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Anion Gap Metabolic Acidosis

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Anion gap usmle - anion gap metabolic acidosis normal anion gap metabolic acidosis

Anion Gap: Reference Range, Interpretation, Collection And Panels

The anion gap is the difference between primary measured cations (sodium Na+ and potassium K+) and the primary measured anions (chloride Cl- and bicarbonate HCO3-) in serum. This test is most commonly performed in patients who present with altered mental status, unknown exposures, acute renal failure, and acute illnesses. [ 1 ] See the Anion Gap calculator. The reference range of the anion gap is 3-11 mEq/L The normal value for the serum anion gap is 8-16 mEq/L. However, there are always unmeasurable anions, so an anion gap of less than 11 mEq/L using any of the equations listed in Description is considered normal. For the urine anion gap, the most prominently unmeasured anion is ammonia. Healthy subjects typically have a gap of 0 to slightly normal (< 10 mEq/L). A urine anion gap of more than 20 mEq/L is seen in metabolic acidosis when the kidneys are unable to excrete ammonia (such as in renal tubular acidosis). If the urine anion gap is zero or negative but the serum AG is positive, the source is most likely gastrointestinal (diarrhea or vomiting). [ 2 ] The anion gap (see the Anion Gap calculator) can be defined as low, normal, or high. Laboratory error always needs to be rule Continue reading >>

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  1. Laurie R Zawiskie, RHIT

    Has anyone tried to code DKA in a patient with DM 2? The 3M encoder takes you to the code for secondary/other diabetes and then when you try to code other diabetic manifestations you get an excludes 1 notes saying they can't be coded with other diabetes. My code book is a 2014 draft, so I don't know if this has been corrected in the 2015 version, but there is not an entry for DM 2 with DKA. I think the 3M encoder is wrong to code it as secondary/other diabetes, but I can't find another way to code it.

  2. Lynn M Farnung

    Laurie,
    There is a Coding Clinic that addresses the type of DM with DKA. I have pasted it below.
    Diabetes mellitus with diabetic ketoacidosis
    Coding Clinic, First Quarter 2013 Page: 26-27 Effective with discharges: March 27, 2013
    Related Information
    Question:
    What is the correct code assignment for type 2 diabetes mellitus with diabetic ketoacidosis?
    Answer:
    Assign code E13.10, Other specified diabetes mellitus with ketoacidosis without coma, for a patient with type 2 diabetes with ketoacidosis. Given the less than perfect limited choices, it was felt that it would be clinically important to identify the fact that the patient has ketoacidosis. The National Center for Health Statistics (NCHS), who has oversight for volumes I and II of ICD-10-CM, has agreed to consider a future ICD-10-CM Coordination and Maintenance Committee meeting proposal.
    © Copyright 1984-2015, American Hospital Association ("AHA"), Chicago, Illinois. Reproduced with permission. No portion of this publication may be copied without the express, written consent of AHA. ------------------------------
    Lynn Farnung
    Inpatient/Outpatient coder, AHIMA Approved ICD-10 Trainer
    Original Message

  3. Laurie R Zawiskie, RHIT

    Thanks, Lynn. If a patient also has DM 2 w/nephropathy (E11.21), I guess we will have to ignore the Excludes 1 note that says E13.10 can't be coded with Type 2 DM (E11.-).
    ------------------------------
    Laurie Zawiskie
    Coder III
    Original Message

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Inspired by Dr. Myat Soe, MD Internal Medicine Series: Clinical Clerkships Overview and Causes of Non-Anion Gap Metabolic Acidosis Made with help of Blueberry Flashback Recorder

Treatment Of Acute Non-anion Gap Metabolic Acidosis

Treatment of acute non-anion gap metabolic acidosis Medical and Research Services VHAGLA Healthcare System, Division of Nephrology, VHAGLA Healthcare System Correspondence to: Jeffrey A. Kraut; E-mail: [email protected] Search for other works by this author on: Clinical Kidney Journal, Volume 8, Issue 1, 1 February 2015, Pages 9399, Jeffrey A. Kraut, Ira Kurtz; Treatment of acute non-anion gap metabolic acidosis, Clinical Kidney Journal, Volume 8, Issue 1, 1 February 2015, Pages 9399, Acute non-anion gap metabolic acidosis, also termed hyperchloremic acidosis, is frequently detected in seriously ill patients. The most common mechanisms leading to this acidbase disorder include loss of large quantities of base secondary to diarrhea and administration of large quantities of chloride-containing solutions in the treatment of hypovolemia and various shock states. The resultant acidic milieu can cause cellular dysfunction and contribute to poor clinical outcomes. The associated change in the chloride concentration in the distal tubule lumen might also play a role in reducing the glomerular filtration rate. Administration of base is often recommended for the treatment of acute non-anion ga Continue reading >>

