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Compensated Metabolic Acidosis

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Acid Base Disorders

Arterial blood gas analysis is used to determine the adequacy of oxygenation and ventilation, assess respiratory function and determine the acid–base balance. These data provide information regarding potential primary and compensatory processes that affect the body’s acid–base buffering system. Interpret the ABGs in a stepwise manner: Determine the adequacy of oxygenation (PaO2) Normal range: 80–100 mmHg (10.6–13.3 kPa) Determine pH status Normal pH range: 7.35–7.45 (H+ 35–45 nmol/L) pH <7.35: Acidosis is an abnormal process that increases the serum hydrogen ion concentration, lowers the pH and results in acidaemia. pH >7.45: Alkalosis is an abnormal process that decreases the hydrogen ion concentration and results in alkalaemia. Determine the respiratory component (PaCO2) Primary respiratory acidosis (hypoventilation) if pH <7.35 and HCO3– normal. Normal range: PaCO2 35–45 mmHg (4.7–6.0 kPa) PaCO2 >45 mmHg (> 6.0 kPa): Respiratory compensation for metabolic alkalosis if pH >7.45 and HCO3– (increased). PaCO2 <35 mmHg (4.7 kPa): Primary respiratory alkalosis (hyperventilation) if pH >7.45 and HCO3– normal. Respiratory compensation for metabolic acidosis if pH Continue reading >>

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  1. GMX

    I've been ketoing now almost 5 weeks but have been struggling to get my fasting blood glucose down. This morning my blood ketones registered at .8 but my blood glucose was 122. I'm eating about 90-100g protein a day but I weigh 217. Is it still just too much protein? Carb intake is negligible. Fat intake is probably 250g a day. Any thoughts? Thanks.

  2. Mare

    For your weight, that does not seem like a lot of protein to me. I weigh 145, and I've calculated my minimum protein at 60g and can go as high as 100g.
    As to blood glucose, there's a phenomenon with ketosis where fasting BG is elevated, but it is benign. Peter at Hyperlipid had a post on his blog some time ago that provided the science behind this, but I could not follow it. This may be what you're experiencing.

    My endo told me that this is true, and he goes by my A1C rather than my fasting because of this.

  3. carolT

    Protein could be lower if you are female (sorry, can't tell) and/or not exercising, but the ketone level indicates you are accessing some fat overnight.

    Have you taken glucose readings at night or before your main meal? Are they lower? You may be experiencing "dawn phenomenon" where glucose is higher in the morning because 1.) the same hormones that wake you up also give you some extra glucose to start the day or 2.) your glucose dropped overnight and your body reacts by making more of it. Also, if you happen to get up in the middle of the night, you could see what your glucose is doing before your normal waking time.

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

Metabolic Acidosis Treatment & Management

Approach Considerations Treatment of acute metabolic acidosis by alkali therapy is usually indicated to raise and maintain the plasma pH to greater than 7.20. In the following two circumstances this is particularly important. When the serum pH is below 7.20, a continued fall in the serum HCO3- level may result in a significant drop in pH. This is especially true when the PCO2 is close to the lower limit of compensation, which in an otherwise healthy young individual is approximately 15 mm Hg. With increasing age and other complicating illnesses, the limit of compensation is likely to be less. A further small drop in HCO3- at this point thus is not matched by a corresponding fall in PaCO2, and rapid decompensation can occur. For example, in a patient with metabolic acidosis with a serum HCO3- level of 9 mEq/L and a maximally compensated PCO2 of 20 mm Hg, a drop in the serum HCO3- level to 7 mEq/L results in a change in pH from 7.28 to 7.16. A second situation in which HCO3- correction should be considered is in well-compensated metabolic acidosis with impending respiratory failure. As metabolic acidosis continues in some patients, the increased ventilatory drive to lower the PaCO2 m Continue reading >>

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  1. spblind

    I've googled and there are so many different answers, i don't know which to believe !

