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Alcoholic Acidosis

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What is DIABETIC KETOACIDOSIS? What does DIABETIC KETOACIDOSIS mean? DIABETIC KETOACIDOSIS meaning - DIABETIC KETOACIDOSIS definition - DIABETIC KETOACIDOSIS explanation. Source: Wikipedia.org article, adapted under https://creativecommons.org/licenses/... license. SUBSCRIBE to our Google Earth flights channel - https://www.youtube.com/channel/UC6Uu... Diabetic ketoacidosis (DKA) is a potentially life-threatening complication of diabetes mellitus. Signs and symptoms may include vomiting, abdominal pain, deep gasping breathing, increased urination, weakness, confusion, and occasionally loss of consciousness. A person's breath may develop a specific smell. Onset of symptoms is usually rapid. In some cases people may not realize they previously had diabetes. DKA happens most often in those with type 1 diabetes, but can also occur in those with other types of diabetes under certain circumstances. Triggers may include infection, not taking insulin correctly, stroke, and certain medications such as steroids. DKA results from a shortage of insulin; in response the body switches to burning fatty acids which produces acidic ketone bodies. DKA is typically diagnosed when testing finds high blood sugar, low blood pH, and ketoacids in either the blood or urine. The primary treatment of DKA is with intravenous fluids and insulin. Depending on the severity, insulin may be given intravenously or by injection under the skin. Usually potassium is also needed to prevent the development of low blood potassium. Throughout treatment blood sugar and potassium levels should be regularly checked. Antibiotics may be required in those with an underlying infection. In those with severely low blood pH, sodium bicarbonate may be given; however, its use is of unclear benefit and typically not recommended. Rates of DKA vary around the world. About 4% of people with type 1 diabetes in United Kingdom develop DKA a year, while in Malaysia the condition affects about 25% a year. DKA was first described in 1886 and, until the introduction of insulin therapy in the 1920s, it was almost universally fatal. The risk of death with adequate and timely treatment is currently around 1–4%. Up to 1% of children with DKA develop a complication known as cerebral edema. The symptoms of an episode of diabetic ketoacidosis usually evolve over a period of about 24 hours. Predominant symptoms are nausea and vomiting, pronounced thirst, excessive urine production and abdominal pain that may be severe. Those who measure their glucose levels themselves may notice hyperglycemia (high blood sugar levels). In severe DKA, breathing becomes labored and of a deep, gasping character (a state referred to as "Kussmaul respiration"). The abdomen may be tender to the point that an acute abdomen may be suspected, such as acute pancreatitis, appendicitis or gastrointestinal perforation. Coffee ground vomiting (vomiting of altered blood) occurs in a minority of people; this tends to originate from erosion of the esophagus. In severe DKA, there may be confusion, lethargy, stupor or even coma (a marked decrease in the level of consciousness). On physical examination there is usually clinical evidence of dehydration, such as a dry mouth and decreased skin turgor. If the dehydration is profound enough to cause a decrease in the circulating blood volume, tachycardia (a fast heart rate) and low blood pressure may be observed. Often, a "ketotic" odor is present, which is often described as "fruity", often compared to the smell of pear drops whose scent is a ketone. If Kussmaul respiration is present, this is reflected in an increased respiratory rate.....

Alcoholic Ketoacidosis

Seen in patients with recent history of binge drinking with little/no nutritional intake Anion gap metabolic acidosis associated with acute cessation of ETOH consumption after chronic abuse Characterized by high serum ketone levels and an elevated AG Consider other causes of elevated AG, as well as co-ingestants Concomitant metabolic alkalosis can occur from dehydration (volume depletion) and emesis Ethanol metabolism depletes NAD stores[1] Results in inhibition of Krebs cycle, depletion of glycogen stores, and ketone formation High NADH:NAD also results in increased lactate production Acetoacetate is metabolized to acetone so elevated osmolal gap may also be seen Differential Diagnosis Starvation Ketosis Binge drinking ending in nausea, vomiting, and decreased intake Positive serum ketones Wide anion gap metabolic acidosis without alternate explanation Urine ketones may be falsely negative or low Lab measured ketone is acetoacetate May miss beta-hydroxybutyrate Consider associated diseases (ie pancreatitis, rhabdomyolysis, hepatitis, infections) Oral nutrition if able to tolerate Consider bicarb if life-threatening acidosis (pH <7.1) unresponsive to fluid therapy Discharge home af Continue reading >>

