What Is Metabolic Acidosis?
Metabolic acidosis happens when the chemical balance of acids and bases in your blood gets thrown off. Your body: Is making too much acid Isn't getting rid of enough acid Doesn't have enough base to offset a normal amount of acid When any of these happen, chemical reactions and processes in your body don't work right. Although severe episodes can be life-threatening, sometimes metabolic acidosis is a mild condition. You can treat it, but how depends on what's causing it. Causes of Metabolic Acidosis Different things can set up an acid-base imbalance in your blood. Ketoacidosis. When you have diabetes and don't get enough insulin and get dehydrated, your body burns fat instead of carbs as fuel, and that makes ketones. Lots of ketones in your blood turn it acidic. People who drink a lot of alcohol for a long time and don't eat enough also build up ketones. It can happen when you aren't eating at all, too. Lactic acidosis. The cells in your body make lactic acid when they don't have a lot of oxygen to use. This acid can build up, too. It might happen when you're exercising intensely. Big drops in blood pressure, heart failure, cardiac arrest, and an overwhelming infection can also cause it. Renal tubular acidosis. Healthy kidneys take acids out of your blood and get rid of them in your pee. Kidney diseases as well as some immune system and genetic disorders can damage kidneys so they leave too much acid in your blood. Hyperchloremic acidosis. Severe diarrhea, laxative abuse, and kidney problems can cause lower levels of bicarbonate, the base that helps neutralize acids in blood. Respiratory acidosis also results in blood that's too acidic. But it starts in a different way, when your body has too much carbon dioxide because of a problem with your lungs. Continue reading >>
Hyperglycaemic Crises And Lactic Acidosis In Diabetes Mellitus
Hyperglycaemic crises are discussed together followed by a separate section on lactic acidosis. DIABETIC KETOACIDOSIS (DKA) AND HYPERGLYCAEMIC HYPEROSMOLAR STATE (HHS) Definitions DKA has no universally agreed definition. Alberti proposed the working definition of “severe uncontrolled diabetes requiring emergency treatment with insulin and intravenous fluids and with a blood ketone body concentration of >5 mmol/l”.1 Given the limited availability of blood ketone body assays, a more pragmatic definition comprising a metabolic acidosis (pH <7.3), plasma bicarbonate <15 mmol/l, plasma glucose >13.9 mmol/l, and urine ketostix reaction ++ or plasma ketostix ⩾ + may be more workable in clinical practice.2 Classifying the severity of diabetic ketoacidosis is desirable, since it may assist in determining the management and monitoring of the patient. Such a classification is based on the severity of acidosis (table 1). A caveat to this approach is that the presence of an intercurrent illness, that may not necessarily affect the level of acidosis, may markedly affect outcome: a recent study showed that the two most important factors predicting mortality in DKA were severe intercurrent illness and pH <7.0.3 HHS replaces the older terms, “hyperglycaemic hyperosmolar non-ketotic coma” and “hyperglycaemic hyperosmolar non-ketotic state”, because alterations of sensoria may be present without coma, and mild to moderate ketosis is commonly present in this state.4,5 Definitions vary according to the degree of hyperglycaemia and elevation of osmolality required. Table 1 summarises the definition of Kitabchi et al.5 Epidemiology The annual incidence of DKA among subjects with type 1 diabetes is between 1% and 5% in European and American series6–10 and this incidence appear Continue reading >>
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Metabolic Acidosis: Causes, Symptoms, Diagnosis, Treatment, Prognosis, Prevention
Acidosis- A medical condition in which the fluids present in the body start to develop increased amount of acidic content making the body fluids acidic. There are two types of Acidosis- Respiratory Acidosis and Metabolic Acidosis. Respiratory Acidosis occurs as a result of malfunction of lungs. Metabolic Acidosis occurs as a result of malfunction of the kidneys. In this article, we will look into about Metabolic Acidosis. We will look into the causes, diagnosis, and treatment of Metabolic Acidosis. As stated, Metabolic Acidosis is a medical disorder in which the body starts producing excessive amounts of acid and/or the kidneys are not able to remove enough acidic content from the body. If not corrected at the appropriate time, Metabolic Acidosis can lead to a medical condition