-
-
Now let's say that you
have a vial of plasma.
-
And I'm actually going
to label it as we go.
-
We've got some sodium
floating in here
-
and you've got some anion
in purple over here.
-
And this could be anything
that really binds to sodium.
-
So if this is some negatively
charged ion, maybe chloride,
-
or bicarb, those are
the two most common.
-
And you've also got, let's
say, some glucose in here.
-
And maybe some urea, or we
call it urea nitrogen as well.
-
So you've got a few things
floating around the plasma
-
and someone asks
you, well, what is
-
the total osmolarity
of the plasma?
-
And you know that
this is in units
-
of osmoles per liter
blood, Actually,
-
I should write liter
plasma to be more accurate.
-
Since that's what we're
talking about here.
-
So per one liter of plasma.
-
And these are the units
that we have to think about
-
to answer this
question, is, what
-
are the osmoles per
liter of plasma?
-
So let's go through this.
-
And I'm going to give
you some lab values
-
and we'll see how based on just
a few lab values and really
-
just four of the most
representative solutes,
-
or most important
solutes, we can
-
get a pretty close
guesstimate of the osmolarity.
-
So you don't actually need to
know every single osmole that's
-
in your plasma.
-
You can figure it
out based on four
-
of the most important ones.
-
So let's go with the
first one, sodium.
-
-
And let's say the lab tells
you, well, your sodium value--
-
and I'm going to write the labs
in kind of this grey color,
-
somehow that reminds
me of the lab--
-
let's say they say the sodium
value is 140 milliequivalents
-
per liter.
-
So how do you take that and
make it into osmoles per liter?
-
Well, our denominator
is already OK.
-
But immediately, you can
say, OK, well 140 millimoles
-
per liter is what that equals.
-
And you know that because
sodium is a monovalent.
-
It's only got one charge.
-
-
If it's monovalent,
then that means
-
that the equivalents
equal the moles.
-
And now that you're
in moles, you
-
can actually go
across to osmoles.
-
You could say 140 osmoles
or milliosmoles per liter.
-
And you know that because
once sodium is in water,
-
it acts the same way that
you would expect it to act.
-
It doesn't split
up or anything like
-
that because it's one particle.
-
So it acts as a single particle.
-
One particle.
-
So if it's one
particle, it's going
-
to have 140
milliosmoles per liter.
-
And we've effectively gotten one
quarter of this problem done.
-
Because all we need to do is
take the four different solutes
-
that we've identified
and add them up together.
-
So we've figured out sodium.
-
And now let's move
on to the anion.
-
And the trick to the anion is
just thinking of it as sodium.
-
It's almost the same as
sodium, but just the reverse.
-
So we know that it's
going to be 140.
-
We're going to use 140
as the number here.
-
Because our assumption is that
sodium is a positive charge
-
and for every one
positive charge,
-
you need one negative charge.
-
So we're going to assume that
all the negative charges are
-
coming from these anions.
-
And these would be
things like we said,
-
things like chloride or
bicarb, something like that.
-
So again, we don't
actually get these numbers
-
or even need these
numbers, we simply
-
take that 140 and
we multiply by 2
-
and assume that the other half
is going to be some anion.
-
Now we actually have
to convert units still.
-
We have to get over to
milliosmoles per liter.
-
And so we know that the anion
is going to be monovalent
-
and that gets us to millimoles.
-
And we use the same
logic as above.
-
We just say, OK, well
if that was millimoles
-
and it's still one particle,
meaning it's not splitting up
-
when it hits water and going
in two different directions,
-
in a sense, having
twice the effect,
-
we're going to end up with
140 milliosmoles per liter,
-
just as before.
-
So this is our second
part done, right?
-
So two parts are done.
-
We figured out the sodium
and we figured out the anion.
-
Now let's go over to glucose.
-
So let's figure out how to
get glucose as units from what
-
the lab gives us, which I'll
tell you in just a second,
-
into something more usable.
-
So how do we actually get
over to something usable?
-
Let me actually, switch over.
-
There we go.
-
Make some space on our canvas.
-
So let's say we have
our glucose here.
-
And the lab calls us
and says, hey, we just
-
got your lab result, it was
90 milligrams per deciliter.
-
It's actually a very,
very common lab value
-
or common range for
a glucose lab value.
-
One thing we have
to do right away
-
is figure out how to get
from milligrams to moles.
-
And you know that this is
what glucose looks like.
-
This is the formula for it.
-
So to get the overall
weight, the atomic weight,
-
you could say,
well, let's take 6,
-
because that's how
many carbons we have,
-
times the weight of
carbon, which is 12,
-
plus 12, because that's
what we have here,
-
times the weight of
hydrogen, which is 1,
-
plus 6, times the
weight of oxygen.
-
And that's going to equal--
this is 72, this is 12,
-
and this is 96, and add them all
up together, and we get-- 180.
-
So we have 180 atomic mass
units per glucose molecule.