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Popular Questions

  1. Porthardygurl

    I am feeling rather upset and concerned right now at this time. I have been OP since i started this program this time around..Not a lick , taste or a bite and my numbers show the continuous losses from week to week..I have been so happy being in ketosis and not feeling hungry...
    HOWEVER... I was feeling seriously nauseated in the store today, felt like i was going to puke...so my hubby grabbed me a 1 litre gingerale and we booked it out of there pronto...I get to the car, unscrew the cap and suck it back like nobodys business...hoping that it would help..Well..good news is..it did help... BAD NEWS is... It wasnt diet ...
    I didnt even look at the label on the bottle till after i had drank some..Usually i pick up diet .... i never buy the sugar laden soft drinks..but my hunny must have picked it up in a rush, and didnt look..and of course me thinking that he has my best interest at heart..assumed it was diet....
    So now im seriously conerned i have knocked myself out of ketosis...
    The carb content per 8oz were 25 grams of carbs... 16 grams of sugar...
    I measured the rest of the gingerale out when i got home to see how much i had drank..and it looks like maybe 1/2 a cup was gone..My question is...if thats half a cup...then thats about 13 total carbs for that 1/2 cup....
    My other food for the day..has consisted of..
    morning shake: 2 g net carb
    Lunch shake : 2 g net carb
    wafer packet alternative: 6 net carb
    So thats 10 grams of Net carbs without adding in vegs yet...So 10 plus 12 is 22 Net carbs...will this kick me out of ketosis????? Ive worked so hard to stay OP 100% I dont want to have ruined it...

  2. CarCamMom

    Quote:

    Originally Posted by Porthardygurl
    I am feeling rather upset and concerned right now at this time. I have been OP since i started this program this time around..Not a lick , taste or a bite and my numbers show the continuous losses from week to week..I have been so happy being in ketosis and not feeling hungry...
    HOWEVER... I was feeling seriously nauseated in the store today, felt like i was going to puke...so my hubby grabbed me a 1 litre gingerale and we booked it out of there pronto...I get to the car, unscrew the cap and suck it back like nobodys business...hoping that it would help..Well..good news is..it did help... BAD NEWS is... It wasnt diet ...
    I didnt even look at the label on the bottle till after i had drank some..Usually i pick up diet .... i never buy the sugar laden soft drinks..but my hunny must have picked it up in a rush, and didnt look..and of course me thinking that he has my best interest at heart..assumed it was diet....
    So now im seriously conerned i have knocked myself out of ketosis...
    The carb content per 8oz were 25 grams of carbs... 16 grams of sugar...
    I measured the rest of the gingerale out when i got home to see how much i had drank..and it looks like maybe 1/2 a cup was gone..My question is...if thats half a cup...then thats about 13 total carbs for that 1/2 cup....
    My other food for the day..has consisted of..
    morning shake: 2 g net carb
    Lunch shake : 2 g net carb
    wafer packet alternative: 6 net carb
    So thats 10 grams of Net carbs without adding in vegs yet...So 10 plus 12 is 22 Net carbs...will this kick me out of ketosis????? Ive worked so hard to stay OP 100% I dont want to have ruined it... I wish I could help you, but I'm too new to be sure....All I can do is hope for you!! I think the magic number I hear is 40 carbs or less a day, so you might be ok???? I'm sure someone else will know. I've got my fingers crossed for you!
    Look on the bright side...this will make for an excellent update on IPTV!

  3. scorbett1103

    I'm way too new to be an expert, but I've done LOTS of reading on the forums since starting. I have seen more than one person post that their coach allowed for a "cheat" day (which I can only assume means they would be eating a lot more carbs than usual) followed by 2 days on VERY strict phase 1 protocol with NO restricted packets/bars. Not something to make a habit of, but it might be worth doing for the next 2 days and talk to your coach. You might stall just a little but you shouldn't lose too much ground.

