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Can Starvation Cause Metabolic Acidosis?

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

Metabolic Acidosis

Metabolic acidosis is the most common acid–base disorder and can be life threatening. It results from excessive cellular acid production, reduced acid secretion, or loss of body alkali. The body has two buffering mechanisms to counteract an increase in acid. The initial response is to increase carbon dioxide excretion by increasing ventilation. The second response is increased renal excretion of acids and renal regeneration of bicarbonate. The adequacy of compensation can be assessed by the quick check method or the Winter formula (Table 2). Metabolic acidosis can be classified into two categories using the anion gap. Each category has a distinct differential diagnosis. Anion gap = [Sodium] – ([Chloride] + [Bicarbonate]) Normally, the anion gap is approximately 12 ± 2 meq/L (12 ± 2 mmol/L). Most unmeasured anions consist of albumin. Therefore, the presence of either a low albumin level or an unmeasured cationic light chain, which occurs in multiple myeloma, results in a low anion gap. Increased hydrogen ion concentration or decreased bicarbonate concentration will increase the gap. When the primary disturbance is a metabolic acidosis, the anion gap helps to narr Continue reading >>

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  1. hxy

    Too much protein can kick you out of ketosis

    Quote from Lyle McDonald - The Ketogenic Diet:
    -To briefly recap, during the first weeks of ketosis, approximately 75 grams of glucose must
    be produced (the other 18 grams of glucose coming from the conversion of glycerol to glucose) to
    satisfy the brain�s requirements of ~100 grams of glucose per day. After approximately 3 weeks
    of ketosis, the brain�s glucose requirements drop to approximately 40 grams of glucose. Of this,
    18 grams are derived from the conversion of glycerol, leaving 25 grams of glucose to be made
    from protein.
    Since 58% of all dietary protein will appear in the bloodstream as glucose (3), we can
    determine how much dietary protein is required by looking at different protein intakes and how
    much glucose is produced.
    Protein intake and grams of glucose produced *
    Protein intake (grams) converted into Glucose (grams)
    50---> 27
    100-----> 58
    125----->72.5
    150----->87
    175------->101.5
    200-------->116
    * Assuming a 58% conversion rate
    Summery: dieters should consume zero Carbs on 150g protein diet since protein will provide 87g glucose by process called gluconeogenesis and other glucose will come from fat burning or you should lower protein intake and increase glucose intake from food.

  2. Atavis

    If you do that, you need to eat more protein. Better to eat a few carbs to compensate for the protein loss.
    Worth a read: How Many Carbohydrates Do You Need?

    Originally Posted by Lyle
    Early research into the topic of starvation and low-carbohydrate dieting found that as few as 15 grams of carbohydrates per day can limit nitrogen loss in the body. And raising carbohydrate intake to 50 grams per day severely limits the need for the body to use amino acids for gluoconeogenesis (which is why I suggested setting daily carbs on the low-carb days of The Ultimate Diet 2.0 at 50 grams).
    This occurs via at least two mechanisms:
    1. The increased carb intake maintains blood glucose and insulin at a higher level (inhibiting cortisol release).
    2. The carbohydrate provides glucose for the brain, limiting the need to break down body protein.
    Basically, in the context of dieting, dieters can either jack up dietary protein to cover the increased carbohydrate requirements of dieting or simply eat slightly more carbohydrates to provide them directly. Both have the same end-result. 15-50 grams per day limits the body’s need to break down protein and will allow protein requirements to be set lower than a diet providing essentially zero carbohydrates per day.
    ...snip...
    So, summing up mid-article, the absolute requirement for carbohydrates is zero grams per day. However, depending on protein intake, a practical minimum for carbs lies between 50 grams/day (if someone functions well in ketosis) to 100-120 grams per day (if they don’t function well in ketosis). Let me mention very specifically that I’m not suggesting those numbers are a recommended level, I’m simply using them to represent a practical minimum value.


    Both approaches can work though, as evidenced by the RFL diet he has. Personally, I like the ability to eat a more varied diet when I want.

  3. hxy

    Thnx its true worth reading, my protein intake at 125g and my carbs at 10g which supply the body with 87g glucose and the deficient glucose comes from burned fat.

