I first want to uh deal with the subject of water because after all we are 60% water um I don't know how many of you who want to go into Fields like nursing uh know just how important it is for nurses to track water balance in a patient uh you may or may not know that every time fluids are administered to a patient especially by IV drip so they have to the the nurse writes down what the volume of fluid was that was administered to the patient sometimes uh nurses are asked to measure the volume of urine that is excreted by the patient there's a measuring cup that's in the toilet and when the patient goes to a urinate it collects it in the cup and the nurse is supposed to measure and record right down how much fluid came out uh before they uh you know flush it down the toilet and obviously it's very important in terms of water balance you can't there has to be some relationship between the amount of water going into the patient and the amount of water coming out of the patient if there's a lot more water coming out than going in they're going to become dehydrated on the other hand if there's more water going in than coming out uh they're going to burst from too much water going in so the water balance is a very very important subject um we can estimate the tbw the total amount of water in somebody's body uh using this little simple formula that uh the total body water is 60% of the body weight expressed in kilograms now uh we're going to explain shortly why you have to use the body weight in kilograms and not pounds but before we do since this formula says we have to know uh uh if you wanted to calculate your own amount of water in your body you would multiply 60% times your body weight in kilograms the problem is most of us don't have uh scales at home that measure in kilograms they measure in pounds so we have to know how to convert from pounds to kilograms you learn how to do this in a chemistry course but we're going to remind you if you've had chemistry and if you haven't you'll learn it now uh the one the method you use that we're going to use commonly in this class is kind of this cancelling of units if uh let's just imagine somebody weighed 154 pounds all right so they weigh 154 pounds right you can figure out how much you in a way let's convert that to kilograms now what we do is when we want to convert from one unit to another we start out with this is what's given and the unit we want to get rid of we put in the denominator of a fraction this is a fraction and the top part's called the numerator and the bottom Parts called the denominator so we put pounds on the denominator that way the pound units will cancel out and we put in the numerator the new unit we want to convert to and that's kilograms we want to go from pounds to kilograms now we're all set to go except we just need to say State some true make some true relationship between pounds and kilograms those of you who had chemistry I'm sure learned that 1 kilogram is about 2.2 really 2.24 pounds so you should know that if you didn't know it before you know it now so on a test expect the expect a question and inally there study guide questions like this expect a question on the test where you have to convert from pounds to kilograms so um now uh let's uh multiply this out 154 * 1 is 154 4 / by 2.2 the pound units cancel out and it's kilogram now this is the point where everybody usually pulls out a calculator right and uh over the years I've seen students use calculators unfortunately this is commonly what it looks like to me I'll see a student basically trying to calculate this and it looks like this I'm looking I don't know what the hell they're doing all right I I have no idea they're punching in so many numbers I have no idea what they're doing before you you get use that calculator I strongly urge you to estimate what the number should be if we were dividing two into 150 what's two and 150 75 you should be able to know that the answer has to be about 7 all right now that you know it's about 75 now you can take your calculator 2.2 into 154 comes out 70 we knew the answer we estimated was going to be at 75 but it sure isn't seven or 700 and that's what I will sometimes see students give me an answer of seven or 700 now what they'll commonly say is wait a second Professor think don't I get partial credit I mean the decimal point was in the wrong place and my response is you killed your patient your patient is dead the most important part of any number is the decimal point that's what's important I would rather have you estimate 2 into 150 is 75 then tell me the right answer is 700 or 7 you're not going to kill anybody if the right answer 70 and you wrote 75 you can kill somebody if you wrote seven or 700 all right so what we're saying is somebody weighs 154 pounds weighs equivalent to 70 kg all right so now let's calculate the amount of water in that person's body 60% time 70 kilg because 60% of the body weight is is water now to convert from 60% percent to a decimal you move the decimal point two places to the left so 60% becomes 6 think about this isn't 50% the same as 0.5 all right so 50% is the same as 0.5 60% is 6 so 6 * 70 all right now 0.5 half of 70 would be 35 we