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What is KETOACIDOSIS? What does KETOACIDOSIS mean? KETOACIDOSIS meaning - KETOACIDOSIS definition - KETOACIDOSIS explanation. Source: Wikipedia.org article, adapted under https://creativecommons.org/licenses/... license. SUBSCRIBE to our Google Earth flights channel - https://www.youtube.com/channel/UC6Uu... Ketoacidosis is a metabolic state associated with high concentrations of ketone bodies, formed by the breakdown of fatty acids and the deamination of amino acids. The two common ketones produced in humans are acetoacetic acid and ß-hydroxybutyrate. Ketoacidosis is a pathological metabolic state marked by extreme and uncontrolled ketosis. In ketoacidosis, the body fails to adequately regulate ketone production causing such a severe accumulation of keto acids that the pH of the blood is substantially decreased. In extreme cases ketoacidosis can be fatal. Ketoacidosis is most common in untreated type 1 diabetes mellitus, when the liver breaks down fat and proteins in response to a perceived need for respiratory substrate. Prolonged alcoholism may lead to alcoholic ketoacidosis. Ketoacidosis can be smelled on a person's breath. This is due to acetone, a direct by-product of the spontaneous decomposition of acetoacetic acid. It is often described as smelling like fruit or nail polish remover. Ketosis may also smell, but the odor is usually more subtle due to lower concentrations of acetone. Treatment consists most simply of correcting blood sugar and insulin levels, which will halt ketone production. If the severity of the case warrants more aggressive measures, intravenous sodium bicarbonate infusion can be given to raise blood pH back to an acceptable range. However, serious caution must be exercised with IV sodium bicarbonate to avoid the risk of equally life-threatening hypernatremia. Three common causes of ketoacidosis are alcohol, starvation, and diabetes, resulting in alcoholic ketoacidosis, starvation ketoacidosis, and diabetic ketoacidosis respectively. In diabetic ketoacidosis, a high concentration of ketone bodies is usually accompanied by insulin deficiency, hyperglycemia, and dehydration. Particularly in type 1 diabetics the lack of insulin in the bloodstream prevents glucose absorption, thereby inhibiting the production of oxaloacetate (a crucial molecule for processing Acetyl-CoA, the product of beta-oxidation of fatty acids, in the Krebs cycle) through reduced levels of pyruvate (a byproduct of glycolysis), and can cause unchecked ketone body production (through fatty acid metabolism) potentially leading to dangerous glucose and ketone levels in the blood. Hyperglycemia results in glucose overloading the kidneys and spilling into the urine (transport maximum for glucose is exceeded). Dehydration results following the osmotic movement of water into urine (Osmotic diuresis), exacerbating the acidosis. In alcoholic ketoacidosis, alcohol causes dehydration and blocks the first step of gluconeogenesis by depleting oxaloacetate. The body is unable to synthesize enough glucose to meet its needs, thus creating an energy crisis resulting in fatty acid metabolism, and ketone body formation.

Alcoholic Ketoacidosis

Author: George Ansstas, MD; Chief Editor: Romesh Khardori, MD, PhD, FACP more... In 1940, Dillon and colleagues first described alcoholic ketoacidosis (AKA) as a distinct syndrome. AKA is characterized by metabolic acidosis with an elevated anion gap, elevated serum ketone levels, and a normal or low glucose concentration. [ 1 , 2 ] Although AKA most commonly occurs in adults with alcoholism, it has been reported in less-experienced drinkers of all ages. Patients typically have a recent history of binge drinking, little or no food intake, and persistent vomiting. [ 3 , 4 , 5 ] A concomitant metabolic alkalosis is common, secondary to vomiting and volume depletion (see Workup). [ 6 ] Treatment of AKA is directed toward reversing the 3 major pathophysiologic causes of the syndrome, which are: An elevated ratio of the reduced form of nicotinamide adenine dinucleotide (NADH) to nicotinamide adenine dinucleotide (NAD+) This goal can usually be achieved through the administration of dextrose and saline solutions (see Treatment). The pathogenesis of AKA is complex. [ 7 ] Although the general physiological factors and mechanisms leading to AKA are understood, the precise factors have not Continue reading >>