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A review of the differential diagnosis of an elevated anion gap metabolic acidosis, focusing predominantly on lactic acid, ketoacids, and toxic alcohols (i.e. methanol, ethylene glycol, and propylene glycol). Also includes discussion of renal failure, oxoproline, toluene, and paraldeyhyde. Use of the VA and Stanford name/logos is only to indicate my academic affiliation, and neither implies endorsement nor ownership of the included material.

Starvation Ketoacidosis: A Cause Of Severe Anion Gap Metabolic Acidosis In Pregnancy

Abstract Pregnancy is a diabetogenic state characterized by relative insulin resistance, enhanced lipolysis, elevated free fatty acids and increased ketogenesis. In this setting, short period of starvation can precipitate ketoacidosis. This sequence of events is recognized as "accelerated starvation." Metabolic acidosis during pregnancy may have adverse impact on fetal neural development including impaired intelligence and fetal demise. Short periods of starvation during pregnancy may present as severe anion gap metabolic acidosis (AGMA). We present a 41-year-old female in her 32nd week of pregnancy, admitted with severe AGMA with pH 7.16, anion gap 31, and bicarbonate of 5 mg/dL with normal lactate levels. She was intubated and accepted to medical intensive care unit. Urine and serum acetone were positive. Evaluation for all causes of AGMA was negative. The diagnosis of starvation ketoacidosis was established in absence of other causes of AGMA. Intravenous fluids, dextrose, thiamine, and folic acid were administered with resolution of acidosis, early extubation, and subsequent normal delivery of a healthy baby at full term. Rapid reversal of acidosis and favorable outcome are achi Continue reading >>

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  1. CombatGynecologist

    Was running around today looking for Ketostix. For them at Walgreens for ~$17/50 pcs
    Thought that was a good deal until we went to Costco and found them for ~$17/100 pcs -Half Price!
    Also, IIRC - you don't have to be a Costco member to purchase from the Pharmacy
    Hope this helps

  2. MrBunglesBest

    $6.50 for 50 at WalMart.

  3. enforce1

    came here to say this, I'm like, damn, costco ripping people off.

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High anion gap metabolic acidosis

Starvation Ketoacidosis: A Cause Of Severe Anion Gap Metabolic Acidosis In Pregnancy

Copyright © 2014 Nupur Sinha et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Pregnancy is a diabetogenic state characterized by relative insulin resistance, enhanced lipolysis, elevated free fatty acids and increased ketogenesis. In this setting, short period of starvation can precipitate ketoacidosis. This sequence of events is recognized as “accelerated starvation.” Metabolic acidosis during pregnancy may have adverse impact on fetal neural development including impaired intelligence and fetal demise. Short periods of starvation during pregnancy may present as severe anion gap metabolic acidosis (AGMA). We present a 41-year-old female in her 32nd week of pregnancy, admitted with severe AGMA with pH 7.16, anion gap 31, and bicarbonate of 5 mg/dL with normal lactate levels. She was intubated and accepted to medical intensive care unit. Urine and serum acetone were positive. Evaluation for all causes of AGMA was negative. The diagnosis of starvation ketoacidosis was established in absence of other causes of Continue reading >>

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  1. jpallan

    Normally, I'd drink Gatorade, but I'm otherwise doing well and don't want to set things off course. I need something slightly flavoured, has some electrolytes in it, and can take the taste out of my mouth just long enough to throw it back to where I can drink water again. Since this will happen lots of times, I need a long-term solution. I've already kicked caffeine, so I know it's definitely ketosis playing tricks on me.

  2. essexjan

    I find chewing sugar-free gum helps get that taste out when I'm on the Scarsdale or General Motors diets (both low-carb diets). It also gets the saliva going, and makes me feel less thirsty.

  3. that girl

    How about chicken broth? Not really so great on the go, but at home it should work pretty well. You also might be able to make somewhat salty veggie broth or drink that works well cold.
    Is simple lemon juice in water insufficient to make the taste problem go away? Adds flavor but no/negligible carbohydrates.

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