know the right answer has to about be about 35 6 * 70 is 42 but it sure isn't 4.2 or 420 the decimal point is the most important thing about these numbers because then you're off by factors of 10 or 100 or a thousand or you've only given a tenth or a 100th or a thousand so again I'd rather have you estimate and be off a little bit then have that decimal point in the wrong place all right so what we're saying here is that uh if somebody weighs 70 kilogram 42 of their 70 kilograms in their body weight is water now why did the water body weight have to be expressed in kilograms why couldn't we have used pound and here's why when they designed the metric system they did something very clever one liter of fluid weighs one kilogram that's the way the system was designed L one liter of water or fluid in general weighs one kilogram there is no one toone relationship between a CT of water weighing one pound for sure it doesn't Okay so because there's this one toone relation relationship in the metric system that means that when we come back here if somebody if the fluid in their body weighs 42 kilograms which we calculated using their body weight then they have about 42 lers of fluid in their body all right so that's why we use it that way so uh that there's a onetoone relationship all right now if we look on the next page on page uh C2 so uh this is showing this is repr representing the fluid in our body by a rectangle okay so this represents the fluid in our body and uh you'll notice right up here at the top it uh even points out uh it says the total body water is 60% of the body weight I added kilograms and it says the normal volume is 42 L wait a second hold on wait a second when I gave the example on page C1 we calculated 42 lers on the assumption that somebody weighed 70 kilg or 154 PB they're saying on that diagram that there's normally 42 lers of water in somebody's body in other words I did not arbitrarily choose 70 kgrs or 154 pounds that number is the reference person so in fact if you look on this diagram let's read what it says right here in small print at the bottom fluid compartments of the body volumes are for the average 70 kilogram man now when you took Anatomy you learned in an anatomy class that there was an anatomic position you remember that a reference position so when you're explaining you know where your thumbs are compared your little fingers you know where they are depends upon which position your hand is turned but we know the reference or anatomic position is with the hands turned like this Palms forward well in physiology and Medicine there is a reference person and that reference person we always make reference to is a young adult man weighing 70 kg so now you know I when I use that example of 154 pounds 70 kg that I didn't just make that up that is our reference person so anytime we learn what a normal value is like the amount of water in the body it assumes the person is a young adult man weighing 70 kilograms that is our reference person this is also used in drugs in Pharmacology the reference person is a young adult man weighing 70 kilograms so when you read what the dose is that dose is for a young adult male weighing 70 kilogram that's not the dose of the drug you would give to a child it's not the dose you would give to an 80-year-old elderly person it's not the dose you would give to a small petite woman so that is the dose that is given to our reference person now the reason why they came up with this 70 kogam young adult Guy is when when they were learning what normal values were who did they originally obtain this data from so it's not like they had a lot of Volunteers in the 1940s and 1950s not like everybody was volunteering why don't you go and analyze me so they got what was normal from two sources they got them from young young uh young uh they got him from new Army recruits because when you join the Army or your draft it they give you a complete physical exam and so they assume they're dealing with relatively healthy people and they basically determine that the normal values for almost all these things in these approximately 154 pound 70 kilogram young adult guys that's how they were able to get find out what's normal what's uh the normal blood pressure what's the normal heart rate what's the normal body temperature what's the normal everything uh the second group they got the data from was first year medical students and in the 1940s and 1950s most firste medical students were young adult guys weighing about 70 kg now of course today whether we look at army recruits or first year medical students uh you know there's plenty of women so we know what normal values are for women today as well as guys but nevertheless they still in all the books in physiology and medical books all books anytime they are telling you what's normal it is for a young ad adult Gody now you might say well why don't they tell us what it is for a young adult woman and be because the values are different let me show you how they're different the normal lung volume of a guy young adult guy normal lung volume is six lers the normal lung volume of women young ad women is about four lers that's a difference of two laders now you might