Alcoholic Ketoacidosis Uptodate

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Acute kidney injury (also called acute renal failure) nursing NCLEX review lecture on the nursing management, stages, pathophysiology, and causes (prerenal, intrarenal, postrenal). What is Acute Kidney Injury? It is the SUDDEN decrease in renal function that leads to the build up of waste in the blood, fluid overload, and electrolyte imbalances. What are the causes of Acute Kidney Injury? There are three causes, which are based on location. The first is known as prerenal injury and this is an issue with the perfusion to the kidneys that leads to decreased renal function. A second cause is known as intrarenal injury, and this is due to damage to the nephrons of the kidney. Lastly, postrenal injury is due to a blockage located in the urinary tract after the kidney that can extend to the urethra. This is causing the back flow of urine, which increases the pressure and waste in the kidneys. Stages of Acute Kidney Injury: There are four stage of acute kidney injury, which include initiation, oliguric, diuresis, and recovery stage. The initiation stage starts when a cause creates an injury to the kidney and then signs and symptoms start to appear. This leads to the oliguric stages. The p

Effects Of Chronic Alcohol Exposure On Ischemiareperfusion-induced Acute Kidney Injury In Mice: The Role Of -arrestin 2 And Glycogen Synthase Kinase 3

Original Article | Open Effects of chronic alcohol exposure on ischemiareperfusion-induced acute kidney injury in mice: the role of -arrestin 2 and glycogen synthase kinase 3 Experimental & Molecular Medicine volume 49, page e347 (2017) Little is known about the effects of chronic alcohol intake on the outcome of acute kidney injury (AKI). Hence, we examined the effects of chronic alcohol intake on the development of renal fibrosis following AKI in an animal model of bilateral renal ischemiareperfusion (IR) injury. We first found that chronic alcohol exposure exacerbated bilateral IR-induced renal fibrosis and renal function impairment. This phenomenon was associated with increased bilateral IR-induced extracellular matrix deposition and an increased myofibroblast population as well as increased bilateral IR-induced expression of fibrosis-related genes in the kidneys. To explore the mechanisms underlying this phenomenon, we showed that chronic alcohol exposure enhanced -arrestin 2 (Arrb2) expression and Akt and glycogen synthase kinase-3 (GSK3) activation in the kidneys. Importantly, pharmacological GSK3 inhibition alleviated bilateral IR-induced renal fibrosis and renal function Continue reading >>

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  1. JKat

    I had a great first week or so then got my period. My mood was aweful and I was hungry constantly. I did over eat a couple times but kept it to nuts and peanut butter. My cravings came flooding back and it surprised me... Does anyone else have trouble. I am permetapausal and my hormones seem to be all over the place during my period. It's like the bottom drops out. I have been journaling regularly so I know there is this 7-10 days that I am really off mood and appetite. I am curious about others or any advice. I a still trying to find my way. I am thinking about trying Judd with NK.
    Thank you for your thoughts. Jodi

  2. SweetMe678

    Oh yes! I have started calling it shark week. The cravings are insane some days. So I've decided.
    A. Not to weight, even if I'm faithful I normally don't lose. This way I'm not discouraged if I don't see a scale change.
    B. To just eat general low carb, and to plan some chocolatey lc desserts and snacks. For some reason my biggest craving is chocolate and creamy. Followed by salty and crunchy.
    In the last year I've started having some premenopausal symptoms as well. So I really sympathize. What used to be pms, is now shark week!
    I'd rather just eat too much lc foods, rather than give into other things and kick myself out of ketosis completely.

  3. MerryKate


    Originally Posted by JKat
    Does anyone else have trouble. I am permetapausal and my hormones seem to be all over the place during my period. It's like the bottom drops out. Ketosis is very much effected by hormone swings, so be kind to yourself - don't get weighed that week, and don't bother testing your ketones. Just stick to the plan as much as possible, and know a few slips along the way will not do you in, as long as you get back to NK when you can.
    I'm also in perimenopause and was starting to think I'd never lose weight again. I had to cut out dairy, limit my nut consumption, and start intermittent fasting (eating only between 1-9 p.m. each day) to get things moving again.
    Something that helps me a great deal is using progesterone cream. Because your body stores excess estrogen in fat cells, weight loss leads to excess estrogen in the bloodstream. When the levels of estrogen & progesterone are seriously out of balance, you get a whole host of fun symptoms, and moodiness, the munchies, and difficulty losing weight are among them. Using progesterone cream during the second half of your cycle can help balance that extra estrogen.
    Be sure to add anti-estrogenic foods to your plan, like chia seeds, cruciferous veggies (cabbage, broccoli, brussels sprouts, etc.), green leafy vegetables, fermented foods, onions and garlic. The fermented foods are especially important, since a healthy gut helps flush away the excess estrogen.
    I hope things start looking up for you soon!