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  1. Aaron1963

    Peter Attia on people who don't do well on a Ketogenic Diet

    I know there's a few people around here who don't do well on a ketogenic diet. I know for myself, who does extremely well with this way of eating, it's sometimes hard to understand why it doesn't work for everyone. And I think sometimes the people who it doesn't work well for get exasperated with all the talk of LCHF and ketogenic diets. Well, Peter Attia, who I have a lot of respect for, talks some in this podcast about how there are some people who just don't do well on a ketogenic diet. I don't know if it would be of any interest for those of you who have this problem or not:
    http://timferriss.libsyn.com/ep-65-s...dr-peter-attia
    He doesn't go into a lot of detail about it, but it's more that it's just interesting that there is a minority of people who do have this problem.

  2. furball64801

    Its amazing how all things do not work well for everyone. Ah the saying none of us is exactly alike. I did real well on a low carb diet when I was 25 only wanted to lose about 15 lbs then, was not diabetic had energy coming out my ears. Tried it 20 yrs later and did not change my numbers that much, yes better but not to normal. I hear from some weight falls right off them and numbers turn to normal, nice if you can get it maybe pancreas function should be measured who knows why or what causes this.

  3. Aaron1963

    Just to be clear, this wasn't in relation to diabetes, but people in general who want to go on a ketogenic diet but apparently have problems with eating all that fat.

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A lecture on the differential diagnosis of a normal anion gap metabolic acidosis, focusing on renal tubular acidosis, but also covering diarrhea, saline infusion, hyperkalemia, kidney failure, and ureteral diversion

Review Of The Diagnostic Evaluation Of Normal Anion Gap Metabolic Acidosis

Acid-Base, Electrolyte and Fluid Alterations: Review Review of the Diagnostic Evaluation of Normal Anion Gap Metabolic Acidosis I have read the Karger Terms and Conditions and agree. I have read the Karger Terms and Conditions and agree. Buy a Karger Article Bundle (KAB) and profit from a discount! If you would like to redeem your KAB credit, please log in . Save over 20% compared to the individual article price. Buy Cloud Access for unlimited viewing via different devices Access to all articles of the subscribed year(s) guaranteed for 5 years Unlimited re-access via Subscriber Login or MyKarger Unrestricted printing, no saving restrictions for personal use * The final prices may differ from the prices shown due to specifics of VAT rules. For additional information: Background: Normal anion gap metabolic acidosis is a common but often misdiagnosed clinical condition associated with diarrhea and renal tubular acidosis (RTA). Early identification of RTA remains challenging for inexperienced physicians, and diagnosis and treatment are often delayed. Summary: The presence of RTA should be considered in any patient with a high chloride level when the CL-/Na+ ratio is above 0.79, if the Continue reading >>

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  1. Karin

    Hi guys,
    I can't see anything with the topic "KETO FLU". I started eating the Maria way two days ago, and am now super nauseous and vomiting. I am also weak and shaky. Is the vomiting a typical symptom of the Keto Flu, which should just be pushed through, or is something else going on?
    I was already gluten and sugar free before starting the keto diet, but was still eating a lot of carbs from gluten free breads, rice and potatoes. Should I have cut back slowly, rather than jumping in? I have been drinking plenty of water, and eating lots of salt, so I doubt that's the problem.
    Any suggestions and/or experiences would be very much appreciated, as I am miserable right now!

  2. jollyjollyme

    I've never experienced the nausea or vomiting and I've never heard of anyone else experiencing that with low carb or nutritional ketosis. I've had shakes and felt weak when just getting into it. I wasn't getting enough sodium and fluids. I've also felt shaky and weak when trying to go too low on calories at the urging of my doctor.
    Are you sure you don't have the flu or some stomach bug?

  3. savethewhales

    I experienced some nausea in the beginning, but never actually vomited. In my case, I think I started using MCT oil too quickly. Have you introduced new oils that you weren't eating before? Hope you feel better and be kind to yourself in the beginning.

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