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Can Lr Cause Lactic Acidosis?

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In this video we discuss the progression of a systemic infection including systemic inflammatory response syndrome, sepsis, severe sepsis, septic shock and multi organ dysfunction syndrome.

Which Solution Is The Best Solution (to Resuscitation In Sepsis)? - Critical Care Medicine Section Newsletter, August 2011

Which solution is the best solution (to resuscitation in sepsis)? - Critical Care Medicine Section Newsletter, August 2011 Department of Critical Care / Emergency Medicine Before you spend any time reading this be warned: this article does not answer the question, which is the best fluid for resuscitating septic patients. I do not think there is a proven evidence-based answer. This paucity of evidence disturbs me because every day we give crystalloid fluids thinking it is harmless, but perhaps this intervention is all wrong. For example, it was recently shown that children with impaired perfusion due to malaria did worse with fluid boluses compared to no boluses.(1) This is completely counterintuitive, but that is the newest evidence. This paper intends to re-examine the evidence for fluid choice in septic shock (crystalloids, colloids and blood) to see if it makes physiologic sense during resuscitation. Let us start with some physiology. One of the major goals in sepsis is to fill the tank (ie, increasing intravascular volume). This increases cardiac filling, increasing cardiac output (steeper portion of starling curve), and subsequently improve tissue perfusion. Filling the tank Continue reading >>

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  1. HighOnGoofballs

    Was the "standard diet" also running a caloric deficit? I looked but couldn't tell.

  2. LexicanLuthor

    From the article:
    Each participant elected to self- register for a 10-week study and was randomly assigned to either an experimental group using a benign dietary ketogenic diet (<30g carb/day), a group with the participant’s normal dietary protocol, or a group with the participant’s normal dietary protocol and 3-5 days of exercise for 30 minutes
    So your groups were:
    Eating exactly what made them fat in the first place
    Eating exactly what made them fat in the first place, but added exercise
    Eating a keto diet.
    Turns out, diet controls weight more than exercise, but we already knew that.
    EDIT: note to self - downloading and then reading scientific articles can rake in some serious karma. who knew.

  3. naughtilidae

    This is one of those time where a good headline/title makes something painfully obvious sound insightful. I feel like it should probably be tagged misleading at that point.

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Lactated ringers refers to intravenous fluid that is used to treat someone after trauma, blood loss, fluid loss or burn injury. Find out why normal saline can be preferable to lactated ringers, because lactated ringers creates an imbalance within electrolytes, with help from a licensed RN in this free video on IV fluids. Expert: Kayti Brosnan Bio: Kayti Brosnan has been a licensed RN in the state of Texas since 2003. Filmmaker: Todd Green

Comparisons Of Normal Saline And Lactated Ringers Resuscitation On Hemodynamics, Metabolic Responses, And Coagulation In Pigs After Severe Hemorrhagic Shock

Comparisons of normal saline and lactated Ringers resuscitation on hemodynamics, metabolic responses, and coagulation in pigs after severe hemorrhagic shock 1US Army Institute of Surgical Research, JBSA Ft, 3698 Chambers Pass, Sam Houston, TX 78234, USA Received 2013 Aug 22; Accepted 2013 Dec 5. Copyright 2013 Martini et al.; licensee BioMed Central Ltd. 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 work is properly cited. This article has been cited by other articles in PMC. Ongoing improvements in trauma care now recommend earlier use of blood products as part of damage control resuscitation, but generally these products are not available at far forward battlefield locations. For the military, questions continue to arise regarding efficacy of normal saline (NS) vs. lactated Ringers (LR). Thus, this study compared the effects of LR and NS after severe hemorrhage in pigs. 20 anesthetized pigs were randomized into control (n = 6), LR (n = 7), and NS (n = 7) groups. Hemorrhage of 60% estimated total blood volume was induced Continue reading >>

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  1. Old Forum Import

    What would cause my breath to smell like I've been drinking sometimes and I have not? Nor did I have anything to drink the night before? I've gotten in trouble at work because I suffer from occasional vascular migraines and I look like I'm drinking and now my supervisor says I smelled like I was drinking. I think she's lying -- but could there be a cause? I don't drink because I'm really a chronic dieter and don't want the empty calories.

