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Can Metabolic Acidosis Be Caused By Seizures?

Metabolic Acidosis

Metabolic Acidosis

Metabolic acidosis is a condition that occurs when the body produces excessive quantities of acid or when the kidneys are not removing enough acid from the body. If unchecked, metabolic acidosis leads to acidemia, i.e., blood pH is low (less than 7.35) due to increased production of hydrogen ions by the body or the inability of the body to form bicarbonate (HCO3−) in the kidney. Its causes are diverse, and its consequences can be serious, including coma and death. Together with respiratory acidosis, it is one of the two general causes of acidemia. Terminology : Acidosis refers to a process that causes a low pH in blood and tissues. Acidemia refers specifically to a low pH in the blood. In most cases, acidosis occurs first for reasons explained below. Free hydrogen ions then diffuse into the blood, lowering the pH. Arterial blood gas analysis detects acidemia (pH lower than 7.35). When acidemia is present, acidosis is presumed. Signs and symptoms[edit] Symptoms are not specific, and diagnosis can be difficult unless the patient presents with clear indications for arterial blood gas sampling. Symptoms may include chest pain, palpitations, headache, altered mental status such as severe anxiety due to hypoxia, decreased visual acuity, nausea, vomiting, abdominal pain, altered appetite and weight gain, muscle weakness, bone pain, and joint pain. Those in metabolic acidosis may exhibit deep, rapid breathing called Kussmaul respirations which is classically associated with diabetic ketoacidosis. Rapid deep breaths increase the amount of carbon dioxide exhaled, thus lowering the serum carbon dioxide levels, resulting in some degree of compensation. Overcompensation via respiratory alkalosis to form an alkalemia does not occur. Extreme acidemia leads to neurological and cardia Continue reading >>

Topiramate In Monotherapy Or In Combination As A Cause Of Metabolic Acidosis In Adults With Epilepsy

Topiramate In Monotherapy Or In Combination As A Cause Of Metabolic Acidosis In Adults With Epilepsy

159www.neurologia.com Rev Neurol 2015; 60 (4): 159-163 Topiramate has been widely used for the treatment of focal and generalized epilepsy since it received FDA approval in 1993. Its broad anticonvulsant properties rely on multiple inhibitory mechanisms, which include voltage-activated sodium channels, L-type high-voltage-activated calcium channels and kainate-evoked currents. In addition to aecting membrane currents, TPM also inhibits isoenzymes I-VI of carbonic anhydrase (CA), which are present in neurons and nephrons [1]. is results in a pre- disposition to metabolic acidosis that has been widely described in children due to its deleterious eect on the acid-base balance and its associated symptoms such as nausea, headache, diarrhea, hy- perventilation, and hypercalciuria, which may lead Because metabolic acidosis may have adverse clinical consequences, even in its milder forms, we performed this prospective cross-sectional study to assess the severity and prevalence of metabolic aci- dosis in adults taking topiramate and to attempt to dene some factors that determine its presence, specically if acidosis is signicantly associated with drug dose, concomitant drug regimen or with the time that the patient has been taking the drug. e study was approved by the ISSSTE local re- search and ethics committee, and all patients gave written informed consent. Patients were recruited from the Epilepsy Clinic of the National Medical Center 20 de Noviembre ISSSTE, in Mexico City, which is a third-level national reference center. We recruited consecutive patients who met the follow- ing criteria: willing to participate, aged 18 years or older, had been using topiramate alone or in combi- nation for at least 1 month, and attended regular follow-up visits at the epilepsy clinic. We e Continue reading >>

