June 4, 2023

In this video we discuss the loop of henle, loop diuretics, and how you can treat a variety of common diseases!

Hello everyone and welcome back to clinicalcousins youtube channel today we’re going to continue our discussion on the nephron we’re going to be talking about the workers in the urine assembly line that come after the proximal convoluted tubule okay so we talked about these workers in the assembly line in our last video we know that they do a lot for us so now we’re

Going to talk about something a little bit more straightforward we’re going to be talking about the loop of henle as it’s called so we have our thin descending limb we have our thin ascending limb and then we have our money maker our thick ascending loop of henle so we know that the proximal convoluted tubule guys did a lot they did a lot of reabsorbing and now

We’re gonna see what the then ascending loop of henle uh the thin descending the thick ascending we’re gonna see what that does for us and it’s really gonna deal with solutes so right off the bat i want you to know this simple simple fact the deeper that we go in the kidney the saltier the kidney gets so remember that the deeper you go into the kidney the saltier

It gets okay so let’s pretend this is the top of the kidney that we’re talking about say it’s about 200 milliosmoles uh that we we should know that our blood is around 300 so it’s a little salty up here but the deepest part of the kidney could be anywhere from 12 to 1400 so really really really salty down here that’s why a lot of people don’t eat kidneys but they

Eat other organ meats so let’s talk about why that is okay so proximal convoluted tubule then we have thin descending loop of henle we’re going to call him the concentrator he’s going to concentrate our pre urine now this part of the nephron it’s diving deep it’s losing its salt it’s losing its water but it’s really going to help us form this concentrated urine

So that’s why our juxta medullary nephrons remember those ones with the really deep long loops of henle they help us make concentrated urine why is this so because they have these long loops that reach down into the saltiest part of the kidney okay so we have our concentrated urine it’s very concentrated at this point so what’s next we’re going to move into the

Thin ascending loop of henle so we’re going to call this guy a diluter he is a diluting segment okay so the thin ascender he loses its solutes but it actually holds on to its water this part is impermeable to water so next we have the thick ascending loop of henle this is the really important guy okay so this is the star of our show and it is going to likely affect

Every single one of your lives you’re definitely going to give a medication that affects this part of the nephron right here this thick ascending loop is also a diluter but the only thing we have to remember about this guy is that he has a special channel it’s called the sodium potassium two chloride co-transporter it doesn’t sound very cool but it’s arguably one

Of the most important parts of the nephron it’s my favorite part to talk about this is because 25 of sodium reabsorption takes place here that is a ton of sodium you have to think these nephrons are processing 180 liters of fluid per day or more so i mean 25 of our sodium that’s a lot this is a very important job so in fact this is so important it’s so good

At its job that the more sodium we throw at it the more it’s going to reabsorb so this is why diuretics that work in this co-transporter they’re very very powerful and i know what you’re going to say and this is exactly what i thought too well christian wouldn’t diuretics that work on the proximal convoluted 2 would be more powerful because they reabsorb 67 of our

Sodium and that is a great thought and it’s close but with no cigar okay so the sodium that stays in the tubule after the proximal convoluted tubule it gets picked up by the thin or thick ascending loop of henle so these proximal convoluted tubule diuretics let’s say that you inhibited all the sodium reabsorption here all that sodium it’s going to get picked up by

Our different code transporters especially in the thick ascending loop of henle so that is why diuretics that work in this segment are much more powerful okay so thick loop of henle the big guy how does he work well there’s a sodium potassium two chloride transporter and it does exactly what you think it literally moves sodium potassium and chloride from our tubule

From our pre urine into our blood so we’re saving it okay so we’re reabsorbing sodium potassium and chloride okay but not water this guy’s a diluter as well and there’s something very very interesting that happens okay this is uh going to have some clinical uh implications for us later so potassium actually it’s reabsorbed but it actually leaks out into the lumen

Remember the lumen is the inside of something so the inside is filled with positive potassium okay so this positive potassium remember too many bachelors here too many positive bachelors they want to go away from each other so calcium and magnesium actually get reabsorbed they get pushed this positive push pushes calcium magnesium to be reabsorbed back into the

Blood now inter day shift nurse’s least favorite drug we’re talking about lasix we’re talking about furosemide right this is a powerful diuretic a powerful water pill as they call it they’re called loop diuretics because they work on the loop of henle that’s where they get the name from okay so furosemide lasix it is actually going to block this co-transporter

Okay so we can anticipate what’s going to happen so we know that what are we going to lose here we’re going to lose sodium we’re going to lose potassium we’re going to lose chloride and then what happens here well if we don’t have that potassium to sneak back out and make it positive if it’s already gone away then what can’t we shove between our cells we’re gonna

Lose calcium we’re gonna lose magnesium okay so if there’s no potassium to leak out then there’s no positive push to reabsorb that calcium magnesium remember where are we reabsorbing to always the blood okay so what does lasix do right it is going to cause more sodium potassium chloride magnesium calcium they’re going to be lost in the urine they’re not going

To be put back in the blood they’re going to be lost in our urine they’re going to be peed out of our body along with water right so the reason why furosemide can be used to treat hypercalcemia too much calcium hypermagnesemia too much magnesium when you’re when the patient has a flash pulmonary edema uh hypertension congestive heart failure the reason why it is

Going to treat that is because we are going to rid our body of fluid and certain electrolytes right it’s going to be peed out and also it’s going to decrease our blood volume which means a decrease of blood pressure okay so i know you’re excited to push lasix into your patient because you don’t like the day nurse and you want to make your patient better but also

You want to make your patient pee a lot you want to see that nurse that you don’t like run up and down the floor trying to take the patient to the bathroom in time before they fall well we have to slow down this medication is odo toxic i know you can’t see my ears right now i’m wearing a beanie but if you push it too fast it can cause tinnitus to occur in your

Patient that constant ringing or clicking sound also we have to check the patient’s blood pressure and this confuses a lot of people if it’s low and you see it’s their first time taking the medication you’re going to push it slowly always follow your facilities protocol but usually if grammy’s been taking the medication for 20 years you’re probably not going to

See a big drop in her blood pressure because the body is used to it it’s expecting to get that furosemide that lasix however if your patient has just had a heart attack they’re new they don’t take medications uh they’re very new to this medication make sure their blood pressure is extra stable and be sure to put three side rails up uh tell them to get up slowly

So they don’t get dizzy use a call light or else you might hear a loud thud and then you might have to rush to treat your patients new head trauma and do neural checks and that is no fun okay so for your patients on lasix be aware we are going to lose a lot of potassium and we’ll talk about why that is later in another video but you can anticipate we’re already

Losing potassium right here and we’re going to lose more down the road so we know that if we’re losing potassium we have to replace the potassium in our diet that means they’re going to have to eat lots of fruits and vegetables your dark leafy greens are going to be their new best friends and chances are if your patient is needing lasix and you practice in america

Your patient probably lives on a diet of fried chicken biscuits and crisco right so this will be a huge change for them so definitely make your dietitian your best friend because you are going to need them to convince your patient to make lifestyle changes although most of the time it doesn’t usually work so as always thank you so much for taking the time with us

To learn today and remember to like and subscribe for more content and we can’t wait to see you next time thank you

Transcribed from video
NCLEX Prep: The Nephron (Loop of Henle, Furosemide, Lasix) By Clinical Cousins