-
Which means, if you
think back, which
-
means that one mole of
glucose equals 180 grams.
-
And since these
are way, way bigger
-
than, I mean this is grams, and
we're talking about milligrams
-
over here, so I'm going to
just switch it down by 1,000.
-
So one millimole of glucose
equals 180 milligrams.
-
All I did was divide by 1,000.
-
So now I can take this unit and
actually use our conversions.
-
I could say, well, let's
multiply that by 100
-
and-- let's say, one
millimole rather,
-
one millimole per 180
milligrams, that'll
-
cancel the milligrams out.
-
And I also have to get from
deciliters to liters, right?
-
So I've got to go 10
deciliters equals 1 liter.
-
And that'll cancel
my deciliters out.
-
So I'm left with-- and this
10 will get rid of that 0--
-
so I'm left with
90 divided by 18,
-
which is 5 millimoles per liter.
-
And, just as above, I
know that the glucose
-
will behave as one particle
in water, in solution.
-
So it's going to be 5 osmoles,
or milliosmoles, actually.
-
5 milliosmoles per liter.
-
And that's the
right units, right?
-
So I figured out another
part of my formula.
-
And I'll show you the actual
formula at the end of this,
-
but I wanted to work
through it piece by piece.
-
So we've done glucose now and
we're ready for our last bit,
-
so let's do our last one,
which is going to be urea.
-
Specifically, the lab is not
going to call us about urea,
-
it's going to call us
about blood urea nitrogen.
-
And actually, it
matters what this means.
-
So what that exactly
means is that they're
-
measuring the nitrogen
component of urea.
-
And so they'll call you and
say, well, we measured it
-
and the value came to 14
milligrams per deciliter.
-
Something like
that, so let's say
-
that's the amount
of urea we find
-
in our little tube of plasma.
-
How do we convert that to moles
per liter like we did before?
-
Well, again, it'll be helpful if
I draw out a molecule of urea.
-
So we have something like this.
-
A couple nitrogens.
-
And this is what
urea looks like.
-
It's a pretty small molecule.
-
A couple nitrogens,
carbon, and oxygen.
-
And these nitrogens have an
atomic mass unit of 14 apiece.
-
So that's 14.
-
And this is 14
over here, as well.
-
So what the lab actually
measures is just this part.
-
It's just measuring
the two nitrogens.
-
It's not measuring the weight
of the entire molecule.
-
So all it's going to give you
is the weight of the nitrogens
-
that are in the molecule.
-
So what that means is that we
say, OK, well, that tells us
-
that one molecule of urea is
going to be 28 atomic mass
-
units of-- I'm going to put
it in quotes-- urea nitrogen.
-
Because that's the part of
urea that we're measuring
-
and that means that
one mole of urea
-
is going to be 28
grams of urea nitrogen.
-
And because, again,
this is much, much more
-
than what we actually have,
let me divide by 1,000.
-
So one millimole equals 28
milligrams of urea nitrogen.
-
So that's how we figure
out the conversion.
-
And I do the exact
same thing as above.
-
I say, OK, well, let's
times-- let's say,
-
I want to get rid of
the milligrams, right?
-
So 1 millimole divided
by 28 milligrams,
-
and that'll get rid
of my milligrams.
-
And I'll take, let's say,
10 deciliters over 1 liter
-
and that'll help me get
rid of my deciliters.
-
And so then I'm left with
14 over 28, which is 0.5.
-
And then times 10, so that's 5.
-
5 millimoles per liter.
-
And as I've done
a couple times now
-
and we know that it's
the urea nitrogen
-
or the urea is going to act and
behave like one molecule or one
-
particle when it's
in water, it's
-
not going to split up
or anything like that,
-
so that means that
it's going to basically
-
be 5 milliosmoles per liter.
-
And so I figured out the
last part of my equation.
-
-
So going back to the
top, we have sodium.
-
And this turned
out to be a total
-
of 140 milliosmoles per liter.
-
And then for our anion, we had
140 milliosmoles per liter.
-
And then for our glucose, we
had 5 milliosmoles per liter.
-
And for our urea, we had
5 milliosmoles per liter.
-
So adding it all up, our total
comes to 140 times 2 plus 10.
-
So we get, if I do
my math correctly,
-
I think that's 290
milliosmoles per liter.
-
That's the answer
to our osmolarity.
-
Our total osmolarity
in the plasma
-
is 290 milliosmoles per liter.
-
Now that was kind of the
long way of doing it.
-
Let me give you a very,
very quick and dirty way
-
of doing it.
-
Let me actually make
some space up here.
-
You could do the exact same
problem, you could say,
-
well, this osmolarity
equals, you could say,
-
sodium times 2, plus
glucose, divided by 18,
-
plus BUN divided by 2.8.
-
And that takes all
of those conversions
-
and simplifies it down.
-
So if you ever get your sodium
value, your glucose value,
-
and your BUN, and you
want to quickly calculate
-
your osmolarity, now you
know the fast way to do it.