Alcohol Associated Lactic Acidosis

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Metformin-associated Lactic Acidosis Presenting As An Ischemic Gut In A Patient Who Then Survived A Cardiac Arrest: A Case Report

Ncomanzi et al.; licensee BioMed Central Ltd.2014 Lactic acidosis is the most common cause of metabolic acidosis in hospitalized patients. It is recognized as a potential complication of metformin use, particularly in patients with risk factors such as renal dysfunction, liver disease, and heavy alcohol ingestion. These conditions are associated with systemic hypoxemia, which may be caused by cardiorespiratory disease, major surgery, sepsis, dehydration, old age, and overdose. The reported frequency of lactic acidosis is 0.06 per 1000 patient-years, mostly in patients with predisposing factors. This case is important because it details the seriousness of metformin-associated lactic acidosis in a critically ill patient and because, to the best of our knowledge, our patient survived with minimal residual defect despite experiencing a cardiac arrest. A 66-year-old Caucasian woman presented to our hospital with profound lactic acidosis, which was initially thought to be ischemic gut. She then survived an in-hospital pulseless electrical activity arrest. Metformin-associated lactic acidosis is a diagnosis by exclusion; however, a high degree of clinical suspicion supplemented by prompt Continue reading >>

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Popular Questions

  1. Desley

    Help! I'm frustrated, I'm into my 2nd week on Induction & I'm still not into Ketosis. I've been keeping my carbs below 20 carbs a day.
    If fact I've been averaging 18. Testing my Urine every 2sd day for the recommended 15 seconds. Anybody got any ideas?

  2. Desley

    Have been reading some old posts (2011) about bringing on Ketosis by upping your fat intake using Coconut Oil. Has anyone got any info on this. What does Atkins think about this?

  3. Helen

    The ketostix are not always accurate. You may be in ketosis when they say you aren't.
    Are you thirsty all the time? Has your hunger gone away? Those are generally the best two ways to recognise that you are in ketosis.
    Saying that, while most people can achieve ketosis in 3-6 days, for some it can take a few weeks, especially if they are insulin resistant.
    Not sure about the Coconut oil (although it is good for you). I have read that it can help in ketogenic diets, but not sure if it will help in the case of Atkins.

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Survival From Profound Alcohol-related Lactic Acidosis - Sciencedirect

Survival from profound alcohol-related lactic acidosis Author links open overlay panel DavidLienMDa Timothy JMaderMDa Get rights and content We present the case of a patient with profound alcohol-related lactic acidosis (lactate = 16.1 mmol/L; pH = 6.67) associated with a multitude of metabolic derangements who made a remarkable recovery following aggressive management. The patient was in extremis upon arrival in the emergency department (ED), and resuscitation was begun immediately. While in the ED, the problem list generated included: acute alcohol intoxication, severe lactic acidosis, dehydration, hypothermia, hypoglycemia, acute renal insufficiency, and hepatic failure. Resuscitation continued in the intensive care unit with remarkable improvement and satisfactory outcome. In this patient, the severe lactic acidosis and associated abnormalities were all attributed to acute and chronic effects of ethanol. A brief summary of the proposed mechanism by which these metabolic derangements developed and an outline of her management follows. Continue reading >>

