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Anion Gap Metabolic Acidosis

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

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 cau Continue reading >>

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  1. hkcool

    Got a quick call today from my doctor since I had a routine physical and got bloodwork and urine tests done.
    He said everything was normal except for really low vitamin D levels and oddly enough, ketones in my urine. He explained that typically it's a sign of uncontrolled diabetes but my blood sugar is fine. He ordered an a1c done at the time that I got all of my bloodwork done just to be thorough. I don't have the results in front of me but I could request a hard copy of them. Anyway, he assured me that I'm not diabetic.
    I'm a 20 y/o college student.
    Is ketones in the urine a precursor to diabetes? I did read that fasting or starvation can lead to temporary high ketone levels. As a full-time college student, let's just say that my sleeping schedule is rather...irregular. I had to fast for the blood test that morning so my last meal was dinner that evening. I didn't sleep until 7 am that morning and my appointment was at 9 am, so...yeah...
    The doctor said the next step would be a 24 hr urine test since they double-checked my results to make sure I actually had ketones in my urine and I did. But he also said there's no rush at all. I can't get the test till I'm actually back home so I'm just wondering now what it could be

  2. labrat

    Did you know the volume of ketones in your urine? Was it slight or high?
    Slight to moderate ketones can occur with exercise. Did you work out or do some strenuous physical activity before your appointment?
    People on low carbohydrate diets go into ketosis (usually preferably). These are things to consider if your testing does rule out Diabetes.
    Plus, this was a one time test. Without other symptoms or clinical presentations to preclude a diagnosis, it may be easier to simply repeat a urine sample next time, too. Shouldn't need to be a fasting sample, either.

  3. sweetthing

    Most likely caused by dehydration. Young people often do not get enough to drink. I would just make sure you have lots of water before your next test. You said you had been fasting since supper the night before? If you were a bit dry then and didn't drink anything, you could very easily have been dehydrated.

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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

Normal Anion Gap Acidosis

Terry W. Hensle, Erica H. Lambert, in Pediatric Urology , 2010 Nonanion gap acidosis occurs in situations in which HCO3 is lost from the kidney or the gastrointestinal tract or both. When this occurs, Cl (along with Na+) is reabsorbed to replace the HCO3; this leads to the hyperchloremia, which leaves the anion gap in normal range.10 Diarrhea causes a hyperchloremic, hypokalemic metabolic acidosis. Treatment depends on the severity of the acidosis incurred. In mild to moderate acidosis (pH >7.2), fluid and electrolyte replacement is often all that is required. Once adequate renal perfusion is restored, excess H+ can be excreted efficiently, restoring the pH to normal. In severe acidosis (pH <7.2), the addition of intravenous bicarbonate may be needed to correct the metabolic deficit. Before bicarbonate is administered, a serum potassium level should be obtained. The addition of bicarbonate can worsen hypokalemia, leading to neuromuscular complications. Hyperchloremic acidosis also occurs with renal insufficiency and renal tubular acidosis.9,20 Katherine Ahn Jin, in Comprehensive Pediatric Hospital Medicine , 2007 As in any condition, the first priority in management is stabilizing Continue reading >>

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  1. lorrained8

    Metformin and lactic acidosis

    Has anyone here had lactic acidosis because of taking metformin
    I have leg and muscular pain I feel tired and weak
    I've discontinued my met er
    I will talk to my dr tomorrow

  2. Sweetpoison

    Originally Posted by lorrained8
    I have leg and muscular pain I feel tired and weak
    I have leg pain and bad night cramps but I had that occasionally before I even started Met. I am sorry, Lorraine, this is happening to you!
    How long have you been on the Met ER before you realized this?

  3. Lynnw

    Originally Posted by lorrained8
    Has anyone here had lactic acidosis because of taking metformin
    I have leg and muscular pain I feel tired and weak
    I've discontinued my met er
    I will talk to my dr tomorrow Are you on any other medications that could cause that? How long have you been on the Metformin? Metformin made me incredibly fatigued, to the point where I couldn't do anything but drag myself from my bed to my chair (I'm normally a very active person). I never figured out if that was lactic acidosis, Vit B-12 deficiency (which Metformin can cause), or something else. Others have had the same experience.

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Ever wondered what on earth the Anion Gap was all about? Yeah us neither. But when you've got yourself a metabolic acidosis, this is a good place to start. If you liked this, why not subscribe? And more importantly, let us know what you'd like to see us cover next.

Anion Gap

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] Continue reading >>

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  1. 1 Posts

    Is ketosis dangerous? I'm in phase one and my kidneys ache! Thanx

  2. Phil

    No, it isn't. Kidney pain is not a symptom of ketosis - please see a doctor.

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