How Does Ketoacidosis Affect Blood Ph

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Severe Ketoacidosis (ph ≤ 6.9) In Type 2 Diabetes: More Frequent And Less Ominous Than Previously Thought

Go to: 1. Introduction Diabetic ketoacidosis (DKA) is a life-threatening acute metabolic complication of uncontrolled diabetes. This illness results from the relative or absolute deficiency of insulin and an increase in counterregulatory hormones such as glucagon, cortisol, catecholamines, and growth hormone [1, 2]. Despite notable advances in treatment and use of novel drugs with multiple mechanisms of action, hospital admissions due to DKA have increased 30% in the US in the last decade [3]. Classically described in type 1 diabetes, DKA can also occur in type 2 diabetes during catabolic stress scenarios such as infections, surgery, and trauma or late during the natural history of the disease, when the beta-cell function is lost. Severe cases of DKA (pH ≤ 7.00, bicarbonate level ≤ 10.0, anion gap > 12, positive ketones, and altered mental status) are commonly encountered in patients with type 1 diabetes and are thought to carry an ominous prognosis [2, 4]. The acid-base status in particular has received great attention, due to the potential of bicarbonate-based therapy. There is not enough information on the clinical course of severely acidotic type 2 diabetes patients with DK Continue reading >>

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  1. Colin Gerber

    There have been studies done on this, one done by Alperin et al. found the following results:
    In the upright posture, venous outflow is considerably less pulsatile (57%) and occurs predominantly through the vertebral plexus, while in the supine posture venous outflow occurs predominantly through the internal jugular veins. A slightly lower tCBF (12%), a considerably smaller CSF volume oscillating between the cranium and the spinal canal (48%), and a much larger ICC (2.8-fold) with a corresponding decrease in the MRI-derived ICP values were measured in the sitting position. [1]
    There are MRI machines that work while sitting up:
    Or laying down:

  2. Ravi Tej

    Its all a play of the 'Gravity'.
    Veins in the legs are enveloped by the skeletal muscles there, and when they are actively contracting this squeezes the veins of its blood in a 'heart-ward' direction. You may ask why couldn't the blood flow the other way, thanks for the 'valves' that are interspersed along the length of this venous channel which prevents this from happening. This is the principle of 'the muscle pump' and it is important so much so that the soleus muscle (the main bulk of your calf) is called the 'second-heart' as it too literally pumps the blood.
    And now coming to what is that that causes the changes in cerebral perfusion with posture:
    [A word of caution: The cerebral perfusion is governed by auto-regulatory phenomenon, wherein the cerebral blood flow remains rather constant even with quite a change in blood pressure and a gross deviation from the normal of the blood pressure is needed to change it. And in fact, only in rare cases does this postural changes causes a syncope (Orthostatic hypotension) ,that too, with an added deficit of the sympathetic reflexes (reflex vasoconstriction)]

    In the supine position, since all of the body is at the same level, it is of the impression that there is no net differential effect of gravity on different parts of the body. And thus there is no active role of gravity in deciding the blood flow, and the other factors which control blood flow comes to play.

    While in standing position and that too in a 'static stance' for long, due to gravity, the blood (venous) pools in the lower limbs, and thus there is less blood that reaches the heart (less venous return) and consequently heart pumps less blood as whatever heart does is just pump the quantity it has been filled before systole (preload). There is a decrease in blood pressure and thus a 'relatively' decreased blood perfusion. As I mentioned earlier too, there are regulatory mechanisms that maintains a constant cerebral perfusion in the face of a changing blood pressure. As the fMRI is quite sensitive a test, it can rather be that it does recognise this slight 'relative' change of the flow. But surely, the transient fall in BP, can be recorded, though this transient fall is quickly compensated by sympathetic activation.
    Its an accepted fact that in cases of orthostatic hypotension, the syncope (caused by cerebral hypoperfusion) is caused in patients of a sympathetic defecit (or decreased activity) when in the standing posture, where the decreased blood pressure remains uncompensated and a fall in BP below a critical level does with a decrease in cerebral perfusion for a few seconds and due to this hypoxic condition syncope occurs. And ironically, when the person falls of syncope, the gravity component is canceled and he regains his consciousness due to corrected cerbral flow, thus this can too be taken as a proof of the effect of posture on cerebral perfusion.

  3. Sohan

    To know about Blood flow in very important for a man . To maintain your blood flow you have to exercise regularly.You should improve your blood flow for a good health.

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