called acidemia in which pH scale in the blood gets low as a result of the kidneys being unable to form bicarbonates in the body. Causes Of Metabolic Acidosis The amount of acid in the blood can is determined by measuring the pH. A lower value of the pH means that the blood is acidic and a higher value of pH means that rhe blood is basic. Ideal pH value in the blood should be around 7.5. There are many processes in an individual's body which produces acid. Usually, the lungs and the kidneys take care of the excess production of acid; however, if there is a malfunction of these organs it results in Acidosis. As stated, Metabolic Acidosis begins in the kidneys. It develops when the kidneys are not able to discard excessive acid or in cases when they discard too much basic content from the body. Metabolic Acidosis is of three types: Diabetic Acidosis: This occurs in poorly controlled diabetes patients. In this form, there is formation of excess ketones making the blood acidic. Hyperchloremic Acidosi Continue reading >>
Acid-base Physiology
Case 15 : An old man with abdominal pain and shock Clinical Details An 85 year old man was admitted with severe abdominal pain and shock. The abdominal pain had started about 1500hrs and quickly became quite severe. There was no radiation to the back. The patient was known to have an abdominal aortic aneurysm (AAA). On arrival at hospital, the patient was shocked with peripheral circulatory failure and hypotension (BP 70-80 systolic). His abdomen was guarded and quite tender. He was distressed but able to talk and could understand instructions. Past history was of hypertension (on metoprolol and prazosin) and angina (on Isordil). Prior to this event, the patient was mobile and independent. A ruptured AAA was diagnosed clinically and he was transferred to theatre for emergency laparotomy. On arrival in theatre, BP was 120 systolic. The patient was talking but distressed by pain with rapid respirations at a rate of 30/min. It was noted that neck veins were very distended. An external jugular triple lumen central line and a brachial arterial line were placed before the surgical team had arrived in theatre. CVP was +40 mmHg. The blood gases were collected from an arterial line during preoxygenation with 100% oxygen at 1738 hrs (i.e. about 4.5 hours after onset of symptoms). Investigations: Biochemistry at 1520hrs was Na+ 138, K+ 4.9, Cl- 107, Bicarbonate 20, Glucose 11.2, Urea 12.8, creatinine 0.188, lactate 8.3 (all results in mmol/l). Haemoglobin 133 G/l. pH 7.35 pCO2 24 mmHg pO2 182 mmHg HCO3 13.8 mmol/l Assessment Initial clinical assessment The clinical expectation was an acute metabolic acidosis (lactic acidosis) due to peripheral circulatory failure, and respiratory alkalosis due to pain-induced hyperventilation. Respiratory compensation for the metabolic acidosis wo Continue reading >>
5,194 Possible Causes For Acidosis + High Pitched Bowel Sounds + Severe Abdominal Pain In Usa
Small Bowel Obstruction Severe Abdominal Pain Acidosis High Pitched Bowel Sounds The classic physical examination findings of abdominal distension, tympany to percussion, and high-pitched bowel sounds suggest the diagnosis.[medbullets.com] Positive findings on examination were limited to a softly distended non-tender abdomen and loud high-pitched bowel sounds.[saudijgastro.com] Symptoms include Severe abdominal pain or cramping Vomiting Bloating Loud bowel sounds Swelling of the abdomen Inability to pass gas Constipation A complete intestinal obstruction[medlineplus.gov] Intestinal Obstruction Severe Abdominal Pain High Pitched Bowel Sounds Clinical signs include abdominal distention, tympany due to an air-filled stomach and high-pitched bowel sounds. [ 9 ] History There is considerable overlap with the presentation[patient.info] Decreased pH and C02 content (metabolic acidosis ) reflect lactic acidosis occurring with bowel infarction Increased pH and C02 content (metabolic alkalosis) secondary to[diagnose-me.com] Because of the serious complications that can develop from small bowel obstruction, seek immediate medical care if you have severe abdominal pain or the other symptoms listed[virginiamason.org] Abdominal Distension Abdominal Fullness Abdominal Pain Abdominal Pain Worsens after Meals Acute Abdomen Acute Pancreatitis Acute Peritonitis Amylase Increased Arterial Blood pH Decreased Aspiration Pneumonia Bezoar Bilious Vomiting Blind Loop Syndrome Bowel Distention Colic Colonic Diverticulosis Complete Blood Count Abnormal Constipation Crohn's Disease Dehydration Dyspepsia Flatulence, Bloating and Distension Hernia Hyperactive Bowel Sounds Hypokalemia Hyponatremia Hypovolemic Shock Ileus Increased Abdominal Girth Inguinal Hernia Intestinal Adhesions Intestinal Diseas Continue reading >>
