Correction Of Metabolic Acidosis

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Inspired by Dr. Myat Soe, MD Internal Medicine Series: Clinical Clerkships Overview and Causes of Non-Anion Gap Metabolic Acidosis Made with help of Blueberry Flashback Recorder

Treatment Of Acute Non-anion Gap Metabolic Acidosis

Treatment of acute non-anion gap metabolic acidosis Medical and Research Services VHAGLA Healthcare System, Division of Nephrology, VHAGLA Healthcare System Correspondence to: Jeffrey A. Kraut; E-mail: [email protected] Search for other works by this author on: Clinical Kidney Journal, Volume 8, Issue 1, 1 February 2015, Pages 9399, Jeffrey A. Kraut, Ira Kurtz; Treatment of acute non-anion gap metabolic acidosis, Clinical Kidney Journal, Volume 8, Issue 1, 1 February 2015, Pages 9399, Acute non-anion gap metabolic acidosis, also termed hyperchloremic acidosis, is frequently detected in seriously ill patients. The most common mechanisms leading to this acidbase disorder include loss of large quantities of base secondary to diarrhea and administration of large quantities of chloride-containing solutions in the treatment of hypovolemia and various shock states. The resultant acidic milieu can cause cellular dysfunction and contribute to poor clinical outcomes. The associated change in the chloride concentration in the distal tubule lumen might also play a role in reducing the glomerular filtration rate. Administration of base is often recommended for the treatment of acute non-anion ga Continue reading >>

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Popular Questions

  1. Heather

    I've been on the diet now for 7 days. Day 1 and 2 I dropped 2 kilos, and since that I haven't budged.
    I check my pee twice a day and am always in the top or second top keto reading...
    Is it possible to be in ketosis, but still doing something wrong ?

  2. Helen

    Ketosis just means that you are burning fat instead of carbs/glucose for energy. If you are having too many calories (or even not enough), you may find that you do not lose weight.
    Also, if you only have a few kgs to lose, then your weight loss will be slower than someone who has a lot of weight to lose. What is your BMI?
    Are you doing a lot of intensive exercise? Sometimes you may be losing fat, but building muscle, so the scales appear to not move.
    Regardless of what diet you follow, you will not lose weight each and every day. 2 kgs in 1 week is a pretty good loss, especially if you don't have a lot of weight to lose.
    Chances are that if you continue to follow the program properly and keep avoiding carbs, you will lose more weight in the next few days. Some call it the "whoosh" effect, lol. Some people lose weight slowly and steadily. Many more of us, lose it in stops and starts. We lose a bit, then a few days of nothing and then another "whoosh".
    Keep at, and you should get results.
    [ed. note: Helen (1169825) last edited this post 3 years, 7 months ago.]

  3. Heather

    My Bmi is 30.51. I've got about 15 kilos to lose, but on a bazillion diets I never seem to get past 6 or 7kg.
    I'm not currently exercising because I'm just too tired. I'm hoping to get back to the gym soon though.
    I'll stick it out in hopes for this whoosh hehe. Thanks Helen.

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

Correcting Metabolic Acidosis - Is It Beneficial? Is It Safe?

Correcting metabolic acidosis - is it beneficial? Is it safe? Summarized from Aschner JL, Poland RL. Sodium bicarbonate: basically useless therapy. Pediatrics 2008; 122: 831-35. Metabolic acidosis is the most common disturbance of acid-base balance among the critically ill of all ages, usually due to increased lactate production consequent on inadequate tissue perfusion and/or hypoxemia. The condition is characterized by primary reduction in bicarbonate and pH revealed during arterial blood gas analysis. For more than 50 years, standard care of patients suffering metabolic acidosis, whatever its cause, has included iv administration of the base sodium bicarbonate to correct the acidosis. Although sodium bicarbonate is certainly effective in restoring pH towards normal, in recent years doubt has been cast on the notion that it is necessary to artificially restore pH, and controversy has surrounded the ritual administration of sodium bicarbonate to patients with metabolic acidosis. This controversy is revisited in a recently published paper from two US pediatricians who robustly argue that sodium bicarbonate has no benefit and may cause harm to neonates. A major plank of their argum Continue reading >>

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Popular Questions

  1. c_washington

    Anyone have to use these? my MFM doc told me to get them but the pharmacy ordered glucose and protein... these don't test for ketones. I am going to return them tomorrow. Anyone have any suggestions for which brand to get and where to get them for not too much money? I see some on Amazon that are cheap and some that are expensive. What do you think?

