Anion gap usmle - anion gap metabolic acidosis normal anion gap metabolic acidosis
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 . 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
What is BASAL METABOLIC RATE? What does BASAL METABOLIC RATE mean? BASAL METABOLIC RATE meaning - BASAL METABOLIC RATE definition - BASAL METABOLIC RATE explanation. Source: Wikipedia.org article, adapted under https://creativecommons.org/licenses/... license. Basal metabolic rate (BMR) is the minimal rate of energy expenditure per unit time by endothermic animals at rest. It is reported in energy units per unit time ranging from watt (joule/second) to ml O2/min or joule per hour per kg body mass J/(hkg)). Proper measurement requires a strict set of criteria be met. These criteria include being in a physically and psychologically undisturbed state, in a thermally neutral environment, while in the post-absorptive state (i.e., not actively digesting food). In bradymetabolic animals, such as fish and reptiles, the equivalent term standard metabolic rate (SMR) is used. It follows the same criteria as BMR, but requires the documentation of the temperature at which the metabolic rate was measured. This makes BMR a variant of standard metabolic rate measurement that excludes the temperature data, a practice that has led to problems in defining "standard" rates of metabolism for many mammals. Metabolism comprises the processes that the body needs to function. Basal metabolic rate is the amount of energy expressed in calories that a person needs to keep the body functioning at rest. Some of those processes are breathing, blood circulation, controlling body temperature, cell growth, brain and nerve function, and contraction of muscles. Basal metabolic rate (BMR) affects the rate that a person burns calories and ultimately whether that individual maintains, gains, or loses weight. The basal metabolic rate accounts for about 60 to 75% of the daily calorie expenditure by individuals. It is influenced by several factors. BMR typically declines by 12% per decade after age 20, mostly due to loss of fat-free mass, although the variability between individuals is high. The body's generation of heat is known as thermogenesis and it can be measured to determine the amount of energy expended. BMR generally decreases with age and with the decrease in lean body mass (as may happen with aging). Increasing muscle mass has the effect of increasing BMR. Aerobic (resistance) fitness level, a product of cardiovascular exercise, while previously thought to have effect on BMR, has been shown in the 1990s not to correlate with BMR when adjusted for fat-free body mass. But anaerobic exercise does increase resting energy consumption (see "aerobic vs. anaerobic exercise"). Illness, previously consumed food and beverages, environmental temperature, and stress levels can affect one's overall energy expenditure as well as one's BMR. BMR is measured under very restrictive circumstances when a person is awake. An accurate BMR measurement requires that the person's sympathetic nervous system not be stimulated, a condition which requires complete rest. A more common measurement, which uses less strict criteria, is resting metabolic rate (RMR).
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 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 sev
Watch more Epilepsy & Seizure Disorders videos: http://www.howcast.com/videos/502007-... Patty McGoldrick NP, MPA: So absence or petit mal seizures as they used to be called are a form of generalized seizures. So again, the whole brain lights up with electricity all at once. They often present in childhood, usually around six to eight years old, maybe a little older, but we've had kids as young as three or four presenting with it. So they look like a sort of eye roll or an eye deviation and a staring spell. Steve Wolf MD: I'll act it for you. So they could be talking to you, and suddenly they'll. . . [pause]. . .What did you say? Patty: Right. And it's more than just your child not paying attention to you. And this goes on repeatedly, and then you realize after a while that they're sort of missing things. And they occur in all situations. They occur watching TV, watching movies. They occur during a conversation. So you have to really weed out and say to the parents when they come in, "Does this only happen when they're watching TV? Or does it only happen in school when the lesson is something they don't understand?" Steve: And there short. They're like three to five seconds sometimes. It can be very easy to miss them. Sometimes the teachers pick them up. But you know, it's hard to differentiate from daydreaming. How do you do that? Patty: Well that's when you bring them in and you do an EEG, because it has a very distinct pattern on the EEG. Steve: But the most important part on the EEG is if you don't capture the episode of the staring spells, then you haven't made the diagnosis. Patty: So on the EEG, there is a pattern that's called 3-hertz spike and wave, and if you look at the EEG you see this big burst of electricity that lasts for a few seconds, and it's across the whole EEG. The problem is that if you do a short EEG for 30 or 40 minutes, you may not get one of these events, and you may not see the abnormality. Because the EEG otherwise is perfectly normal. Steve: But we tell families that this is like one of the better epilepsies, because it has the highest chance of outgrowing it. But if you don't treat it, it really can affect things academically. You worry about kids walking down the block, not you know walking into the street because they'll zone out, falling down the stairs if they zone out. So it's important to treat. Patty: It is important to treat, and it's very important to treat as the kids get older and they're taking subways or buses alone, or they're driving cars, because you don't want them to have an absence seizure or a staring spell in the middle of that. So again, absence seizures are a form of generalized seizures. The electricity lights up in the whole brain all at once. They're short. They can happen many times a day. They may not happen every hour, so they may not be captured on a short EEG. They're very treatable, and it's very important to treat them so a, the child doesn't get hurt, and b, that the child is not missing information in school and doing poorly academically.
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
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 isoenzyme ...
Bench-to-bedside review: Is there a place for epinephrine in septic shock? The use of epinephrine in septic shock remains controversial. Nevertheless, epinephrine is widely used around the world and the reported morbidity and mortality rates with it are no different from those observed with other vasopressors. In volunteers, epinephrine increases heart rate, mean arterial pressure and cardiac output. Epinephrine also induces hyperglycemia and hy ...
Are you studying metabolic acidosis and need to know a mnemonic on how to remember the causes? This article will give you a clever mnemonic and simplify the signs and symptoms and nursing interventions on how to remember metabolic acidosis for nursing lecture exams and NCLEX. In addition, you will learn how to differentiate metabolic acidosis from metabolic alkalosis. Don’t forget to take the metabolic acidosis and metabolic alkalosis quiz. Thi ...
Zieliński J. · Koziorowski A. From the Department of Internal Medicine (Prof. Dr. B. Jochweds) and Department of Pathophysiology (Dr. A. Koziorowski), Institute of Tuberculosis, Warszawa Authors’ address: Dr. Jan Zielinski and Dr. Antoni Koziorowski, Instytut Gruzlicy, Klinika Chorób Wewnetrznych, Plocka 26, Warszawa (Poland) ...
Arterial Blood Gas (ABG) analysis requires in-depth expertise. If the results are not understood right, or are wrongly interpreted, it can result in wrong diagnosis and end up in an inappropriate management of the patient. ABG analysis is carried out when the patient is dealing with the following conditions: • Breathing problems • Lung diseases (asthma, cystic fibrosis, COPD) • Heart failure • Kidney failure ABG reports help in answering ...
Abstract The intent of this review is to provide a broad overview of the interorgan metabolism of glutamine and to discuss in more detail its role in acid-base balance. Muscle, adipose tissue, and the lungs are the primary sites of glutamine synthesis and release. During normal acid-base balance, the small intestine and the liver are the major sites of glutamine utilization. The periportal hepatocytes catabolize glutamine and convert ammonium and ...