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Blood Gases And Acute Pancreatitis
Summarized from Sharma V, Devi T, Sharma R et al. Arterial pH, bicarbonate levels and base deficit at presentation as markers of predicting mortality in acute pancreatitis: a single-centre prospective study. Gastroenterol Rep (Oxf) 2014; 2(3): 226-31 Acute pancreatitis, i.e. acute inflammation of the pancreas, causes sudden onset of severe upper abdominal pain often radiating to the back. Other symptoms include vomiting, constipation and pyrexia. Two main causes - alcohol abuse and gall stone disease – account for the majority (~80 %) of cases. The condition has a variable course. In many cases inflammation resolves with little or no intervention over a period of a few days to a week, with no long-term consequences, but in others the condition can be severe, progressing rapidly to systemic inflammation, sepsis and multiple organ failure. Severe acute pancreatitis is thus a potentially fatal condition that warrants immediate admission to intensive care. A major problem for initial emergency room management of patients presenting with acute pancreatitis is to distinguish those whose course is likely to be benign from those who are likely to suffer severe disease and therefore require admission to intensive care. There is currently no single reliable prognostic test and clinicians must depend on rather cumbersome clinical scoring systems to predict outcome. The authors of a recently published study sought to examine the value of admission acid-base parameters (pH, bicarbonate and base excess) in predicting outcome among patients with acute pancreatitis. The notion that these might be useful prognostic markers is based partially on the observation that metabolic acidosis (characterized by reduced pH, bicarbonate and base excess) is a frequent complication of severe acute Continue reading >>
7,929 Possible Causes For Acidosis + Abdominal Pain + Bronchial Spasm In Usa
Anaphylaxis Acidosis Abdominal Pain pain a weak and rapid pulse runny nose and sneezing swollen tongue or lips wheezing or difficulty breathing a sense that something is wrong with your body tingling hands,[healthline.com] pain.[medical-dictionary.thefreedictionary.com] […] reactions such as hives, flushed skin, or pale skin suddenly feeling too warm feeling like you have a lump in your throat or difficulty swallowing nausea, vomiting, or diarrhea abdominal[healthline.com] Acute Intermittent Porphyria Acute Respiratory Failure Arm Pain Arsenic Poisoning Arterial Blood pH Decreased Aspiration Pneumonia Asthenia Autonomic Neuropathy Back Pain Bilateral Diaphragmatic Elevation Blepharoptosis Brucellosis Bulbar Poliomyelitis Cardiac Arrhythmia Cerebrospinal Fluid Abnormality Cerebrospinal Fluid Protein Increased Chronic Inflammatory Demyelinating Polyneuropathy Cranial Nerve Involvement Decreased Vital Capacity Diminished Respiratory Excursion Diplopia Dysarthria Dysesthesia Encephalocele Facial Nerve Disorder Fahr's Syndrome Fecal Incontinence Fish Poisoning Flaccid Paralysis Flaccid Paralysis of the Lower Extremity Guillain-Barré Syndrome Hypercapnia Hypertension Hyporeflexia Hypotension Influenza Japanese Encephalitis Limb Pain Low Back Pain Low Back Pain Radiating to the Posterior Leg Meningeal Tuberculosis Muscular Atrophy Myasthenia Gravis Neonatal Hypotonia Nerve Conduction Study showing Demyelination Pattern Neurologic Manifestation PO2 Decreased Paresthesia Paresthesia of Lower Extremity Paroxysmal Hypertension Patient Appears Acutely Ill Peripheral Motor Neuropathy Poikilothermia Poliomyelitis Priapism Raynaud's Disease Recent Viral Illness Reduced Abdominal Reflex Respiratory Muscle Paralysis Sensation Disorder Sensory Deficit of the Lower Extremity Shy Drager Continue reading >>
- Is it possible to catch diabetes? It sounds absurd, but that's what a reputable new study suggests. And it may be that other 'lifestyle' diseases such as joint pain and even obesity are contagious, too
- Natural treatment for type I diabetes – Possible Causes
- Diabetes Foot Pain: Strategies for Coping With Diabetes Foot Pain
Systemic Causes Of Abdominal Pain