  2. memali26

    I just check ketones, no proteins. I get my strips at any pharmacy - Walgreens, even Target has them. I think I paid about $11 for 50.

  3. c_washington


    I just check ketones, no proteins. I get my strips at any pharmacy - Walgreens, even Target has them. I think I paid about $11 for 50.
    yea, I have been checking ketones the whole pregnancy and I know those strips are widely available. Since I have type 1, our MFM doc is worried about pre-e so he wants me to test for protein and ketones everyday. I am looking for a combined strip.

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Sodium Bicarbonate Deficit Calc

In all cases, the primary goal in treating metabolic acidosis is to focus on reversal of the underlying process causing the acidosis. Examples: (1) Renal failure: dialysis if needed. (2) Alcoholic ketoacidosis: fluids, electrolytes, thiamine, folic acid. (3) Sepsis/shock: volume resuscitation, vasopressors, etc. (4) Salicylate intoxication: IV fluids, alkalinization of the urine, .... If there is a severe deficit (HCO3- < 10-12 mEq/L and pH<7.2) correct with sodium bicarbonate. Sodium bicarb is also useful if the acidosis is due to inorganic acids (especially if renal disease is present). However, when the acidosis results from organic acids (lactic acid, acetoacetic acid, etc) the role of bicarbonate is controversial. In most cases of DKA or severe lactic acidosis the administration of sodium bicarbonate does not decrease mortality even when the acidosis is severe. In sum, sodium bicarbonate should be reserved for severe cases of acidosis only (pH <7.2 and serum bicarbonate levels <10-12 meq/L). This can be accomplished by adding 1 to 3 ampoules of sodium bicarb to D5W or 1/2NS. IV-push administration should be reserved for cardiac life support and not metabolic acidosis. Sodium Continue reading >>

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  1. michael13

    I had a 2 glasses of wine last night, celebrating my wife's birthday ...
    Does this mean I am now out of Ketosis ?
    I didn't eat anything I shouldn't - just the wine ....
    Some advice ... please ...!!!???

  2. rustpot

    Maybe yes and maybe no is the answer. Either way it is not a problem. It is the excess of carbohydrate from any source that is the key here. It is the reduction in sugar(carbohydrate) that will lead eventually to fat burning and and weight loss. Unused keytones in the body which we refer to as ketosis is only an indication that fat burning may be going on.There is carbohydrate in wine, a small amount left over from the fermentation process. (about 1 to 1.5 grams per ounce)
    But there are beneficial reasons to drink wine, particularly red wine( in moderation).
    However alcohol in general and particularly spirits which have no carbohydrate at all does have an effect on fat burning. It puts it on hold. Alcohol is an energy source, it is like a sugar in that it is absorbed very readily by the body, far more easily than going through the process of converting fat. So the body says yippee. lets take the alcohol first. Spirits are not going to make you fat but they will not help the weight loss either. The real no no is BEER. Beer has alcohol and carbohydrate in it. Beer belly is easy to spot.
    Wine therefore is quite a good bet because in is lower in alcohol by volume than spirits, is relatively low in carbohydrate and some research in France and other european countries has shown a beneficial relationship for the heart.
    Dr. Eades writing in Protein Power believes that wine actually improves insulin sensitivity which is what we are striving for.
    So cheer up and cheers, no harm has been done.

  3. Carol CA

    A friend of mine was telling me about a study concerning the added benefits of red wine as related to weight loss. He said to try drinking one glass per night of red wine - merlot, for example. There are studies coming out that are indicating that something in red wine helps to prevent the product of a protein call Leptin. Leptin, when present in the system, causes the brain to think it must store fat. The more you eat the more you store. The less you eat, you still store.
    Have you heard anything about this study?

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