say okay so I'll just take the average well the average of six and four is five but if you memorize five laders that's not normal for either one if you've memorized five as the normal then that's really less than normal for what guy should be and more than normal for women what you really need to do is memorize both sets of values nobody wants to memorize two sets of values all right it's hard enough to remember one set of values so even though we do know all this information now we still tradition Ally in all the books tell you the normal value for young adult guys and really there's more than just two sets of values because the values change our entire life the uh a normal resting heart rate for guys in their 20s is about 70 to 75 beats a minute does anybody have any idea what the normal heart rate is of an infant 12 about 120 beats a minute so you know don't think that when you memorize and we learn the normal heart rate 75 that's not what our normal heart rate is of an infant and it changes your whole life it becomes changes all everything blood pressure heart rate uh lung volumes everything changes as we go from infancy to Childhood to adolescence our teen years to young adults to middle-aged adults to elderly people in women it changes during pregnancy the normal values for heart rate and blood pressure change between the first trimester the second trimester and the third trimester of pregnancy so it's not just one value or two values or three values it's an infinite number of values so nobody can memorize them all so what we do is we learn one set of values and then when you're dealing with an 80y old woman you're going to look it up what's normal now it's on the computer uh uh you if you're dealing with an 11-year-old uh boy you're going to find out you'll use the computer system to tell you what the normal values would be for 11y old boy so uh and all of these are affected not only by the age of the person by their gender male or female by their size obviously somebody who even a young adult guy uh there's a difference between a guy who's uh weighs 120 pounds who's 5'4 and somebody who's 6' 7 7 foot2 and weighing 320 pounds these have these are very different guys they're very different women in terms of their size all of these also affect our drug dosing so drug dosing there are various formulas that are used to adjust the drug dosage for the person your patient who your patient is so we do not treat ideally you don't treat everybody the same way you you give them the right treatment for who they are and uh this based on gender based based on Age based on height based on weight and so on and there are various formulas for adjusting all this stuff so I just point this out but everything we're going to learn in this class is for young adult guys because we got to start somewhere all right now uh what this diagram indicates is this is the total amount of water in the body now this indicates that two3 approximately 2third of the tbw the toal body water is inside cells intracellular fluid the remaining oneir oneir of the total body water is extracellular fluid outside the cells so we can actually estimate once we know the total body water we can estimate the intracellular fluid volume or the extracellular fluid volume look let's go back to the previous page page C1 at the bottom of page C1 so let's estimate the amount of fluid that's inside the person cells it is about two ICF is a two approximately 2/3 times the total body water in our reference person who weighs 70 kilg he had 42 L of water in his body 2/3 * 42 is 2 * 42 is 84 divided 3 or 28 l so of the 42 l in his body 28 2ir of it is inside his cells I would strongly recommend you try calculating these same things for yourself all right so you because I'm going to give you questions like that on the test all right this was just for a reference person now uh on page C3 the extra cellular fluid is about onethird of the total body water so for a reference person if they have 42 L of water in their body 1/3 * 42 is 42 / 3 or 14 L of fluid is extracellular outside their cells now there are different types of extracellular fluids there different types of extracellular fluids but let's go back uh here to the diagram and we see that there are different types of extracellular fluids there's something called tissue fluid something called transcellular fluids and something called blood plasma these are three different types of extra cellular fluids let's try to convey what this means let's look at the bottom picture the bottom picture is just showing a tissue from the body this represents any part of your body this could be liver tissue this could be pancreatic tissue this could be kidney tissue this could be muscle tissue it could be any tissue in the body so any tissue is made up of tissue cells these are the cells maybe they're liver cells maybe they're pancreas cells maybe they're thyroid cells maybe their stomach cells maybe their muscle cells doesn't matter inside the cells is intracellular fluid ICF surrounding the cells is what we call tissue fluid which is a type of extracellular fluid so what is tissue fluid it is the fluid surround in tissue cells didn't haven't we learned that all