a Department of Emergency Medicine, Thomas Jefferson University Hospital, 1020 Sansom Street, Thompson Building 239, Philadelphia, PA 19107, USA b Division of Emergency Ultrasonography, Department of Emergency Medicine, University of Pennsylvania Medical Center, 3400 Spruce Street, Philadelphia, PA 19104, USA Abstract A variety of systemic and extra-abdominal diseases can cause symptoms within the abdominal cavity. Systemic and extra-abdominal diseases may include abdominal symptoms caused by several mechanisms. This article discusses the most important and common of these causes, namely the metabolic/endocrine causes, hematologic causes, inflammatory causes, infectious causes, functional causes, and the neurogenic causes. Keywords A variety of systemic and extra-abdominal diseases can cause symptoms within the abdominal cavity (Box 1). This article discusses the most important and common of these diseases. Systemic and extra-abdominal diseases may include abdominal symptoms caused by several mechanisms listed in Table 1. Mechanisms include direct pathologic effects on intra-abdominal organs (eg, gallstone formation in sickle cell disease); conversely, systemic illnesses (eg, congestive heart failure, diabetic ketoacidosis [DKA], or addisonian crisis) may themselves be precipitated by diseases in the abdomen. Some systemic illnesses have a direct (eg, constipation in hypercalcemia) or indirect (eg, nausea and vomiting in diabetic or alcoholic ketoacidosis [AKA]) effect on the functioning of the gastrointestinal (GI) tract. Abdominal symptoms may be caused by disease in contiguous organs outside the abdomen (eg, diaphragmatic irritation from disease of adjacent structures in the lung and mediastinum).1–4 Finally, symptoms may be referred to the abdomen from extra-abdom Continue reading >>
Abdominal Pain In Patients With Hyperglycemic Crises.
Abstract BACKGROUND: The aim of the study was to evaluate the incidence and prognosis of abdominal pain in patients with diabetic ketoacidosis (DKA) and hyperglycemic hyperosmolar nonketotic state (HHS). Abdominal pain, sometimes mimicking an acute abdomen, is a frequent manifestation in patients with DKA. The prevalence and clinical significance of gastrointestinal symptoms including abdominal pain in HHS have not been prospectively evaluated. MATERIALS AND METHODS: This is a prospectively collected evaluation of 200 consecutive patients with hyperglycemic crises admitted to a large inner-city teaching hospital in Atlanta, GA.We analyzed the admission clinical characteristics, laboratory studies, and hospital course of 189 consecutive episodes of DKA and 11 cases of HHS during a 13-month period starting in October 1995. RESULTS: Abdominal pain occurred in 86 of 189 patients with DKA (46%). In 30 patients, the cause of abdominal pain was considered to be secondary to the precipitating cause of metabolic decompensation. Five of them required surgical intervention including 1 patient with Fournier's necrotizing fasciitis, 1 with cholecystitis, 1 with acute appendicitis, and 2 patients with perineal abscess. The presence of abdominal pain was not related to the severity of hyperglycemia or dehydration; however, a strong association was observed between abdominal pain and metabolic acidosis. In DKA patients with abdominal pain, the mean serum bicarbonate (9 +/- 1 mmol/L) and blood pH (7.12 +/- 0.02) were lower than in patients without pain (15 +/- 1 mmol/L and 7.24 +/- 0.09, respectively, both P <.001). Abdominal pain was present in 86% of patients with serum bicarbonate less than 5 mmol/L, in 66% of patients with levels of 5 to less than 10 mmol/L, in 36% of patients with Continue reading >>
Chapter 16: Acid-base Imbalances
Sort What is the function of a buffer? a) To excrete weak acids b) To secrete hydrogen ions c) To convert strong acids to weak acids d) To convert ammonia to ammonium ions c) To convert strong acids to weak acids -Buffers convert strong acids to weak acids. Excretion of weak acids, secretion of hydrogen ions into the renal tubule, and conversion of ammonia to ammonium ions takes place in the kidneys. A nurse is caring for a patient three days after abdominal surgery who continues to have poorly controlled abdominal pain with green bilious nasogastric output. The patient's respiratory rate is 32 and heart rate is 128. Which acid-base imbalance does the nurse suspect is occurring? a) Mixed acidosis b) Mixed alkalosis c) Metabolic alkalosis d) Respiratory acidosis b) Mixed alkalosis -Mixed alkalosis can occur in a patient who is losing CO2 via hyperventilation (possibly related to pain) while also losing acid by another method, such as prolonged suctioning with a nasogastric tube. Respiratory acidosis occurs when the primary loss of acid is via a respiratory "blow off" of CO2. Metabolic alkalosis occurs with a systemic loss of acid via a metabolic process such as vomiting or suctioning with a nasogastric tube. Mixed acidosis occurs when acid is retained by both respiratory and metabolic systems, such as in a critically ill patient in shock with hypoperfusion and hypoventilation, and will often cause a more profoundly acidotic pH than either condition could independently create. The nurse is caring for a patient that is in respiratory acidosis. What cardiovascular condition should the nurse closely monitor the patient for? a) Diarrhea b) Confusion c) Abdominal pain d) Ventricular fibrillation d) Ventricular fibrillation -Respiratory acidosis causes compensatory hyperkalemia Continue reading >>