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Educational video on methanol and ethylene glycol toxicity. Medical education. Not official statement of Albert Einstein College of Medicine or Maimonides Medical Center. Not meant as medical advice.

Case Study 23: Methanol Toxicity | Environmental Medicine: Integrating A Missing Element Into Medical Education | The National Academies Press

Methanol toxicity initially lacks severe toxic manifestations. Its pathophysiology represents a classic example of lethal synthesis in which toxic metabolites cause fatality after a characteristic latent period. Methanol is sometimes used as an ethanol substitute by alcohol abusers. The shift to alternative motor fuels may significantly increase both acute and chronic methanol exposures in the general population. This monograph is one in a series of self-instructional publications designed to increase the primary care providers knowledge of hazardous substances in the environment and to aid in the evaluation of potentially exposed patients. See page 21 for more information about continuing medical education credits and continuing education units. A 67-year-old man with headache, nausea, and visual disturbance During an afternoon visit, you see a 67-year-old man for onset of headache, nausea, and visual disturbance. The friend who accompanies him explains that both of them frequent the same senior center and that they have been preparing for a fund-raising event during the past 2 days. During this time, the patient spent between 6 and 9 hours per day reproducing fliers using a spir Continue reading >>

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  1. sonias

    3 This is my topic for this week in nursing school, respiratory & metabolic acidosis/ alkalosis. I am having trouble breaking it down. Can someone please help me understand this please? Any and all help is greatly appreciated.

  2. Esme12

    Normal values:
    PH = 7.35 - 7.45
    C02 = 35 - 45
    HC03 = 21-26
    Respiratory acidosis = low ph and high C02
    hypoventilation (eg: COPD, narcs or sedatives, atelectasis)
    *Compensated by metabolic alkalosis (increased HC03)
    For example:
    ph 7.20 C02 60 HC03 24 (uncompensated respiratory acidosis)
    ph 7.33 C02 55 HC03 29 (partially compensated respiratory acidosis)
    ph 7.37 C02 60 HC03 37 (compensated respiratory acidosis)
    Respiratory alkalosis : high ph and low C02
    hyperventilation (eg: anxiety, PE, pain, sepsis, brain injury)
    *Compensated by metabolic acidosis (decreased HC03)
    ph 7.51 C02 26 HC03 25 (uncompensated respiratory alkalosis)
    ph 7.47 C02 32 HC03 20 (partially compensated respiratory alkalosis)
    ph 7.43 C02 30 HC03 19 (compensated respiratory alkalosis)
    Metabolic acidosis : low ph and low HC03
    diabetic ketoacidosis, starvation, severe diarrhea
    *Compensated by respiratory alkalosis (decreased C02)
    ph 7.23 C02 36 HC03 14 (uncompensated metabolic acidosis)
    ph 7.31 C02 30 HC03 17 (partially compensated metabolic acidosis)
    ph 7.38 C02 26 HC03 20 (compensated metabolic acidosis)
    Metabloic alkalosis = high ph and high HC03
    severe vomiting, potassium deficit, diuretics
    *Compensated by respiratory acidosis (increased C02)
    ph 7.54 C02 44 HC03 29 (uncompensated metabolic alkalosis)
    ph 7.50 C02 49 HC03 32 (partially compensated metabolic alkalosis)
    ph 7.44 C02 52 HC02 35 (compensated metabolic alkalosis)
    *Remember that compensation corrects the ph.
    Now a simple way to remember this......
    CO2 = acid, makes things acidic
    HCO3 = base, makes things alkalotic
    Remember ROME
    Ok always look at the pH first...
    pH<7.35 = acidosis
    pH>7.45 = alkalosis
    Then, if the CO2 is high or low, then it is respiratory...If the HCO3 is high or low then it is metabolic. How you remember that is that the respiratory system is involved with CO2 (blowing air off or slowing RR), and the kidneys (metabolic) are involved with HCO3 (excreting or not excreting).
    Here is how you think thru it: pH = 7.25 CO2 = 40 HCO3 = 17
    Ok, first, the pH is low so think acidosis. CO2 is WNL. HCO3 is low. Draw arrows if it helps. The abnormal values are both low (think Equal). Metabolic imbalances are equal. So, this must be metabolic acidosis!
    Now, for compensation...If you have a metabolic imbalance, the respiratory system is going to try to compensate. Respiratory = CO2. If the CO2 is normal in the ABG, then there is no compensation going on. Compensation in acidosis will decrease the CO2 because you want to get rid of the acid (CO2). In alkalosis, it will increase because you want to add more acid (CO2)
    If you have a respiratory imbalance, the kidneys will try to compensate. Kidneys = HCO3. If the HCO3 is normal in the ABG, then there is no compensation going on. Compensation in acidosis will increase HCO3 because you want to hold on to the base to make it more alkalotic. In alkalosis, it will decrease because you want to excrete the base to make it more acidic.