living cells must be surrounded by fluid you'd say when did you tell us this go back to page B1 page B1 you drew a picture of a cell and that's where you wrote down cytoplasm is 80% water and all living cells are surrounded by extracellular fluid called tissue fluid hb1 now we've talked about intracellular fluid inside the cells and tissue fluid which is an extracellular extracellular means outside the cells in close proximity to all tissue cells are blood vessels here's a capillary here's a capillary capillaries we know are going to are the way that that we deliver nutrients and uh to the cells and carry away waste products away from the cells what's inside blood vessels blood all right what is blood whole blood is made up of two things blood cells and fluid called plasma that's what's in blood vessels blood cells and plasma all right now the blood most of the blood cells are red blood cells we have far far fewer white blood cells than red blood cells we measure red blood cell counts in the Millions uh and we measure white blood cells in the thousands now obviously inside a red blood cell is intracellular fluid right that's inside the cell um the surrounding the blood cells is extracellular fluid fluid outside the cells but we give a special name to the extracellular fluid around blood cells compared to the extracellular fluid around regular tissu cells surrounding tissue cells we call it tissue fluid but surrounding blood cells we call it plasma plasma is the extracellular fluid surrounding blood cells and it is confined to the blood vessels so in the diagram above so far we've seen the distinction between what we call tissue fluid which is the extracellular fluid around most cells of the body and blood plasma which is the name for the extracellular fluid around blood cells now there's one more category of extracellular fluid it's called transcellular fluids what are transcellular fluids well first of all let's look on page C3 on C3 so you'll notice on C3 we've listed extracellular fluids and then here's these three that we've been mentioning tissue fluid transcellular fluids and blood plas now tissue fluid is also known as interstial fluid or intercellular fluid in fact most nursing books call tissue fluid interstial fluid that's the term used in all nursing books why is it called that interstial means between the spaces between the spaces of the cells there's this tissue fluid interstial fluid it's also called inter cellular inter means between between the cells so tissue fluid is the fluid between tissue cells between the spaces of the cells no make sure you know that all three of those terms mean the same thing again in the future your clinical courses they're going to use the term interstitial fluid now what are transcellular fluids transcellular fluids are also extracellular they are outside the cells but they are located in specific anatomic areas they are located in specific anatomic areas in specific anatomic areas you might say what does that mean all right let me give you a really easy example to start with let's look at the last uh of these transcellular fluids intraocular fluid you'd say what's that that's the fluid in your eyeball some of you in anatomy might have heard the terms aquous humor and Vitus humor whether you heard those terms or not we will be learning them in this class but those are the fluids that are in your eyeball they're outside cells that's not the fluid inside cells but it is contained in your eyeball it is an extracellular fluid localized anatomically in your eyeball other examples of extracellular fluids located in specific anatomic areas is cerebrospinal fluid you may have heard of that whether you have or not we'll be reviewing it at another time that's the fluid on the outside of your brain and spinal cord there's about 100 milliliters of cerebros spinal fluid surrounding your brain and spinal cord it's actually made made within your brain but it circulates on the outside of your brain and spinal cord it is outside the cells but and it is confined within your skull and your vertebral column it's contained around your brain and spinal cord another example is you all know this from Anatomy syoval fluid you learned about sovial joints such as the knee joint and so you know that there is this kind of slippery fluid that is found within a sovial or movable joint and sometimes there can be a buildup if there's injury or trauma to the knee there's a buildup of that sovial fluid that is a transcellular fluid it is an extracellular fluid that is localized in a specific anatomic place all right anatomic location other examples are slippery Cirrus fluids I call them fluids um the uh for example perianal fluid perianal fluid is secreted by perianal membranes in your abdomen and so we this is a fluid in your abdominal cavity it is confined and located in the abdominal cavity it's called perianal fluid um sometimes there may be a buildup of excessive amounts of this perianal fluid does anybody know what that's called called it's actually written right here it's called aides any ever heard that term aides is the name for a buildup of abdominal or perianal fluid aites a c t s uh there uh plural fluid what's plural