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Metabolic Acidosis Compensation Formula

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Metabolic Acidosis Treatment & Management

Approach Considerations Treatment of acute metabolic acidosis by alkali therapy is usually indicated to raise and maintain the plasma pH to greater than 7.20. In the following two circumstances this is particularly important. When the serum pH is below 7.20, a continued fall in the serum HCO3- level may result in a significant drop in pH. This is especially true when the PCO2 is close to the lower limit of compensation, which in an otherwise healthy young individual is approximately 15 mm Hg. With increasing age and other complicating illnesses, the limit of compensation is likely to be less. A further small drop in HCO3- at this point thus is not matched by a corresponding fall in PaCO2, and rapid decompensation can occur. For example, in a patient with metabolic acidosis with a serum HCO3- level of 9 mEq/L and a maximally compensated PCO2 of 20 mm Hg, a drop in the serum HCO3- level to 7 mEq/L results in a change in pH from 7.28 to 7.16. A second situation in which HCO3- correction should be considered is in well-compensated metabolic acidosis with impending respiratory failure. As metabolic acidosis continues in some patients, the increased ventilatory drive to lower the PaCO2 m Continue reading >>

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  1. wordsmithe

    So I just came back from the doctor and her jaw literally dropped when she saw my cholesterol levels.
    My hdl was 90, but my LDL was 372. She told me to stop ketoing immediately and start taking cholesterol pills.
    Has anyone had such a high cholesterol level? If so, did you guys take medication?
    EDIT I've been reading a lot about high LDL levels and low TG levels and how there are different types of lipids in our blood. I'm not going to take the medication at this point and take a VAP test to see what kind of lipids are in my bloodstream.
    Also, I think it would be helpful to post some basic information.
    25 male 72 KG (159 lbs) 173 cm (5'9) Keto for six months Usual macros 45/45/10
    Keto helped me lose fat and gain muscle. I've been grateful for having keto guide me to a healthier lifestyle, but I'm willing to give it up if my heart is at risk.

  2. gogge

    Some people have issues with saturated fat, dietary cholesterol, or keto.
    Thomas Dayspring talks about a similar case (but with confirmed high LDL particle count) in one of his articles, I posted this in another thread:
    Some people react badly to saturated fat and dietary cholesterol (hyperresponders, longer post), they can probably still do keto (depends on how sensitive they are) just don't overdo the coconut oil, butter (eat more olive/avocado/canola oil instead) and cut down on eggs.
    Others might do better on just general non-ketogenic low carb, check out this article from Thomas Dayspring (a lipidologist referenced by Peter Attia and Gary Taubes) with a case very similar to yours (formatted for readability):
    “I started eating paleo/low-carb (with dairy) in Apr 2011. I should add that my diet has never been ultra low-carb -- just lower-carb than most people. My last blood test before going paleo was in Nov 2010 and my past numbers have always been similar:”
    Total cholesterol = 196
    LDL-C =105
    HDL-C = 75
    TG = 78 (all in mg/dL)
    TSH = 2.15
    “I lost 30 pounds in about 3 months and have kept it off ever since. Today I weigh 124 and maintain my weight easily eating this way, even though I am menopausal.”
    The lipid panel was repeated on the new diet:
    TC = 323
    LDL-C = 230
    HDL-C 83
    TG 49 (all in mg/dL)
    Total LDL-P = 2643 nmol/L (99 th percentile population cut point)
    TG/HDL-C = 0.59 (poor man’s marker of insulin sensitivity) Under 2.0 is excellent
    Not great changes, very high LDL cholesterol similar to your reaction, and this likely also means very high LDL particle count.
    Here's what they did:
    The dietary advice was to cut back on saturated fat and use more MUFA and PUFA without increasing carbs. After doing just that for a few months the patient reports:
    “The only modifications I've made because of my high lipids are eating steel cut oats regularly, adding chia seeds to my diet, and eating apples regularly (to increase fiber levels); cutting out most dairy; and watching my saturated fat intake a little more closely--all aimed at getting my high LDL-P down.” Weight has remained stable.
    Here are the follow up labs:
    TC = 178
    LDL-C = 92 (was 230)
    HDL-C = 82
    TG = 21
    Non-HDL-C = 96 (all inmg/dL)
    Total LDL-P: 948 nmol/L (recall it was grossly elevated at 2643) < 1000 nmol/L (20 th percentile population cut point) is desirable
    Small LDL-P: < 90 nmol/L (normal)
    LDL Size: 21.4 nm (quite large)
    CRP was near 0.
    Thomas Dayspring, "Lipidaholics Anonymous Case 291 Can losing weight worsen lipids?"
    The article is a very long read, but it's also absolutely excellent at explaining why some people can react badly and what to really look for in a lipid test, and what to do about it when things look bad.

  3. wordsmithe

    Thanks for the extensive response. Im definitely going to take some time today to do more reading and research. Im still 50/50 on taking the medication, but I do feel better knowing otbers have had similar reactions from keto.

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