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  1. datums

    Unfortunately, biochemistry is not the kind of topic that can be easily researched online without formal training. There are a number of points you make that are incorrect. I keto myself, so don't think I am trying to attack your general position here.
    Starvation and the keto diet are actually nearly identical from a biochemical perspective. The key pathway is fat mobilization, where fatty acid chains are broken down two carbons at a time to produce energy. When this process starts to happen faster than your body can manage it, some of the chemical constituents of the process actually break down to become the ketones that can be detected in the urine and breath. In other words, ketones are a side effect, rather than a major player.
    The idea that a calorie deficit, ie starvation, is somehow bad, is incorrect. Anybody who is using diet and exercise to become more lean is doing the same thing. There is no magic method to lose weight without some form of starvation. The reason why the keto diet does not cause significant lean tissue loss is that the starvation involved is not sufficiently severe.
    An important point that you bring up is the idea that the keto diet stabilizes insulin levels. This is basically correct. Insulin signals cells to take up glucose from the blood, and also tells the liver to begin glycogenesis - the process of packing glucose into glycogen. High blood sugar triggers this. These effects are basically reversed by adrenaline, which tells the liver to start breaking glycogen down to make glucose.
    Part of the difficulty with this is that with a normal diet, blood sugar spikes after meals. This leads to cyclic variance in levels of glucose, insulin and adrenaline. As the cycle progresses toward the adrenaline end, you start to get cravings for foods that will once again spike your blood glucose.
    However, when you are relying on fat mobilization to make glucose, these spikes are greatly reduced. Fat mobilization is not efficient, and is not able to provide sudden bursts of glucose. It is more constant. This makes athletic activity much more difficult aswell.
    But this is the real reason why the keto diet works - it mitigates the cycle of spiking and lowering blood sugar, providing a more level and constant supply. This reduces the propensity for craving food.
    In essence, the keto diet is not unique in terms of the basic biochemistry of metabolism. It simply makes 'starvation' more tolerable, and easier to manage. For many of us, that is exactly what we need.
    Edit - swapped 'gluconeogenesis' with 'glycogenesis'.

  2. gogge

    Insulin signals cells to take up glucose from the blood, and also tells the liver to begin gluconeogenesis - the process of packing glucose into glycogen. High blood sugar triggers this. These effects are basically reversed by adrenaline, which tells the liver to start breaking glycogen down to make glucose.
    Insulin inhibits gluconeogenesis (creation of new glucose), you probably meant glycogenesis (conversion of glucose to glycogen)?

  3. datums

    You are right on that one. The word I was looking for was glycogenesis. It can be a little tricky to remember that between glycolysis, glucogenesis, and gluconeogenesis, one means glycogen synthesis, and the other two mean glycogen breakdown.

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Cells need glucose (sugar) and insulin to function properly.Glucose comes from the food you eat, and insulin is produced by the pancreas.When you drink alcohol, your pancreas may stop producing insulin for a shorttime. Without insulin, your cells wont be able to use the glucose you consumefor energy. To get the energy you need, your body will start to burn fat. When your body burns fat for energy, byproducts known as ketonebodies are produced. If your body is not producing insulin, ketone bodies willbegin to build up in your bloodstream. This buildup of ketones can produce alife-threatening condition known as ketoacidosis. Ketoacidosis, ormetabolic acidosis, occurs when you ingest something that is metabolized orturned into an acid. This condition has a number of causes, including: In addition to general ketoacidosis, there are several specifictypes. These types include: alcoholic ketoacidosis, which is caused by excessive consumptionof alcohol diabetic ketoacidosis (DKA), which mostly develops in peoplewith type 1 diabetes starvation ketoacidosis, which occurs most often in women whoare pregnant, in their third trimester, and experiencing excessive vomiting Each of these situatio Continue reading >>

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  1. maxell

    I'm wondering how people are coping with the stinky smell of ketosis. I'm on a ketogenic low-carb diet -- usually 60g of net carbs or less. I've tested myself with ketostix several times and I can smell the rancid urine smell when I pee.
    The problem here is that my toilet doesn't seem to flush completely and the ketogenic smell stays in the bathroom and even leaks to the living room. My super came in to my apartment once and asked what that smell is, whether I'm flushing my toilet.
    I've been using Lysol before I leave to air out the bathroom but that doesn't seem to be enough. Now, I'm using air fresheners, fragrance refills, and toilet bowl cleaners but I can still smell it when I enter my apartment. Not as bad but the smell is unmistakable.
    How do people deal with this ketogenic smell? It's good that I'm ketogenic. But I can do without the smell.

  2. skunk

    my daily carbs is less than 20 grams, and the acetone in my breath is so strong, i swear i can knock out flies LOL
    Not just that, my sweat has a strange smell too.
    I guess we just have to get used to it?
    At least now i know how Paleolithic Cavemen used to smell like lol

  3. Matt51

    A healthy person on a ketogenic diet, should only be slightly in ketosis according to the keto-sticks. After a couple weeks in ketosis, you should not be having a problem with bad breath or urine. 60g carbs a day is more than enough one should be out of ketosis.
    My guess is you have some other problem. Taking an activated charcoal tablet a day should help with the odor.

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