  2. Doc Kelley

    There are some people that produce alcohol in their intestinal tract from undigested food in excess of normal amounts. This has resulted in incorrect accusations, arrests, and even, in some cases, intoxication without actually drinking alcoholic beverages.

  3. Old Forum Import

    Do you know if any vitamins or minerals taken as
    a daily supplement cause the same smell ??
    Also, do you know if Diflucan taken daily can cause
    a similar smell or interact with other drugs to cause
    an alcohol aroma ??
    Charles

    kstew likes this.

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Lactic Acidosis Treatment & Management: Approach Considerations, Sodium Bicarbonate, Tromethamine

Author: Kyle J Gunnerson, MD; Chief Editor: Michael R Pinsky, MD, CM, Dr(HC), FCCP, MCCM more... Treatment is directed towards correcting the underlying cause of lactic acidosis and optimizing tissue oxygen delivery. The former is addressed by various therapies, including administration of appropriate antibiotics, surgical drainage and debridement of a septic focus, chemotherapy of malignant disorders, discontinuation of causative drugs, and dietary modification in certain types of congenital lactate acidosis. Cardiovascular collapse secondary to hypovolemia or sepsis should be treated with fluid replacement. Both crystalloids and colloids can restore intravascular volume, but hydroxyethyl starch solutions should be avoided owing to increased mortality. [ 21 ] Excessive normal saline administration can cause a nongap metabolic acidosis due to hyperchloremia, which has been associated with increased acute kidney injury. [ 32 ] Balanced salt solutions such as Ringer lactate and Plasma-Lyte will not cause a nongap metabolic acidosis and may reduce the need for renal replacement therapy; however, these can cause a metabolic alkalosis. [ 33 ] No randomized, controlled trial has yet est Continue reading >>

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  1. celiacgirls

    This past weekend, my 8 year old daughter was complaining that she was always thirsty. Then on Tuesday, my husband noticed she had acetone breath. She has had it before, last January, and they did the blood sugar test in the pediatrician's office and it was fine. They said her bad breath could be from not brushing her teeth properly. I don't really buy that but it did go away until now. She had just brushed her teeth when my husband noticed it. Because of the increased thirst and the acetone breath, I have her scheduled for the blood test again on Monday, when her doctor gets back from vacation.
    Are there any other causes of acetone breath that aren't related to diabetes? Even if her blood sugar is ok, could this be a sign she is at risk of diabetes?
    I'm already expecting the doctor to think I'm just an overzealous mom. I did tell her the girls are on a gluten-free/CF diet due to Enterolab and she didn't seem overly interested one way or the other, so maybe there is hope she will be ok with this.

  2. CarlaB

    I don't know about acetone breath, but I notice my kids get very bad breath even right after they've brushed if they have loose teeth, even slightly loose, it's like you can smell the root rotting away.
    I'd still have her checked out to be sure, but it's not unusual for a kid to have bad breath.

  3. 2kids4me

    This is an excellent link that discusses why a non-diabetic child may have acetone breath.
    http://www.childrenwithdiabetes.com/dteam/...10/d_0d_bc8.htm
    a bit from that link:
    Quote

    My six year old adopted son has had acetone breath consistently for several weeks. I've tested his urine with the strips for glucose and ketones twice, and they are both negative. He has had this previously only when he was slightly dehydrated from bouts of nausea and vomiting. He is otherwise perfectly healthy and active and has no symptoms of diabetes. We have a dog with diabetes which is why I am familiar with the signs and the breath odor and have the urine strips. Are there other causes of acetone breath in an otherwise normal six year old? In view of the negative strips should I still have his blood glucose tested?
    Answer:
    Not everyone can smell acetone, but if you can, the most sensitive vehicle is the breath which may explain why urine testing has been negative. Ketosis in children can occur when the body is unable to get sufficient basal energy needs from the metabolism of carbohydrate and resorts to the breakdown of fat stores with the production of ketones. This can occur because of diabetes, but, as you have noticed, this is most likely to occur when appetite is diminished by intercurrent illness. The same can happen if energy consumption is increased and a child is too busy to eat sufficiently.

    I think it very unlikely that what you describe has anything to do with diabetes, but if you have a diabetic dog and the means of measuring blood sugars you might test your son after a period of energetic activity to see if it is low because the phenomenon I have described is called ketotic hypoglycemia.

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