Norepinephrine Acidosis

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Norepinephrine A Tangled Web

Levophed, also known as norepinephrine, is another stress hormone, and the topic for today. Weve mentioned norepinephrine in the posts on dopamine and epinephrine , but now were going a little deeper. Levophed will leave em dead, I was taught as a new nurse in the ICU, and definitely it can. Norepinephrine is a powerful alpha-1-agonist, producing intense vascular vasoconstriction. High doses of this medication will clamp the vascular system, both arterial and venous, to the extent no perfusion occurs in the capillary beds. In other words, it increases afterload. In fact, it can increase afterload so much that it causes metabolic acidosis. Because of its venous activity it diminishes preload. At the same time, cardiac output drops as the heart rate falls.This mechanism makes it a poor choice as an inotrope. Lets look at this. Norepinephrine has beta-1 agonist activity comparable to epinephrine, but it has NO effect on beta-2 receptor sites. But didnt I say that beta-1 agonists increase contractility and heart rate ? Yes, I did. The increase in mean arterial pressure levophed induces will cause baroreceptor-mediated drop in heart rate, which the beta-1 stimulation of norepinephrine Continue reading >>

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  1. iwannabeayummymummy

    Where do you buy ketone sticks/strips from on the net? i'm from UK so need a UK site not exspensive either lol

  2. elliebird

    You can buy them in Boots, they will be behind the counter so ask the pharmacist, they are about £5 - I hope this helps

  3. Yambabe

    I got mine from sainsburys, again you have to go to the pharmacy and ask.

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Intravenous Sodium Bicarbonate

Intravenous sodium bicarbonate, also known as sodium hydrogen carbonate, is a medication primarily used to treat severe metabolic acidosis . [1] For this purpose it is generally only used when the pH is less than 7.1 and when the underlying cause is either diarrhea , vomiting , or the kidneys . [2] Other uses include high blood potassium , tricyclic antidepressant overdose , and cocaine toxicity as well as a number of other poisonings . [1] [3] [4] It is given by injection into a vein . [2] Side effects may include low blood potassium , high blood sodium , and swelling . [1] [4] It is not recommended in people with low blood calcium . [5] Sodium bicarbonate is in the alkalinizing family of medication. [5] It works by increasing blood bicarbonate , which buffers excess hydrogen ion and raises blood pH . [5] Commercial production of sodium bicarbonate began between 1791 and 1823. [6] Intravenous medical use began around the 1950s. [4] It is on the World Health Organization's List of Essential Medicines , the most effective and safe medicines needed in a health system . [7] Sodium bicarbonate is available as a generic medication . [5] The wholesale cost in the developing world is abo Continue reading >>

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  1. Liang-Hai Sie

    Nothing to do with his diabetes, more with his molar problem?
    He might have contracted a foodborne infection, often seen when living under less than optimal hygienic circumstances... That can also be a viral infection e.g. acute viral gastro-enteritis, viral hepatitis (there are so many, A and e aren't transfered by blood contact) etc. etc.
    For his health, he better take good care of his diabetes, if not can get blind, have a heart attack, a stroke, or terminal end stage kidney disease (in the US 1 out of 3 is due to diabetes!). Many not well educated diabetics aren't motivated to do anything about controling their diabetes since it doesn't cause any symptom, and wait until catastrophe strikes, by then having been so much damaged that all we docs can do is minimal damage control, too late: Complications of diabetes

  2. Michael Soso

    If he has a history of nauseating headache, the headaches could simply be migraine attacks, unrelated to his diabetes and tooth problem. This is the least alarming interpretation of the facts provided.
    Unfortunately, other possibilities are much more concerning. If he has a dental abscess, the possible complications in the presence of poorly controlled diabetes are numerous, as other posters have indicated. Visits to a dentist and a doctor would appear warranted.
    I hope it all proves to be minor and resolves without much trouble. The comments provided by healthcare providers describe some of the more serious problems that might develop. The Original Poster needs to read these judiciously.
    I suspect some physicians reading your question would immediately want to send a MedEvac helicopter to airlift your father to a major urban hospital. To grossly understate the situation, physicians are worrywarts. If you show us a hangnail, we're already worrying about your imminent need for amputation before you die from gangrene and sepsis because, believe me, we've seen it. No symptom, no matter how seemingly innocuous to a patient, is casually dismissed by a thoughtful doctor. To the contrary, we can't suppress the reflexive review of all the horrors we might be overlooking.
    Consequently, I hope the comments your question elicits are helpful rather than simply terrifying. Best wishes to you and your father.