Severe Diabetic Ketoacidosis Complicated By Hypocapnic Seizure

Severe Diabetic Ketoacidosis Complicated By Hypocapnic Seizure

Summary In clinical practice, seizures independent of hypoglycemia are observed in patients with type 1 diabetes mellitus (T1DM) more frequently than expected by chance, suggesting a link. However, seizures during management of diabetic ketoacidosis (DKA) have generally been considered a bad prognostic factor, and usually associated with well-known biochemical or neurological complications. We present the case of a 17-year-old girl with known T1DM managed for severe DKA complicated by hypocapnic seizure. We review the literature on this rare occurrence as well as outline other possible differentials to consider when faced with the alarming combination of DKA and seizure. Learning points: Seizures during DKA treatment require immediate management as well as evaluation to determine their underlying cause. Their etiology is varied, but a lowered seizure threshold, electrolyte disturbances and serious neurological complications of DKA such as cerebral edema must all be considered. Sudden severe hypocapnia may represent a rare contributor to seizure during the treatment of DKA. Background Diabetic ketoacidosis (DKA) is an endocrine emergency occurring in patients with both new-onset and established type 1 diabetes (T1DM). In brief, the diagnosis is based on clinical suspicion followed by fulfillment of biochemical criteria: Hyperglycemia (blood glucose level (BGL) >11 mmol/L); ketonuria and/or ketonemia and metabolic acidosis (pH <7.3, bicarbonate <15 mmol/L). It is a leading acute cause of diabetes-related morbidity and mortality, particularly in children (1), often due to well-described complications of treatment. The most common of these include cerebral edema, and electrolyte disturbances such as hypoglycemia and hypokalemia. Seizure activity occurring during treatment o Continue reading >>

Dehydration, Seizure, Metabolic Acidosis: Causes & Diagnoses | Symptoma.com

Dehydration, Seizure, Metabolic Acidosis: Causes & Diagnoses | Symptoma.com

A state of catabolism precipitated by any stressor can contribute to exacerbation of the underlying metabolic decompensation and promote worsening metabolic acidosis, ketosis [newenglandconsortium.org] Study participants were evaluated at steady state and were without clinical symptoms of metabolic instability or evidence of ketosis or lactic acidosis. [ajcn.nutrition.org] Recognition of poor feeding, vomiting, dehydration, hypotonia, respiratory distress, and seizure may help in identifying ongoing metabolic decompensation. [emedicine.medscape.com] Acute Presentation Lethargy, altered mental status Nausea, vomiting Hepatomegaly Laboratory Findings Hypoglycemia Metabolic acidosis with anion gap Hyperammonemia There are [newenglandconsortium.org] New methods for calculating metabolic rate with special reference to protein metabolism . [ajcn.nutrition.org] [] to exacerbation of the underlying metabolic decompensation and promote worsening metabolic acidosis, ketosis, and also possibly hyperammonemia. [newenglandconsortium.org] This enzymatic deficiency leads to severe metabolic derangement, manifested clinically as vomiting, dehydration, and acidosis progressing to seizures, coma, and death. [thefreelibrary.com] Fluid, electrolyte and acid-base balance Electrolyte disturbance - Na Hypernatremia / Hyponatremia - Acidosis ( Metabolic , Respiratory , Lactic ) - Alkalosis ( Metabolic [wikidoc.org] acidosis with anion gap Hypoglycemia Ketonuria Hyperammonemia Hyperglycinemia There are two types of presentation of IVA depending on the severity of the metabolic defect [newenglandconsortium.org] The natural history of IVA is characterized by severe metabolic derangement leading to coma, seizure, and death. [thefreelibrary.com] Acid-Base Disorders in Salicylate Toxicity Adults : Continue reading >>

Lactate And Lactic Acidosis

Lactate And Lactic Acidosis

The integrity and function of all cells depend on an adequate supply of oxygen. Severe acute illness is frequently associated with inadequate tissue perfusion and/or reduced amount of oxygen in blood (hypoxemia) leading to tissue hypoxia. If not reversed, tissue hypoxia can rapidly progress to multiorgan failure and death. For this reason a major imperative of critical care is to monitor tissue oxygenation so that timely intervention directed at restoring an adequate supply of oxygen can be implemented. Measurement of blood lactate concentration has traditionally been used to monitor tissue oxygenation, a utility based on the wisdom gleaned over 50 years ago that cells deprived of adequate oxygen produce excessive quantities of lactate. The real-time monitoring of blood lactate concentration necessary in a critical care setting was only made possible by the development of electrode-based lactate biosensors around a decade ago. These biosensors are now incorporated into modern blood gas analyzers and other point-of-care analytical instruments, allowing lactate measurement by non-laboratory staff on a drop (100 L) of blood within a minute or two. Whilst blood lactate concentration is invariably raised in those with significant tissue hypoxia, it can also be raised in a number of conditions not associated with tissue hypoxia. Very often patients with raised blood lactate concentration (hyperlactatemia) also have a reduced blood pH (acidosis). The combination of hyperlactatemia and acidosis is called lactic acidosis. This is the most common cause of metabolic acidosis. The focus of this article is the causes and clinical significance of hyperlactatemia and lactic acidosis. The article begins with a brief overview of normal lactate metabolism. Normal lactate production and Continue reading >>