Lactic Acidosis: What You Need To Know
Lactic acidosis is a form of metabolic acidosis that begins in the kidneys. People with lactic acidosis have kidneys that are unable to remove excess acid from their body. If lactic acid builds up in the body more quickly than it can be removed, acidity levels in bodily fluids — such as blood — spike. This buildup of acid causes an imbalance in the body’s pH level, which should always be slightly alkaline instead of acidic. There are a few different types of acidosis. Lactic acid buildup occurs when there’s not enough oxygen in the muscles to break down glucose and glycogen. This is called anaerobic metabolism. There are two types of lactic acid: L-lactate and D-lactate. Most forms of lactic acidosis are caused by too much L-lactate. Lactic acidosis has many causes and can often be treated. But if left untreated, it may be life-threatening. The symptoms of lactic acidosis are typical of many health issues. If you experience any of these symptoms, you should contact your doctor immediately. Your doctor can help determine the root cause. Several symptoms of lactic acidosis represent a medical emergency: fruity-smelling breath (a possible indication of a serious complication of diabetes, called ketoacidosis) confusion jaundice (yellowing of the skin or the whites of the eyes) trouble breathing or shallow, rapid breathing If you know or suspect that you have lactic acidosis and have any of these symptoms, call 911 or go to an emergency room right away. Other lactic acidosis symptoms include: exhaustion or extreme fatigue muscle cramps or pain body weakness overall feelings of physical discomfort abdominal pain or discomfort diarrhea decrease in appetite headache rapid heart rate Lactic acidosis has a wide range of underlying causes, including carbon monoxide poisoni Continue reading >>
Chronic Metabolic Acidosis Destroys Pancreas
Peter Melamed and Felix Melamed Biotherapy Clinic of San Francisco, USA *Corresponding Author: Biotherapy Clinic of San Francisco 2215 Post Street, Suite 1, San Francisco, CA 94115, USA Phone 1 415 3776643 Fax 1 415 4093909 [email protected] Visit for more related articles at JOP. Journal of the Pancreas Abstract One primary reason for the current epidemic of digestive disorders might be chronic metabolic acidosis, which is extremely common in the modern population. Chronic metabolic acidosis primarily affects two alkaline digestive glands, the liver, and the pancreas, which produce alkaline bile and pancreatic juice with a large amount of bicarbonate. Even small acidic alterations in the bile and pancreatic juice pH can lead to serious biochemical/biomechanical changes. The pancreatic digestive enzymes require an alkaline milieu for proper function, and lowering the pH disables their activity. It can be the primary cause of indigestion. Acidification of the pancreatic juice decreases its antimicrobial activity, which can lead to intestinal dysbiosis. Lowering the pH of the pancreatic juice can cause premature activation of the proteases inside the pancreas with the potential development of pancreatitis.The acidification of bile causes precipitation of the bile acids, which irritate the entire biliary system and create bile stone formation. Aggressive mixture of the acidic bile and the pancreatic juice can cause erratic contractions of the duodenum’s walls and subsequent bile reflux into the stomach and the esophagus. Normal exocrine pancreatic function is the core of proper digestion. Currently, there is no effective and safe treatment for enhancing the exocrine pancreatic function. Restoring normal acid-base homeostasis can be a useful toolfor pathophysi Continue reading >>
<< Guidelines For The Ed Management Of Pediatric Diabetic Ketoacidosis (dka)