  2. rundymc

    When you're breath stinks more than usual.

  3. spblind

    rundymc wrote:
    When you're breath stinks more than usual. i don't feel it leh, i've been on a keto diet for a week, 65% of fats intake and 35% of protein 0% carbs.
    but my urine become damn yellow and the smell of fats oil, very bubbly and thick also and of cos the first few days i felt very giddy and i don't even feel like doing anything, like crashing like that but now better alot alr.

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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

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 sev Continue reading >>

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  1. blondeviolin

    Vomiting and possible hypoglycemia in kids? - UPDATED

    My 3yo has had spells of random vomiting for the last few months. I've asked about it here before and someone mentioned possible hypoglycemia. In wondering if it's something to check out more since the last two episodes were when she hardly ate any dinner the night before.
    The most recent was this morning after having hardly any dinner last night. She woke at 6, vomited yellowish liquid till about 8:30/9 and then passed out and slept HARD. She is absolutely fine this afternoon, acting crazy, eating a huge leach, etc.
    She has an appointment with her pedi this afternoon.
    UPDATE: I took her to the pedi who looked completely confused. She conferred with another pedi who also felt like it merited further investigation, so they are sending her to a pedi GI.

  2. myfunnybunch

    Sounds exactly like my youngest two.
    Does her breath smell sweetish?
    If it is the same type of mild hypoglycemia my children had, it is called ketotic hypoglycemia. (If you Google this, use your common sense and ignore the scary stuff unless it actually applies to what you see with your child. I freaked myself out pretty good, lol.) Basically, it means that the child's tolerance for fasting is low. Typically this is a slender child with a high metabolism and low body fat. They can't go without eating for very long. The solution was VERY simple: Make sure they eat a big evening meal and/or have a snack before bed, something like wheat toast with nut butter, cheese and fruit, milk and a half sandwich. Once we figured this out for my sons, we only had two episodes with my youngest, both when we were not paying attention to what he'd eaten for dinner.
    Other tips: Keep lollipops or popsicles on hand to raise the blood sugar more quickly if she does have an episode. And carry a snack in your purse. I found that when my youngest ds started getting cranky when we were out and about, I could almost always trace it back to needing something to eat.
    The good news is that once they grow enough, they've got enough bbody mass to handle it better--my sons have grown out of it, though they both get a little crabby still if they go too long without eating.
    Cat

  3. Lara

    sounds like hypoglycemia to me!!
    There is a test the Dr can do, but really, you just need to make sure the child eats more protein-- it lasts longer and maintains blood sugar.
    Make sure the child eats something at night (yogurt smoothy with protein powder) ---avoid sugar it will lower the blood sugar.
    Hypoglycemia is where the body makes too much insulin and attacks food (esp sugar) with too much force, so foods high on the glycemic index can actually lower blood sugar.
    Make the child eat more often, you can even wake her and have her drink milk at 3am.
    When there are times of low blood sugar, NOTHING sounds good and all healthy food makes my stomach turn. I will start off with some chocolate milk, then move to something healthy (like an egg)-- I cannot start with an egg or I will barf.
    so----
    Less sugar (and breads and flour products) check the things you already serve that have hidden sugar (yogurt come to mind as something we think is healthy, but is high in sugar-- same with granola) --- cereal will drop my blood sugar like a rock.
    More frequent meals--- apples and peanut butter, hard boiled eggs, beef jerky, --- we always have ham in the house for my 12DD,so she can get something she will eat whenever she needs it. We keep honeyed peanuts and beef jerkey in the car for those emergencies when we are out and she is low.
    try for injecting protein and whole veggies into the diet when ever possible.
    all sweets must be tempered with fat and protein---- my children can have cereal-- if they have an egg first. I can have a cookie, but only with whole milk. You can have corn with dinner--after the chicken is eaten)
    hope that helps and feel free to PM me with any questions.
    Lara

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