fluid where's that located anybody know that's in the chest that's around the lungs so there is fluid around the lungs confined within the chest cab it's actually produced by plural membranes and so you can have a build up a plural fluid all of these are examples of extracellular fluids that are localized in specific anatomic areas all right they're confined they're confined now uh where we're going with this is you can have problems you can either have an excess or deficiency of fluids in any of these different compartments or places you can have a buildup of sovial fluid or intraocular fluid or cerebros spinal fluid question no a scientist aites is a buildup of perianal fluid fluid in the abdomen so uh do anybody know what they call the condition with the buildup of cerebros spinal fluid SP no hydril which literally means Hydro water sealc brain water on the bra brain uh you've heard of buildup of sovial fluid after injury to a knee right where it has to be drained uh anybody know what it's called when you have a increased buildup of fluid and pressure in the eye it's called glaucoma glaucoma all right so you can have problems in all these different fluid compartments as far as what's going on all right uh these are called uh transcellular fluids and then we have blood plasma blood plasma we've said is the name for this extracellular fluid surrounding blood cells that circulates in the blood vessels of our body now um just going back to our diagram here on the previous page I drew some arrows in this diagram to indicate that fluid can move from one compartment to another so I've got arrows going back and forth here and back and forth here and back and forth here and back and forth here and back and forth here you might say I don't get that what do you mean okay let's help you uh understand this better by showing you something more anatomic this is kind of more like anatomy and the other above is more physiology all right so looking at the anatomy if we started to have increased amounts of plasma fluid moving out of the bloodstream into to the area around the cells that would increase the amount of tissue fluid that's commonly known just as edema or swelling so edema or swelling is when we get increased flow or movement of fluid out of the bloodstream the plasma into the tissue fluid and we get this swelling that can occur anywhere in the body you can have edema or swelling in your feet right anybody ever have Emer swelling in your feet you can have Emer swelling in any part of your body in an arm anywhere uh an organ uh we could have the fluid moving in the reverse direction we can have fluid moving out of the cells into the tissue fluid and from the tissue fluid moving into the bloodstream so the cells would start to shrivel up and there's be a decrease in tissue fluid as the fluid moves into the bloodstream that's actually what happens with dehydration with dehydration when somebody's dehydrated the the the fluid in the cells and surrounding the cells is decreasing so the cells are all dehydrated um all right so this fluid that's what we indicated here this fluid can move fluid can move out of the bloodstream into the tissue fluid and then into the cells or vice versa it can move from the cells into the tissue fluid and into the bloodstream it can move from the bloodstream into the transcellular fluid compartments that's what happens commonly with trauma or injury trauma is injury when you injure the knee fluid from the bloodstream starts to flow into the knee joint this increasing synovial fluid in the knee joint uh when you have injury to the head trauma or injury to the Head causes an increased movement of fluid from the bloodstream into the cerebros spinal fluid and you get swelling increased fluids uh build up around the brain and that's called cerebro edema okay swelling in the brain so anytime typically there's injury or trauma it does cause changes in the flow of fluid in the body I think you're getting a sense physiology is very different than Anatomy but it's really clinically relevant to how the whole thing works um the uh now uh we wrote here on page C3 on page C3 how do you estimate theal total blood volume in the body now this is another thing you should know how to estimate total blood volume you'd say why well look if somebody needs blood shouldn't you know about how much blood they should normally have in their body or you just keep pumping it in until they burst in other words we need to estimate what's their normal blood volume and we're going to give them replacement volume of fluid or blood we don't just keep pumping it in in there uh no matter how big of a person they are so the blood volume like most things in our body is proportionate to our size to our weight and our tbv or total blood volume don't confuse that with total body water tbw the total blood volume is approximately 8% of our body weight expressed in kilograms now where did we get this number 8% so I wrote up here that what since whole blood is made up of blood cells mostly red blood cells and plasma our uh the blood cells make up about 3% of our body weight expressed in kilograms and our blood plasma makes up about 5% of our body weight expressed in