaves
65:32 a very, very low solute I would just say 120 but they
65:37 some other mechanisms that we're not. does that make sense? That suppression
65:42 the aqua porn's in place. That me to move water out of the
65:47 trait without vasopressin urine stays watery. , it is with the vasopressin 300
65:57 1 20 just like you saw. now I got aqua porn. So
66:00 does water do? It leaves following concentration. Grady INTs and I can
66:05 a urine that's very, very Mama tell you not to put salt
66:12 your food because it's bad for your . You ever heard that salt bad
66:18 you, right? It increases blood . That's what we train everybody.
66:23 reason is because of sodium load. load is how much salt is in
66:28 body. All right. Now, the proximal tubular in the loop of
66:33 , what we described is we basically we're constantly gonna be re absorbing
66:37 basically at a constant rate. The distal, convoluted tubules cares about
66:42 your actual sodium load is, and under control of hormones. And basically
66:47 it says is if I am having drop in blood pressure, If I
66:54 low hydration states, then what I to do is I need to put
66:59 into my body so I could increase blood pressure and maintain my hydration straight
67:04 . So what the body does is actually produces hormones that are gonna force
67:09 in the system that's responsible for moving or keeping water in the body is
67:14 the Renan Angiotensin Aldo Austrian system. right, so it's a combination of
67:21 things, Renan, angiotensin l'd Renan is not that way. Renan
67:29 the enzyme. Remember that is produced the granular cells. Alright. And
67:33 it's produced by the granular sells, it does is it goes out into
67:37 blood and its job is to start . Um, excuse me.
67:44 starts converting the plasma protein angiotensin login another molecule called angiotensin one. All
67:55 , so this occurs in response to drop in blood pressure. Lows are
68:03 . High salt in the fill trait , um, uh, low blood
68:10 . So has low blood pressure. e cf volume. And, um
68:15 I'm sorry. It's actually decreases insult the filtration, not the other way
68:19 . Sorry. All right. So gonna do is we're gonna start moving
68:22 in. And when I move what's gonna happen is water is gonna
68:25 . So that's really what we're trying get going on here now. Angiotensin
68:31 , which gets converted, angiotensin one into the lungs. So this was
68:35 to show you like it goes, , there's a better picture someplace
68:39 All right? It gets converted into two by ace angiotensin converting enzyme.
68:45 got a better picture, so we'll you the picture when I get
68:48 Alright, so gets converted. Angiotensin angiotensin two is what's responsible for secrete
68:54 Aldo Austrian Aldo Austrians produced in the glands. Alright and so it's Al
69:00 Trone that plays that role. What we say? Aldo Austrian did.
69:04 introduces sodium potassium pumps into the walls these tubular cells and it causes sodium
69:15 , re absorption and potassium secretion. ? So when I need to move
69:21 into the body, I'm gonna pump in. And so this is what
69:24 Strong is really doing. Also introduces channels eso that this is the key
69:30 right there and also the enact And so what we're doing is we're
69:33 more sodium into the body where sodium , water follows results in a rise
69:41 blood pressure. This is the picture trying to get to. So here's
69:45 Renan Renan converts angiotensin wanted angiotensin are angiotensin again. And thio 81 81
69:53 in the lungs. AnAnd's I'm, called ace. Angiotensin converting enzyme causes
70:00 change in angiotensin two. So it's that acts on the adrenal glands produces
70:06 Austro Nelda, Austrian. What does do? We lower sodium excretion.
70:12 , what we're doing is we're re sodium when I reabsorb sodium water is
70:18 . The end result is we increased volume. When I increased blood
70:23 I increased blood pressure. Good. not all act now and I'll throw
70:31 one more thing. See? See the sorts All right, angiotensin two
70:36 a couple of other things. It you thirsty when you're thirsty. What
70:41 you drink? You're supposed to drink , But that's not what we
70:46 We go drink sodas. Well, generation drink sodas, which is primarily
70:50 , which just causes a positive feedback of keeping me to drink sodas.
70:56 fact, that's one of the major of the soda industry is high salt
71:01 you thirsty, you know, makes I drink it, get a little
71:06 of satisfaction. But shortly thereafter, thirsty again. Drink again. So
71:10 and so forth. That's why. then, of course, with all
71:13 glucose and all the other horrible things fructose corn syrup, you're just basically
71:18 all bad. Don't drink. So from Saudi. All right, The
71:23 thing that stimulates vasopressin. What about do aqua porn's all right. So
71:31 we're doing is we're going to increase attention, right? We're putting the
71:36 or in the place of water The field trait goes back into the
71:40 and ultimately back into the body. right. It also causes vaso constriction
71:45 I have a zoo constriction. That's an increase in peripheral pressure. Noticed
71:50 goal here when I have low blood or low e c f. I'm
71:57 e c f. And I'm increasing . That's the big picture. That's
72:05 it all together. All right, just adding on now. If I
72:12 things on, what am I supposed do after I turn things on?
