hey guys it's miragosa's perfectionist where medicine makes perfect sense and we continue our physiology playlist this is the 24th video in the previous video we have discussed fix principle today i'll talk about the donon's equilibrium or the donon's effect first i'll explain it like your woke professor with his powerpoint and then i'll make you understand and then we'll go to the ultimate level of medicos's wisdom and at that level you will never forget it first let's answer the questions of the last video how many types of atp's pump do you have and match the number here with the type of transport enters you have four types of atp in your body sodium potassium atpase in every single sinking cell calcium atp is in muscle cells hydrogen atpase is in the kidney hydrogen potassium atpase is found in two locations number one in your stomach this is the proton pump that you inhibit using the proton pump inhibitor such as omeprazole lansoprazole etc and this same pump is also found in the kidney next question as you see one here this is what simple diffusion no carrier no atpase how about two this is the primary act of transport primary sodium potassium atpase how about three this is secondary active transport secondary to the primary it depends on the primary this is what you call the sodium calcium exchanger or sodium calcium antiport or sodium calcium counter transport how about four four is the paracellular route this is simple diffusion next question how many liters of normal saline do you have to infuse into a patient in order to deliver just one liter to his or her plasma compartment assuming that he is an average dude with a weight of 60 kilograms and here is how you do it jeffrey when you infuse the normal saline you'll infuse it all intravenously no kidding this is the plasma compartment okay and as you know plasma is just one two three interstitial space so intercessor space is 3 4 of the extracellular fluid and the plasma is just 1 4. since the plasma is only one-fourth of the extracellular fluid here's how you do it one-fourth of x equals one liter therefore x equals four stinking liters and this is the answer think about it let's say you gave four liters to this patient oh the fluid will flow between the plasma and the interstitial space until we achieve equilibrium which will happen when the interstitial space has a 3 4 ie 3 liters and the plasma will only have 1 liter which is what's required great by why wouldn't the fluid go from the extracellular space to the intracellular space because you did not change the tonicity doofus you gave a normal saline which has the same osmolality as your freaking body now the donon's equilibrium or the gibbs don law or effect let me do it like your professor okay it's defined as the presence of non-diffusible ions on one side of the membrane this will affect the distribution of diffusible ions on both sides of the semi-permeable membrane and this is the case before equilibrium and this is the case at or after equilibrium okay do you understand anything no now let's do it the mitochosis way first what the flip do we mean by the non-diffusible ions ions that cannot diffuse through a semi-permeable membrane what are these these are plasma proteins they cannot pass through the membrane they are too big great what are the diffusible ions this is your sodium and chloride they can diffuse they are small next do you consider plasma proteins to be positively charged or negatively charged if you remember my video on electrophoresis when we talked about multiple myeloma in my glorious hematology playlist i've told you that this is how we do the serum protein electrophoresis you put the stinking proteins here and suddenly you'll see them repel from the negative electrode and go towards the positive electrode since they migrate towards the positive electrode and you know from physics that opposites attract this is positive therefore the plasma proteins have to be negative they are anions because they are attracted to the anode okay mitochosis but what is the doneness equilibrium first let's do some housekeeping remember my friend that we have only two forces that move ions only two the concentration gradient and the electrical gradient concentration grid from high concentration to low concentration cool how about extra gradient from positive to negative or vice versa positives attract and likes repel donand's equilibrium is how can we reconcile between these two forces here is how it happens before the donna's equilibrium it looks like this in the protein compartment which is in the blood vessel because this is the only compartment that has plasma proteins because plasma proteins are too big to pass we have nine plasma protein particles and as you know plasma proteins are negative therefore you have to have nine positive something oh in this case it's the sodium cool and inside the cell you have nine sodiums and nine chloride wonderful now look here at equilibrium or after the doneness equilibrium what happened oh the proteins have rigged the game first let's focus on one aspect and one aspect only regarding the concentration gradient hey sodium would you rather go this way or this way huh since i have 12 sodiums here and six sodiums here i'd rather go this way down the concentration gradient thank you but the concentration gradient is not the only game in town we also have the electrical gradient hey sodium when it comes to electrical gradient would you rather go towards the protein compartment or towards the non-protein compartment okay let me think here i have only six negatives to attract me but look at here i have three plus nine equals 12 negatives to attract me therefore i'll go from the non-protein compartment to the protein compartment at a certain point these two opposite forces will equalize equalize equilibrium this is the donna's equilibrium okay miracles but what do i have to gain oh six consequences all kinds of gains three equalities and three inequalities let's start with the three equalities the concentration gradient of sodium equals the electrical gradient of sodium yep this happened exactly at equilibrium number two positive charges and negative charges are equal in each compartment oh so you talk about this compartment alone and then we talk about this compartment on its own let's start with the protein compartment can the positive charges please only twelve how about the negative charges nine plus three equals twelve oh positive equals negative perfecto let's go to the non-protein compartments you have six negative and six positive awesome equality number three the product oh multiplication ooh sodium and chloride in the protein compartment equals the product of sodium and chloride in the non-protein compartments let's verify 3 times 12 equals 36 6 times x equals 36 beautimus now the three inequalities the sum oh addition of sodium and chloride in the protein compartment is greater than the sum of sodium and chloride in the non-protein compartment let's verify 3 plus 12 equals 15 but 6 plus 6 is only 12. oh yeah therefore if you have 15 here but 12 here in other