kilograms so since whole blood is both blood cells and plasma what's 3 + 5 %. so 8% of our body weight is our blood volume approximately so now to convert from percent to decimal you move the decimal point two places to the left so 8% becomes .08 You' say I don't get that okay well think about this if it was 10% wouldn't 10% be 0.1 one1 right 0.1 so if 10% becomes 0.1 8% Which is less than 10% is 0.08 it's got to be less than 0.1 08 if you think this through if you're kind of thinking you're not going to make mistakes if you don't think and assume your calculator knows everything you will make mistakes because calculators are no smarter than when we Empower them and just punch numbers in and we're not thinking about what's what's going in anyhow so it let's estimate the answer before we take our calculator and multiply 008 time 70 that's our reference person weigh 70 k kilg if uh the blood volume was 10% or 0.1 of 70 0.1 of 70 would be seven so we know the right answer has to be about about seven now we can use our calculator multiply 08 * 70 and get 5.6 but if you write 056 or 56 you're not even thinking because we estimated that it had to be around seven so it couldn't possibly be 56 56 I only mention this because these are kinds of answers I've seen all right so uh if this means that if we weigh 70 kilograms 5.6 kilograms of our body weight is our blood our whole blood and since there's a approximately a one to one relationship between weight and volume in the metric system there's about 5.6 lers of blood in our body most adults have somewhere between five to six liters of blood five to six L of blood but obviously it's proportional to your body weight if you're a child obviously you weigh less and your blood volume smaller if you're a uh if you're a 6 foot5 350 pound uh uh halfback for the Green Bay Packers uh then your blood volume is significantly bigger now uh I'm sure some of you have donated blood before and when you donate blood they typically draw withdraw one pint they call it a unit of blood one pint or 500 milliliters half a liter of blood so they call it a pint a pint of blood uh so when you donated blood you give gave that pint that unit of blood I mean so what did they take from you did you give them half your blood volume okay so let's let's approximate what you gave 5.6 lers in our reference band is about 5.6 quarts uh you may remember from uh chemistry and biology that one a quart one liter is 1.06 quarts right so a liter is just ever so slightly more than a quart you we can think of them is almost the same so if there's 5.6 liters of blood in your body there's 5.6 quarts of blood but let's just uh round it off to make the numbers really simple let's just say five okay so you have five quarts of blood really you got more than that but let's say five quarts here's a a English conversion one quart is two pints most people don't know that it's no so you if you're buying milk at the market you can either get one quart or two pints they mean the same thing so uh if one quart is two pints five quarts is two time five 10 pints so you've got about 10 or 12 pints of blood in your body so when you donate one pint you are giving less than one tenth of your blood volume because you really had more than 10 10 pints 10% you're giving about 10% or really less they don't want to they always want to take one pint they feel that if they take less than a pint it's not even worth doing they don't want to take a fraction of a pint and so because they do not want to take more than one tenth of your blood volume that's why some of you know that a person who weighs less than 100 pounds doesn't give blood anybody know that if you weigh less than 100 pounds they won't they won't take your blood because since your blood volume is proportional to your body weight if they take a pint of blood from somebody weighing less than 100 pounds they'd be taking more than one/ tenth of their blood volume and they don't want to do that so that's why they have that rule if you're very petite to less than 100 pounds they won't take your blood in other words when you donate blood you've given 10% or less if you gave twice that or lost that twice that volume you lost a liter of blood a quart of blood then you need medical attention on page C5 so this uh says distribution of electrolytes now electrolytes you'll recall are electrically charged chemicals chemicals with an electric charge also known as in organic ions or minerals now uh this was a low chart and I kind of turn this into a cell all right here's a cell there's its nucleus these are the major electrolytes in the ICF the intracellular fluid of the cytoplasm these are the major electrolytes electrically charged chemicals in the ECF the extracellular fluid the fluid on the outside of the cells there are major differences we see that among the univalent cats you'd say what is that a cation has a t which looks like a plus sign univalent means plus one so among the plus one chemicals most of the plus one or univalent CH uh ions that are inside the cell are potassium but most of the univalent cations in the outside of the cell are sodium now we I I'm not yet explaining what that means or what that's for that's