72:20 it off. You walk in the , you turn on the light,
72:24 leave the room, turn it right? Or dad gets mad.
72:30 turn on the air conditioner, you leave the house, you turn it
72:34 while you're away. And if you your blood pressure and you finally get
72:39 the point where your blood pressure where needs to be, turn it
72:44 Right? This is where atrial Your Riddick peptide comes in Alright.
72:51 you where it's made in the atria you what you do. Put the
72:56 in the P. If I put I keep sodium in the fill
73:01 what's water gonna do? It's going stay in the fill trade. So
73:05 gonna lower the volume and thus SCF . Basically, the role of A
73:11 P is to turn off everything All right, so it opposes our
73:17 s. All right. This causes increase in sodium excretion. If I
73:25 sodium excretion, I increase water What that means is I'm Lauren E
73:29 volume. That means I'm luring It also acts to inhibit the production
73:35 Rinnan renting his thing that starts the for Aldo Austrian angiotensin two. And
73:42 vasopressin. So A and P serves the negative regulator of all the other
73:49 . And the way that it gets on Is that the pressure in the
73:54 ? When it goes up, it that blood pressure has gone up.
73:58 this is where I'm going to turn off that zoo where I'm producing.
74:05 right? It also causes vaso Remember what we did was we called
74:10 constriction. So now we're doing vase dilation, and we're basically inhibiting sympathetic
74:17 . Alright. Sympathetic activity is what you know is basically trying to overcome
74:22 pressure. So those are your hormone . I call them the Four.
74:29 Four Horsemen of the Apocalypse. They start with the letter. A right
74:35 favor increasing blood pressure. One lowers pressure. And when I'm talking,
74:41 or decreasing blood pressure, we're talking term regulation. Not minute to
74:46 We're talking our our day to All right, So as over the
74:52 of day, if you don't have water, your blood pressure is gonna
74:55 because you're losing water volume. So this is the level that it's
75:01 at now. This is just some it with you. Information. Wherever
75:07 have a segment in the kidney that permeable to water salute, re absorption
75:16 is accompanied by water re absorption in . Wherever salt goes, water
75:23 Check why? Osmotic considerations. So something that we've all walked that you
75:29 walk out of here with, Solitude. Excretion. Right. So
75:35 you staying in the fill trait is accompanied by comparable water excretion. Why
75:43 followers are waterfall assault. All Why osmotic consideration now a loss or
75:51 a pure water that is not so those circumstances where it's not accompanied by
75:59 , increases or decreases. That's gonna to a change in your e cf
76:04 clarity. And that's when your body gonna have to start making adjustments.
76:09 right, now, here's an If you drink a whole bunch of
76:14 , does your body that's gonna cause increase in water volume in your body
76:20 it's gonna cause a decrease in your are similarity. Body doesn't want
76:24 So what's it gonna dio? It's to get rid of the water that's
76:27 Diary says. That's why you pee out. All right, that's an
76:32 one, right? If I drink much water i p at the
76:36 I think we all figured that one long time ago. All right,
76:40 there are conditions, for example, alcohol that actually play a role in
76:47 vasopressin. And so when you drink whole bunch of alcohol, do you
76:52 that you go to the bathroom a more? Yeah, right.
76:57 Because it's keeping the water in the trait, and your body is just
77:02 rid of that Phil trade. But can still become incredibly dehydrated as a
77:08 of that, right? In that's what a hangover is is just
77:14 . You wanna combat? I'm shouldn't giving you this kind of advice.
77:18 you want to combat hangovers, drink of water while you're drinking. All
77:25 . Doesn't mean you're not gonna get . Doesn't mean you're gonna not behave
77:29 a fool. What it means when you wake up the next
77:33 you're not gonna be praying for Well, you still might be praying
77:36 death, but it won't be a that you're wishing that wouldn't going
77:41 All right, it's simply because you're with the natural process. And if
77:49 ever gone to the beach and taking whole bunch of beer with you and
77:52 volleyball and play and stuff like that every time you get thirsty, you
77:55 more beer, more beer, more . At the end of the
77:57 you're just, like, dried and you can't figure out why.
78:02 , you sweat it out all the , but you are also just being
78:06 all out. Get dehydrate a lot so that there is the kidney,
78:12 kidney heart? No, not Just that little bit about the counter
78:17 mechanism. So what that means is that the remainder of the semester
78:22 downhill. This has put your feet . Put your heads back, kick
78:28 . Relax. We're gonna look at we eat food and processed food.
78:36 to class Thursday, having eaten because gonna talk about food. Any
78:48 No. Okay, well, with in mind, you guys have a
78:54 day. I will see you on trying to find all the different
79:00 you know, up that recording going
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