Acidosis

Acidosis

When your body fluids contain too much acid, it’s known as acidosis. Acidosis occurs when your kidneys and lungs can’t keep your body’s pH in balance. Many of the body’s processes produce acid. Your lungs and kidneys can usually compensate for slight pH imbalances, but problems with these organs can lead to excess acid accumulating in your body. The acidity of your blood is measured by determining its pH. A lower pH means that your blood is more acidic, while a higher pH means that your blood is more basic. The pH of your blood should be around 7.4. According to the American Association for Clinical Chemistry (AACC), acidosis is characterized by a pH of 7.35 or lower. Alkalosis is characterized by a pH level of 7.45 or higher. While seemingly slight, these numerical differences can be serious. Acidosis can lead to numerous health issues, and it can even be life-threatening. There are two types of acidosis, each with various causes. The type of acidosis is categorized as either respiratory acidosis or metabolic acidosis, depending on the primary cause of your acidosis. Respiratory acidosis Respiratory acidosis occurs when too much CO2 builds up in the body. Normally, the lungs remove CO2 while you breathe. However, sometimes your body can’t get rid of enough CO2. This may happen due to: chronic airway conditions, like asthma injury to the chest obesity, which can make breathing difficult sedative misuse deformed chest structure Metabolic acidosis Metabolic acidosis starts in the kidneys instead of the lungs. It occurs when they can’t eliminate enough acid or when they get rid of too much base. There are three major forms of metabolic acidosis: Diabetic acidosis occurs in people with diabetes that’s poorly controlled. If your body lacks enough insulin, keton Continue reading >>

Lactic Acidosis And Exercise: What You Need To Know

Lactic Acidosis And Exercise: What You Need To Know

Muscle ache, burning, rapid breathing, nausea, stomach pain: If you've experienced the unpleasant feeling of lactic acidosis, you likely remember it. It's temporary. It happens when too much acid builds up in your bloodstream. The most common reason it happens is intense exercise. Symptoms The symptoms may include a burning feeling in your muscles, cramps, nausea, weakness, and feeling exhausted. It's your body's way to tell you to stop what you're doing The symptoms happen in the moment. The soreness you sometimes feel in your muscles a day or two after an intense workout isn't from lactic acidosis. It's your muscles recovering from the workout you gave them. Intense Exercise. When you exercise, your body uses oxygen to break down glucose for energy. During intense exercise, there may not be enough oxygen available to complete the process, so a substance called lactate is made. Your body can convert this lactate to energy without using oxygen. But this lactate or lactic acid can build up in your bloodstream faster than you can burn it off. The point when lactic acid starts to build up is called the "lactate threshold." Some medical conditions can also bring on lactic acidosis, including: Vitamin B deficiency Shock Some drugs, including metformin, a drug used to treat diabetes, and all nucleoside reverse transcriptase inhibitor (NRTI) drugs used to treat HIV/AIDS can cause lactic acidosis. If you are on any of these medications and have any symptoms of lactic acidosis, get medical help immediately. Preventing Lactic Acidosis Begin any exercise routine gradually. Pace yourself. Don't go from being a couch potato to trying to run a marathon in a week. Start with an aerobic exercise like running or fast walking. You can build up your pace and distance slowly. Increase the Continue reading >>