  3. Esme12

    Check out this tutorial
    Interactive Online ABG's acid base

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EDUC 270

Harwood-nuss Reading For September 2016

Spinal Trauma, Chest, Abdomen and GU Trauma: Chapters 27-35 General principles of Trauma, Trauma Airway Management, Traumatic Shock, Wound Management, Head Injuries: Chapters 18-22 Pelvic Fractures, Hip and Femur Fractures, Knee Injuries, Ankle and Foot Injuries: Chapters 42-45 Urolithiasis, Urinary Incontinence and Retention, GU stents and catheters : Chapters 126-128 Acid-Base Disturbances, Diabetes, Mellitus, Hyperglycemic Crises, Hypoglycemia, Alcoholic Ketoacidosis, Thyroid Emergencies : Chapters 203-208 Pediatrics: Diabetic Ketoacidosis and Metabolic and Endocrine Disorders : Chapter 274-275 Urinary Tract Infections in Children : Chapter 288 Hematuria, AKI, CKD/ESRD, Renal Transplant, Scrotal Pain, Penile disorders, UTI, Prostatitis, Fournier Gangrene : Chapters 117-125 Pelvic Pain, PID, Vaginal Bleeding, Vaginitis, Bartholin Gland Cyst/Abscess, Breast Masses, Sexual Assault : Chapters 129-135 Pediatrics: Hematuria and Dysuria : Chapter 243 Pediatrics: Genitourinary Disorders : Chapter 287 General Approach to Toxicology, Toxic Alcohols, Acetaminophen, Salicylates, NSAIDs, Opioids, Complications of IVDU : Chapters 295-306 Isoniazid, Organophosphates, Carbamates : Chapters 317 Continue reading >>

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  1. Skiman

    So I was told that you need to be in the range of 70-80 for glucose and 1.5-3.0 to be in Ketosis and be fat adapted. So what is the difference between fat adapted or being in ketosis the whole time.
    My numbers would rarely get in the 70-80's range but mainly would like to hang out around 85-94 Rane with a Keytone reading of 1.5 and greater. Although I was told on this Facebook group that I'm not fat adapted and perhaps not in Ketosis?
    Also my glucose readings were always higher in the mornings with a few exceptions of being in the high 70's.
    Can anyone shed light on this, I feel that the keto community has different optimal ranges for what they think is correct?

    Thanks in advance.

  2. Barbara_Greenwood

    OK - "in ketosis" simply means your liver is producing ketones from partially metabolised fat. If you are more than 0.5 on your ketone meter, you are in ketosis. That will happen with about 48 hours of fasting or a few days of very low carb intake. It's an ephemeral state - eat more carbs, you'll make less ketones - eat less carbs, you'll make more ketones.
    Fat -adapted means that all the enzymes to do with fat metabolism have ramped up, so you are really good at burning fat. Also, your muscles become less keen to take up glucose because they want to leave it for the brain. Some people who low carb find their fasting glucose actually rises after a few months because of this effect.
    As to glucose levels - do you have diabetes? A normal fasting glucose is between 70 and 110, with 70-90 being preferred. I've seen keto people saying that blood glucose above 110 will prevent you being in ketosis. Well, according to my meters, that's a pile of poo, because I've seen 2+ on my ketone meter and 7 (126) on my glucose meter at the same time. But I have diabetes. Maybe in people without diabetes, a blood glucose above 110 only happens if they've eaten a load of carbs, and it's that which prevents ketosis rather than their glucose level per se.
    What enables ketosis is low carb intake. What prevents it is eating more carbs.... and maybe too much protein. More on the difference here:

    Being Fat Adapted Versus "In Ketosis" (Pt.1/3)
    “I got kicked out of ketosis.” If I never hear or read those six words, in that order, ever again, I’ll be one happy individual. ...

    Also be aware that, once you are fully fat adapted, your ketone levels may well fall. Richard and Carl have covered this on the podcast - you become more efficient at making enough ketones for your needs, but not too many. I'd been keto about 3 months when I got my ketone meter - my readings were always over 1.5, usually over 2. Another 4 months on, I rarely get above 1 unless I fast for 24 hours - my usual 20-30g carbs per day and 16/8 or 18/6 IF usually has me between 0.3 and 1. Just tested now - after 12+ hour fast, a keto day yesterday and 1 hour run this morning - BG 6.7 (120), ketones 0.5. BG was 6.1 (110) when I got up - exercise can raise it in the short term, but reduces it long term.

  3. Skiman

    Nope no diabetes on my end, I'm pretty active my events are bodybuilding and powerlifting, I have about 8% bf weighing around 155-160lbs, 39 years of age.
    This is what I read in today fasted.
    85 glucose and 3.3 Keytones this morning.

    Wondering what is the norm for being in ketosis and also fat adapted. I think what I've heard is that you have to be in a sweet spot of 70-80 glucose and 1.5-3.0 Keytones in order to be fat adapted.

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