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  1. munkeesmama

    A little back history. I have always gained a ton in my pregnancies 50+ lbs. I've always started off at a "normal" pre-pregnancy weight, and the weight gain is gradual but consistent from the time I get a positive test. I've also in general had no real issue getitng back to pre-pregnancy weight within a few months.
    Well, this pregnancy I started off as overweight. I am 5'4" and weighed 204. When I found out I was pregnant, I cut WAY back on my soda intake (now i have just a few a week instead of like 6-8 cans a DAY), we also cut out ALOT of fast food and really only eat out once a week or so. I will be 18 weeks tomorrow and have lost a total of 14 lbs. At my last midwife appt. I had Ketones in my urine. (I know some of you don't believe in pee sticks during pregnancy, but that's another post of mine to make). Anyways, my midwife said that with the weight loss and the ketones in my urine that I'm burning too much fat and the ketones can be toxic to the baby and I NEED to gain weight and not spill ketones.
    I'm not really sure how to fix this though. I really think the weightloss is from ditching the soda, and eating better. I'm not dieting, I don't watch my calories, in fact, I'm not really excercising besides walking to the mailbox down the road, shopping, and running after my 3 kids. I am eating smaller more frequent meals, and nothing sounds good, but I wouldn't say i'm not eating enough.
    So, if I were your client, what would you have me do? Should I be worried? Or, could this be normal for somebody who was so overweight to begin with?

  2. dewi

    As a trained CB educator I would encourage you to seek guidance from a nutritionist. Especially since you feel you're eating a balanced diet (not just proteins), you need more guidance than the statement to "gain weight".
    It is not so easy for a very overweight women who is now eating healthier wholesome food to "gain weight" in pregnancy.
    Your calorie intake is probably now "normal" and that is making you loose weight as it should.
    An alternative if you cannot afford to see a nutritionist is to use a Weight Watchers meetings, they will give you the "pregnancy diet". It is great program. It's a 100% balanced nutrition and so much food to eat while you continue to loose or maintain your weight.
    This is a great supportive web site .

  3. munkeesmama

    I should also mention, that my midwife seems to be really "in the know" about nutrition and gave me some suggestions on food, how much protein, veggies, fruits, carbs, etc. I should be eating etc. I guess my question is moreso, is this normal for somebody who is overweight, and now eating better? How dangerous are the ketones to the baby? Is there a way to hep with the ketone issue besides "just gaining weight"?

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Metabolic Abnormalities In Alcoholic Patients: Focus On Acid Base Andelectrolyte Disorders

E-mail: [emailprotected] , [emailprotected] Received Date: December 20, 2014; Accepted Date: January 24, 2015; Published Date: January 27, 2015 Citation: Moses Elisaf MD, Rigas Kalaitzidis MD (2015) Metabolic Abnormalities in Alcoholic Patients: Focus on Acid Base and Electrolyte Disorders. J Alcohol Drug Depend 3:185. doi:10.4172/2329-6488.1000185 Copyright: 2015 Moses Elisaf MD, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Alcoholic patients commonly develop a variety of acid-base and electrolyte disturbances. The aim of this review is to describe the most commonly encountered abnormalities and their significant role in the patients morbidity and mortality. Physicians should be aware of these clinically important disturbances caused by alcohol abuse and their underlying pathophysiological mechanisms involved for their appropriate management. Alcoholic Keto Acidosis (AKA) is a medical emergency is more common than previously thought and is characterized by an increased anion gap metabo Continue reading >>

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  1. CyprusRoots

    Hi all, I'm 5 days into my keto journey and just got a little bit impatient and decided to take a ketones reading using the stick method. The reading was in the purple (very excited) and the reading was +15 (1.5) mg/dl(mmol/L). I haven't a clue what that means? Could someone give me an explanation? Thanks.

  2. Azuriaz

    Sounds like the number is milligrams per deciliter? I never pay attention to that, I just go with the shade of purple. The times I've gone several months straight in ketosis, the tendency is for the sticks to go into the light/moderate range as long as I stay well-hydrated. From what I understand that is normal. I have yet to see the sticks show not in ketosis at all unless I've eaten something that I knew would put me out. Really they're a very rough guide, I'm just too broke to go around spending five bucks on blood test strips!

  3. KnitOrMiss

    You should be able to download a chart online by brand. My general understanding is that the darker the color, the more ketones being dumped as waste. That means you are making a ton, but not yet efficient at using all of what you make (adapted). It's a good first step stage. That being said, as you adapt, you will "waste" less, and those results will become unreliable at best.

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