Acidosis

Acidosis

The kidneys and lungs maintain the balance (proper pH level) of chemicals called acids and bases in the body. Acidosis occurs when acid builds up or when bicarbonate (a base) is lost. Acidosis is classified as either respiratory or metabolic acidosis. Respiratory acidosis develops when there is too much carbon dioxide (an acid) in the body. This type of acidosis is usually caused when the body is unable to remove enough carbon dioxide through breathing. Other names for respiratory acidosis are hypercapnic acidosis and carbon dioxide acidosis. Causes of respiratory acidosis include: Chest deformities, such as kyphosis Chest injuries Chest muscle weakness Chronic lung disease Overuse of sedative drugs Metabolic acidosis develops when too much acid is produced in the body. It can also occur when the kidneys cannot remove enough acid from the body. There are several types of metabolic acidosis: Diabetic acidosis (also called diabetic ketoacidosis and DKA) develops when substances called ketone bodies (which are acidic) build up during uncontrolled diabetes. Hyperchloremic acidosis is caused by the loss of too much sodium bicarbonate from the body, which can happen with severe diarrhea. Poisoning by aspirin, ethylene glycol (found in antifreeze), or methanol Lactic acidosis is a buildup of lactic acid. Lactic acid is mainly produced in muscle cells and red blood cells. It forms when the body breaks down carbohydrates to use for energy when oxygen levels are low. This can be caused by: Cancer Drinking too much alcohol Exercising vigorously for a very long time Liver failure Low blood sugar (hypoglycemia) Medications, such as salicylates MELAS (a very rare genetic mitochondrial disorder that affects energy production) Prolonged lack of oxygen from shock, heart failure, or seve Continue reading >>

Causes Of Lactic Acidosis

Causes Of Lactic Acidosis

INTRODUCTION AND DEFINITION Lactate levels greater than 2 mmol/L represent hyperlactatemia, whereas lactic acidosis is generally defined as a serum lactate concentration above 4 mmol/L. Lactic acidosis is the most common cause of metabolic acidosis in hospitalized patients. Although the acidosis is usually associated with an elevated anion gap, moderately increased lactate levels can be observed with a normal anion gap (especially if hypoalbuminemia exists and the anion gap is not appropriately corrected). When lactic acidosis exists as an isolated acid-base disturbance, the arterial pH is reduced. However, other coexisting disorders can raise the pH into the normal range or even generate an elevated pH. (See "Approach to the adult with metabolic acidosis", section on 'Assessment of the serum anion gap' and "Simple and mixed acid-base disorders".) Lactic acidosis occurs when lactic acid production exceeds lactic acid clearance. The increase in lactate production is usually caused by impaired tissue oxygenation, either from decreased oxygen delivery or a defect in mitochondrial oxygen utilization. (See "Approach to the adult with metabolic acidosis".) The pathophysiology and causes of lactic acidosis will be reviewed here. The possible role of bicarbonate therapy in such patients is discussed separately. (See "Bicarbonate therapy in lactic acidosis".) PATHOPHYSIOLOGY A review of the biochemistry of lactate generation and metabolism is important in understanding the pathogenesis of lactic acidosis [1]. Both overproduction and reduced metabolism of lactate appear to be operative in most patients. Cellular lactate generation is influenced by the "redox state" of the cell. The redox state in the cellular cytoplasm is reflected by the ratio of oxidized and reduced nicotine ad Continue reading >>

Acidosis - An Overview | Sciencedirect Topics

Acidosis - An Overview | Sciencedirect Topics

Acidosis is an important prognostic factor in survival from respiratory failure during COPD exacerbation, and thus early correction of acidosis is an essential goal of therapy. Katherine Ahn Jin, in Comprehensive Pediatric Hospital Medicine , 2007 Acidosis is defined as an abnormal clinical process that causes a net gain in hydrogen ions (H+) in the extracellular fluid. Metabolic acidosis occurs when there is an accumulation of H+ or a loss of bicarbonate ions (HCO3) and is reflected by a decrease in plasma HCO3 (<22 mEq/L). Respiratory acidosis occurs when there is an accumulation of carbon dioxide (CO2) and is reflected by an increase in the arterial partial pressure of carbon dioxide (Pco2 >40 mm Hg). Clinically, acid-base scenarios can involve a primary acidosis or alkalosis with or without compensation, or a mixed acid-base disorder. The pH reflects the net effect of these processes (Fig. 27-1). The term acidemia is defined as an abnormal decrease in blood pH (<7.37). Sharma S. Prabhakar M.D., M.B.A., F.A.C.P., F.A.S.N., in Medical Secrets (Fifth Edition) , 2012 What is the conceptual difference between an AG and a non-AG metabolic acidosis? An AG acidosis is caused by the addition of a nonvolatile acid to the ECF. Examples include diabetic ketoacidosis, lactic acidosis, and uremic acidosis. A non-AG acidosis commonly (but not exclusively) represents a loss of . Examples include lower GI losses from diarrhea and urinary losses due to renal tubular acidosis (RTA). Therefore, when approaching a patient with an AG acidosis, one should look for the source and identity of the acid gained. By contrast, when evaluating a patient with a non-AG acidosis, one should begin by looking for the source of the Mario G. Bianchetti, Alberto Bettinelli, in Comprehensive Pediatric Ne Continue reading >>