  3. Steve Rapaport

    Could mean several things, but one of them is deadly dangerous, diabetes related, and easily preventable, so I'd suggest preventing that one right away.
    Tell your dad to drink lots of water, and take a bit of insulin if he has some.
    That way if he's working his way up to a Diabetic Ketoacidosis or an HHS attack, you can head it off right away. They both result from inadequate insulin levels and inadequate water levels, and can be triggered by an inflammation or infection (such as a tooth problem).
    More on both here: Diabetic Ketoacidosis and Hyperglycemic Hyperosmolar Syndrome

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Show notes: Endocrine FOUR, ADH and Oxytocin https://www.youtube.com/watch?v=p5vFv... Russ Palmeri, MD, FACOG, Instructor, Asheville-Buncombe Technical Community College This video is licensed under a Creative Commons Attribution-ShareAlike 4.0 International (CC BY-SA 4.0) see https://creativecommons.org/licenses/... for details. Reading list: https://www.merckmanuals.com/professi... http://www.merckmanuals.com/professio... The Syndrome of Inappropriate Antidiuresis, n engl j med 356;20 www.nejm.org may 17, 2007 Water deprivation test, see: http://www.pathology.leedsth.nhs.uk/d... This video is licensed under a Creative Commons Attribution-ShareAlike 4.0 International (CC BY-SA 4.0) see https://creativecommons.org/share-you... for details.


endogenously produced by the magnocellular neurone cell bodies of the paraventricular and supraoptic nuclei of the posterior hypothalamus Vasopressin on multiple receptors (GPCRs = g protein coupled) vascular smooth muscle of the systemic, splanchnic, renal, and coronary circulations -> potent vasoconstriction renal efferent arterioles -> increased GFR renal collecting ducts -> anti-diuresis hemostatic system -> induces the release of Von Willebrand Factor (VWF) and Factor VIII:coagulant (FVIII:c) from endothelial cells -> increased platelet aggregation pituitary -> stimulates release of ACTH and hence increased cortisol secretion oxytocin receptor subtypes -> myometrium and vascular smooth muscle Effects are preserved during hypoxia and severe acidosis and catecholamine resistant states 0.01-0.1U/min (onset: fast, offset: fast for vascular, long for kidneys) refractory hypotension (potentiates the actions of over vasoconstrictors) haemostasis in bleeding oesophageal varicies Metabolism peptidases in the liver and kidney Factorial (22) multicenter, double blind, randomised controlled trial Vasopressin (titrated up to 0.06 U/min) +/-Hydrocortisone (50mg q6h and then weaned) versus Continue reading >>

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  1. kristin

    HI everyone,
    Evertime I go super low carb for a couple of days (no fruit, nuts, dairy or alcohol) my body temp gets high at night- so high that my sister refuses to share the same bed because my heat forces her to wake up and move a bit further from me. I don't notice and sleep through the night, wake up and jump out of bed with that crazy energy you get on low carb. But if I continue for a week more I start sweating profusely at night, my pyjama top is literally wet with sweat when I wake up (and the sweat smells quite strong!) I also have to wake up at least once during the night to take a very very very long bathroom break. During this time I am losing lots of weight.
    My question is, is this normal? Or should I consider getting my thyroid checked? Though when I add back carbs for a few days all this heat business stops. Is there an explanation for this?

  2. j3nn

    I would get your thyroid checked, that is a classic sign. Low carb might aggravate it and worsen symptoms. Do you supplement with magnesium? A good idea before bed, especially if you are low carb and losing excessive water weight at night. Take plenty of salt with your food as well.

  3. Dragonfly

    Nothing wrong with your thyroid. This is normal for vlc for some folks (including me!) we just burn fat like crazy when in ketosis, especially at first.
    I find this happens more when I overeat fat, interestingly.

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