words if the number the number of particles is greater here than here therefore the osmotic pressure which cares about the number not the size the number is going to be greater in the protein compartment than than a protein compartment which results in water shift from the non-protein compartment and towards the protein compartment and this is the beauty of the donuts equilibrium we have six consequences of the donand's equilibrium one two five is bs six is huge six is the water shift from the non-protein compartment into the protein compartment from within the cell and into the plasma so we have done it like your professor and then we understood it now let's go to wisdom baby okay smart cookie please summarize physiology to me in just one word what in the world um maybe this is um homeostasis perfect how about pathology in one word um i don't know lack of homeostasis wow you have some potential summarize internal medicine to me just in one word ooh the answer is hypoperfusion you don't believe me consider this hypoperfusion to your heart equals stable angina or unstable engine or non-stemi or god help you the dreaded evil st elevation myocardial infarction hypoperfection to your brain you get tia or worse ischemic stroke the difference is tia is reversible ischemic stroke is irreversible oh medicosis but my professor added that tia happens in less than 24 hours ischemic stroke fits for more than 24 hours um your professor hasn't opened a textbook for 10 plus years shame on him and the horse that i'm sorry too far hypoperfusion to your kidney your kidney will suffer from pre-renal aesotemia which is an acute adrenal failure or now known as acute kidney injury hypoperfusion to your lung your lung can get rid information because of the dual blood supply hypoperfusion to your gut you get mesenteric ischemia hypoperfusion to your hands you get renault's phenomenon it's red white and blue hypoperfusion to your liver you get ischemic hepatitis to your biliary system you get a calcius cholecystitis hypoperfusion to your pituitary gland you get shihan postpartum necrosis ocean syndrome and please don't forget that shock by definition is tissue hypoperfusion and this is internal medicine in just one slide yeah baby and that's why the donuts equilibrium is doozy it takes water from your cell to your blood in order to perfuse your organs without your donan's equilibrium and your oncotic pressure your heart is history your brain is a mystery your kidney is screwed and your gut is bending over backwards your hand is patriotic your bile is full of stones and mommy cannot lactate now you understand and contemplate the significance of the donnans equilibrium now the next segment is a joke not to be taken seriously i'm just using it as a segue to my analogy towards the donovan's equilibrium so please don't say in the comment section oh but of course how dare you say such a thing i disagree with you vehemently shut up get your head out here spanker it's a joke in 1979 phil donahue interviewed the nobel prize winning economist milton friedman fell said quote when you see the desperate plight of millions of people in underdeveloped countries when you say the great and concentration of power within it did you ever have a moment of doubt about capitalism the famous economist replied first of all tell me is there some society you know that doesn't run on greed you think russia doesn't run on greed you think china doesn't run in greed what is greed of course none of us are greedy so the other fellow is greedy the world runs on individuals pursuing their own self-interest the great achievement of civilization have not come from government bureaus einstein didn't construct his theory under order from a bureaucrat henry iv did not revolutionize the automobile industry that way and here are my two cents dr nazeeb didn't revolutionize medical education and help millions of students around the globe under an order from the ministry of education the only cases in recorded history in which the masses have escaped from the kind of grinding poverty that you're talking about is where they have had capitalism and luxury free trade a similar theory is presented in dr thomas's book basic economics imagine that three weeks ago you went to fix falafel and you realize that the falafel sandwich has increased from five dollars a sandwich into nine dollars oh it's because they are greedy imagine that this week he went to the same store and now they have buy one get one free at five dollars what happened what's your theory now did they become generous over time did they suddenly convert an atone and change from devils to angels or maybe it is something more fundamental than that supply and demand this is basic economics shut up medicosis just tell me what are you trying to say i'm trying to say that people act in their own self-interest okay what the flip does that have to do with the donuts equilibrium that plasma proteins are acting in their own self-interest how we have established that perfusion is paramount for the survival of your organs and therefore we need the water to flow from the non-protein compartment into the protein compartment and maintain an effective arterial blood volume to perfuse these doozy organs cool do you know what determines the flow of water number one the oncotic pressure because there are plasma proteins here but not here therefore water flow from here to here number two the donnans equilibrium the proteins have literally rigged the system so that there are more ions here than here 15 versus 12 so water will flow from here to here the plasma proteins are acting in their own self-interest so next time when your professor asks you hey hey student stand up what is the donald's equilibrium with such unction in his voice in your mind donons should disappear and friedman should appear the proteins are acting in their own self-errors oh the presence of non-diffusible ions proteins on one side of the membrane affects the distribution of the diffusible ions sodium and chloride here is 15 but here is only 12 on both sides of semi-permeable membrane and this is one of the forces that allow the water to flow from the non-protein compartment into the protein compartment maintaining an effective arterial blood volume sufficient for tissue perfusion and that's it if your woke professor explain it like this i will retire from youtube and work as a whopper flopper today's question imagine that you have protein compartment and non-protein compartment you had six plasma protein particles in the non-protein compartments you had four chlorides and four sodium in the protein compartment you had two chlorides and how many sodium at equilibrium please answer this question in the comment section you will find the correct answer in the next video i love you guys please subscribe hit the bell and click on the join button you can support me here or here go to my website to get my electrolytes course and my antibiotics course thank you for watching as always be safe stay happy and study hard this is medicos's perfectionist where medicine makes perfect sense