Lactic Acidosis During And After Seizures

Lactic Acidosis During And After Seizures

You have reached the maximum number of saved studies (100). Please remove one or more studies before adding more. Lactic Acidosis During and After Seizures The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details. ClinicalTrials.gov Identifier: NCT01833247 Information provided by (Responsible Party): Robert S. Fisher, M.D., Ph.D., Stanford University Study Description Study Design Groups and Cohorts Outcome Measures Eligibility Criteria Contacts and Locations More Information This project looks at the time course of lactic acid rise (if any) after seizures. Salivary and capillary lactic acid are tested. This type of measurement may be useful in signalling the occurrence or recent history of a seizure. Lactic acid is released from cells during seizures and elevates lactic acid levels in blood and saliva. The time course of this rise is unknown. If lactic acid rises within a few minutes of a seizure, than it might be feasible to develop lactic acid sensors to provide notification of a recent seizure. This could lead to better safety monitoring for people with epilepsy. This study was designed to utilize a commercially available lactic acid sensor (investigators have no connection with the sensor manufacturer and purchased the device at list price) to measure salivary lactic acid levels after a seizure during inpatient video-EEG epilepsy monitoring. Lactic Acidosis During and After Seizures Patients with epilepsy recorded in an inpatient video-EEG monitoring unit after a seizure. Salivary Lactic Acid Levels With Seizures [TimeFrame:Within 10 minutes of end of the seizure] The investigators will assess the Continue reading >>

Metabolic Acidosis

Metabolic Acidosis

Metabolic acidosis occurs when the body produces too much acid. It can also occur when the kidneys are not removing enough acid from the body. There are several types of metabolic acidosis. Diabetic acidosis develops when acidic substances, known as ketone bodies, build up in the body. This most often occurs with uncontrolled type 1 diabetes. It is also called diabetic ketoacidosis and DKA. Hyperchloremic acidosis results from excessive loss of sodium bicarbonate from the body. This can occur with severe diarrhea. Lactic acidosis results from a buildup of lactic acid. It can be caused by: Alcohol Cancer Exercising intensely Liver failure Medicines, such as salicylates Other causes of metabolic acidosis include: Kidney disease (distal renal tubular acidosis and proximal renal tubular acidosis) Poisoning by aspirin, ethylene glycol (found in antifreeze), or methanol Continue reading >>

Metabolic Acidosis? - Usmle Forum

Metabolic Acidosis? - Usmle Forum

A 42-year-old male is brought to ER immediately after a seizure episode. Family gives a history suggestive of grand mal seizures. Jim was on phenytoin for the past 10 years for his seizure disorder until he stopped it, six months ago. He had no seizures for the past nine years. On examination, patient is confused and lethargic. His vitals are, BP: 136/88 mm Hg, RR: 18/min, PR: 96/min. Which of the following is the most appropriate treatment for his metabolic D. Observe and repeat the labs after 2 hours. this pt. had and epileptic sz ...post seizure increased anion gap m.acidosis suggestive of lactic acidosis.. this caused by accelerated production of lactic acid in muscle and reduced hepatic lactate uptake however this post ictal lactic acidosis is transeint and resloves without treatment within 60 to 90 min so best intervention is to observe with 60 to 90 min. and repeat ABG after 2 hr. to see if acidosis resolved This patient has an acidic pH with a decrease in his bicarbonate concentration suggestive of metabolic acidosis. His AG is 140-(102+12) = 26. The patient had an epileptic seizure due to non-compliance with the medication. A post-seizure increased anion gap metabolic acidosis is suggestive of lactic acidosis. This is caused by accelerated production of lactic acid in muscle and reduced hepatic lactate uptake. However, this post-ictal lactic acidosis is transient and resolves without treatment within 60 to 90 minutes. Therefore, the best intervention in this patient is to observe him and repeat his ABG after 2 hours to see if the acidosis has resolved. If it does not resolve, then look for other potential Choice A, B and C: Use of bicarbonate in the treatment of lactic acidosis is very controversial and is recommended only in severe acute acidosis with pH < 7. Continue reading >>