what we're going to be learning but the most of the pottassium in our body is in our cells in the intracellular fluid most of the sodium in our body is in the extracellular fluid among the DI veent cat I plus two charge uh uh ions or electrolytes the major divalent cation on the inside of the cell is magnesium the major divalent cation in the extracellular fluid is calcium again we haven't explained what that's for what but there we're simply pointing out there's a difference in the chemical composition of the fluid inside cells versus the fluid outside cells of the negative charg anions an I have a negative charge the major anions in the extracellular fluid are negative charge chloride and bicarbonate bicarbonate those are the major an ions in the extracellular fluid notice that what we're saying in the extracellular fluid there's a lot of sodium and chloride in other words salt in the extracellular fluid and there's sodium bicarbonate sodium bicarbonate now anybody who's had biology Andor chemistry knows what sodium bicarbonate is or bicarbonate it is a buffer buffers reduce acidity or alkalinity so the major buffer that regulates that's involved in maintaining our pH is sodium bicarbonate or bicarbonate that's the buffer in the extracellular fluid the major anions or NE ative charged chemicals inside cells are negatively polarized phosphate because there's a lot of phosphate in cells for nucleotides and phospholipids and Denine triphosphate and Hine diphosphate and a lot of negatively polarized proteins now most proteins have a slight negative polarity amino acids there are some amino acids that have a positive polarity some have a negative polarity and uh overall most proteins have more amino acids with a negative polarity than positive polarity so overall they have a negative polarity we'll talk more about that later in the course when we talk about electroforesis where proteins move towards a positive pole an electr partic device all right so most proteins have an overall negative polarity now we're going to be right now this is all you need to know about the differences in the electrolytes between what's inside cells and outside cells we're going going to be quantifying this let's show you what I mean look on the previous page at the top C4 all right on page C4 at the top these are the real numbers that we will be learning at least some of these first of all what this shows here it lists the various electrolytes positive charg cation negative charged anions and it gives their actual concentrations in the units Milly equivalents per liter in the intracellular fluid in the tissue fluid and in the blood plasma all right but you'll notice that inside cells there's just a low amount of sodium but there's a significantly high amount of pottassium there's a low amount of calcium but a high amount of relatively speaking magnesium that's what I summarized on the next page you'll notice that among the negative charges there's a significant amount of phosphate and there's also quite a bit of protein which has a negative polarity now tissue fluid and blood plasma are both extra cellular fluids right these are two different extracellular fluid compartments what we notice looking at the numbers is that by and large they're pretty similar almost identical almost identical notice high amounts of sodium in both tissue fluid and blood plasma extracellular fluids in both cases low in potassium uh you'll notice that in both cases high in chloride but uh low in say h phosphate there is one major difference in the uh electrolytes of uh tissue fluid and blood plasma and that big difference is protein you'll notice there's normally zero protein in the tissue fluid but there is a sizable amount of protein in blood plasma now in fact let's go back to C2 back on page C2 on C2 this diagram is shaded in to reflect prot protein levels You' say what do you mean you'll notice right here on the intracellular fluid uh it's shaded in Darkly to represent there's a high amount of protein inside cells after all inside cells are where proteins are manufactured right proteins are synthesized inside cells so whether there's a lot of protein in C plasm it's mostly watered protein notice it's clear in tissue fluid transcellular fluid to represent that the fact that there is normally zero protein in tissue fluid and zero protein in transcellular fluids such as cerebrospinal fluid such as perianal fluid zero protein but you'll notice for blood plasma there's dots to represent proteins not as much protein is inside the cell where it's shaded Darkly but there is protein in plasma there was no protein and tissue fluid or transcellular fluids these are called plasma proteins where did they come from they are mostly secreted by your liver your liver is the major source of these plasma proteins these plasma proteins include albumin they include the blood clotting proteins they include many many other proteins circulating in our bloodstream they are produced largely by our liver good so should we know that yes you okay this is why we're going to see in the future that when somebody has liver disease their plasma protein levels Dr because these proteins are largely made by their liver