Epidemiology, Etiology, And Pathophysiology Epidemiology and Etiology "Type 1" and "Type 2" Diabetes in Children Type 1 diabetes is the most common type of diabetes seen in children today. The primary metabolic derangement in type 1 diabetes is an absolute insulin deficiency. These patients will have a life-long dependence on insulin injections. The overall incidence of insulin-dependent diabetes is about 15 cases per 100,000 people per year (about 50,000 are diagnosed with type 1 diabetes each year). An estimated 3 children of every 1000 will develop insulin-dependent diabetes by the age of 20. Type 1 diabetes is primarily a disease of Caucasians. The worldwide incidence is highest in Finland and Sardinia and lowest in the Asian and black populations. Type 1 diabetes is more frequently diagnosed in the winter months (the reason for this is not known.) Interestingly, twins affected by type 1 diabetes are often discordant in the development of the disease.13 About 95% of cases of type 1 diabetes are the result of a genetic defect of the immune system, exacerbated by environmental factors.13 The autoimmune destruction of the beta cells of the pancreas results in the inability to produce insulin. Inheritance of type 1 diabetes is carried in genes of the major histocompatibility complex, the human leukocyte antigen (HLA) system. Eventually, this research may lead to a vaccine using the insulin B chain 8-24 peptides to actually prevent type 1 diabetes.13 It is currently thought that islet cells damaged by a virus produce a membrane antigen that may stimulate a response by T killer cells of the immune system in the genetically susceptible patient. The T killer cells misidentify the beta cell as foreign and destroy it. As the beta cells in the pancreas are destroyed, the remai Continue reading >>
Metformin-associated Lactic Acidosis
OVERVIEW metformin use is associated with lactic acidosis, but it remians controversial as a disease entity MECHANISM the mechanism of lactic acidosis is uncertain Metabolic effects of metformin include: decreased gluconeogenesis increased peripheral glucose uptake decreased fatty acid oxidation CLINICAL FEATURES presence of risk factors abdominal pain nausea and vomiting fatigue myalgias altered mental status myocardial insufficiency multi-organ failure RISK FACTORS advanced age high dose renal failure (metformin is excreted unchanged in the urine) hypoxia active alcohol intake sepsis dehydration shock acidosis INVESTIGATIONS high anion gap metabolic acidosis (HAGMA) high lactate MANAGEMENT rule out other causes of lactic acidosis (sepsis, cardiogenic shock, hypoperfusion, ischaemic bowel) withdrawal of metformin RRT RRT remove metformin and correct acidosis best performed early due to large volume of distribution of metformin use hemodialysis use HCO3 buffer CONTROVERSY Some argue that metformin itself does not cause lactic acidosis, that it is actually due to the underlying conditions such as renal failure and diabetes mellitus. However, there are definite cases of lactic acidosis from acute metformin overdose with no other underlying risk factors. References and Links Journal articles Orban JC, Fontaine E, Ichai C. Metformin overdose: time to move on. Crit Care. 2012 Oct 25;16(5):164. [Epub ahead of print] PubMed PMID: 23110819; PubMed Central PMCID: PMC3682282. Salpeter SR, Greyber E, Pasternak GA, Salpeter EE. Risk of fatal and nonfatal lactic acidosis with metformin use in type 2 diabetes mellitus. Cochrane Database Syst Rev. 2010 Apr 14;(4):CD002967. doi: 10.1002/14651858.CD002967.pub4. Review. PubMed PMID: 20393934. FOAM and web resources Continue reading >>
What Is The Origin/mechanism Of Abdominal Pain In Diabetic Ketoacidosis?
Other than all papers I could find citing the depth of the keto-acidosis (and not the height of the blood glucose levels) correlating with abdominal pain, nothing else to explain how these two are linked. Decades ago, I was taught that because of the keto-acidosis causing a shift of intracellular potassium (having been exchanged for H+ protons of which in keto-acidosis there were too many of in the extracellular fluid) to the extracellular, so also the blood compartment, resulting in hyperkalemia, paralyzing the stomach, which could become grossly dilated - that’s why we often put in a nasogastric drainage tube to prevent vomiting and aspiration - and thus cause “stomach pain”. This stomach pain in the majority of cases indeed went away after the keto-acidosis was treated and serum electrolyte levels normalized. In one patient it didn’t, she remained very, very metabolically acidotic, while blood glucose levels normalized, later we found her to have a massive and fatal intestinal infarction as the underlying reason for her keto-acidosis….. Continue reading >>