Lactic Acidosis & Seizure: Causes & Diagnoses | Symptoma.com

Lactic Acidosis & Seizure: Causes & Diagnoses | Symptoma.com

[] that result in headaches, seizures, and progressive dementia [5] . [wikigenes.org] The triad of lactic acidosis, seizures, and stroke-like episodes focus on the diagnosis. [omicsgroup.org] MELAS is the acronym for Mitochondrial Encephalopathy, Lactic Acidosis, and Stroke-like episodes. [medicinenet.com] Diabetologia (1997) [ Pubmed ] Mitochondrial myopathy, encephalopathy, lactic acidosis, and strokelike episodes: a distinctive clinical syndrome. [wikigenes.org] This was seen in our patient with seizures, respiratory depression and severe metabolic acidosis. [omicsgroup.org] [] muscle disease with a buildup of lactic acid in the blood (lactic acidosis), temporary local paralysis (strokelike episodes), and abnormal thinking (dementia). [medicinenet.com] Oral sodium bicarbonate or sodium citrate may also be prescribed to manage lactic acidosis. [ninds.nih.gov] Lactic acidosis - a condition characterized by the accumulation of lactic acid in bodily tissues 6. [slideshare.net] The child will eventually begin to experience seizure activity as well as lactic acidosis and resulting kidney and respiratory impairments. [disabled-world.com] Researchers are currently testing dichloroacetate to establish its effectiveness in treating lactic acidosis. [ninds.nih.gov] Progressed symptoms: weakness, loss of muscle, and lactic acidosis which can later affect the kidneys and lungs. [slideshare.net] Sodium bicarbonate can also be prescribed to help manage lactic acidosis. [disabled-world.com] Aspiration pneumonitis Cardiovascular Arrythmias Tachycardia Hypotension / Hypertension Other Lactic acidosis Rhabdomyolysis Hyperglycaemia Hypoglycaemia Management Benzodiazepines [almostadoctor.co.uk] acidosis hypoxia hyperthermia rhabdomyolysis cerebral edema hypotension Please rate topic. [m Continue reading >>

About Epilepsy And Its Treatment

About Epilepsy And Its Treatment

Primary generalized tonic-clonic seizures Seizures associated with Lennox-Gastaut syndrome If you are still having seizures while taking an antiseizure medicine, your healthcare professional may choose to add TOPAMAX to your treatment. TOPAMAX has an established safety and efficacy profile and is a generally well-tolerated antiseizure medicine, proven to be effective in controlling a broad range of seizures in adults and children age 2 or older. Because TOPAMAX works well with other medicines, it may also be prescribed along with another antiepileptic drug for patients who are still having seizures while taking the other treatment. In combination with other antiepileptic drugs, TOPAMAX has demonstrated efficacy in controlling seizures in adults and children age 2 or older who have: Seizures associated with Lennox-Gastaut syndrome Since its introduction in the U.S. in 1997, TOPAMAX has helped many people to achieve better control of their seizures. Other facts you should know about TOPAMAX are listed below. TOPAMAX has an established safety profile. TOPAMAX is not associated with drug-induced weight gain. Just as every person is different, so is every antiseizure medication. Because different people do not always respond in exactly the same way to the same medicine, you may need to try several medicines before you find the medicine (or combination of medicines) that does the best job of controlling your seizures with the fewest side effects. Your healthcare professional can work with you to find the treatment that is best for you. Continue reading >>

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