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Dka Causing Aki

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Acute kidney injury (also called acute renal failure) nursing NCLEX review lecture on the nursing management, stages, pathophysiology, and causes (prerenal, intrarenal, postrenal). What is Acute Kidney Injury? It is the SUDDEN decrease in renal function that leads to the build up of waste in the blood, fluid overload, and electrolyte imbalances. What are the causes of Acute Kidney Injury? There are three causes, which are based on location. The first is known as prerenal injury and this is an issue with the perfusion to the kidneys that leads to decreased renal function. A second cause is known as intrarenal injury, and this is due to damage to the nephrons of the kidney. Lastly, postrenal injury is due to a blockage located in the urinary tract after the kidney that can extend to the urethra. This is causing the back flow of urine, which increases the pressure and waste in the kidneys. Stages of Acute Kidney Injury: There are four stage of acute kidney injury, which include initiation, oliguric, diuresis, and recovery stage. The initiation stage starts when a cause creates an injury to the kidney and then signs and symptoms start to appear. This leads to the oliguric stages. The p

Acute Kidney Injury Differential Diagnoses

Diagnostic Considerations Although acute kidney injury (AKI) is a potentially reversible condition, it can occur in patients with chronic renal failure. Every effort should be made to identify reversibility, even if improvement in renal function is marginal. The best way to identify reversibility is by tracking the rate of deterioration of renal function. If there is an acceleration of the rate at which the patient’s renal function is worsening, the cause should be sought and treated. Differentials to consider in AKI include the following: Urine output in differential diagnosis Changes in urine output generally correlate poorly with changes in the glomerular filtration rate (GFR). Approximately 50-60% of all causes of AKI are nonoliguric. However, the identification of anuria, oliguria, and nonoliguria may be useful in the differential diagnosis of AKI, as follows: Anuria (< 100 mL/day) - Urinary tract obstruction, renal artery obstruction, rapidly progressive glomerulonephritis, bilateral diffuse renal cortical necrosis Nonoliguria (>400 mL/day) - Acute interstitial nephritis, acute glomerulonephritis, partial obstructive nephropathy, nephrotoxic and ischemic ATN, radiocontrast- Continue reading >>

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  1. Ken S

    Ketones, Insulin, And Glucose

    This topic keeps coming up here so I wanted to start a thread which just addresses the issue of ketones. I still have some questions which I will address here.
    I've read that ketones in the presence of high blood sugar can indicate that not enough insulin is being produced. This makes sense in fact since if there isn't enough insulin to drive glucose then you will rely on fat at least somewhat for energy.
    Then, when insulin is very low, and blood sugar goes very high as a result, and ketones also go very high, you can develop diabetic ketoacidosis.
    People say though that ketones with high blood sugar isn't harmful, it's only when the blood sugar gets way high that this is a problem. I've always wondered a bit about that though. If this condition in its extreme form can produce extreme, life threatening results, couldn't it be possible that a lesser amount of ketones, say medium, along with a more modest blood sugar, say 200-250, could be something that we don't want, and may even harm us to some extent?
    What I'm thinking here is that lower insulin output causing ketones may be a different deal, at least a little different, than the kind you get simply from low carb high fat. There are some big ketone fans on here but their blood sugar is normal, mine sure isn't though and while it is going down and my concern with this has been less and less as that has happened, my ketones have pretty much consistently been in the medium range and my diet hasn't been that low carb, averaging somewhere from 80 to 100 depending on what I was eating at the time.
    I have seen what I eat change this though, for instance when I would add protein I'd go down to small. Now that I've added more carbs and am now well over 100 I'm seeing it go down from trace to below small.
    So some of this is due to nutrition, but I still think that some of it may also be due to low insulin. I've taken things which increase insulin and I've also seen that put my ketones down. This makes sense as well as more glucose in the cells means less need for ketosis. My blood sugar is always high so there's always plenty of work for any extra insulin to do.
    The one thing that I have not seen is ketosis bringing down my blood sugar. I know Salim has said this is supposed to happen but it does not work for me. Now he'd say that maybe I'm not in ketosis, and need to test my blood, but I really wonder about that.
    While urinary ketones may not be the most reliable tool to accurately measure ketones, I believe this is similar to saying that urine strips aren't as accurate for glucose. So you can see a lot of glucose in your urine and that may not tell you exactly how much you have but it does tell you that you have a good amount.
    So if you test consistently at medium ketones in your urine that would to me seem to suggest that you have a good amount. Certainly enough to say that you are in ketosis to some degree anyway, even though we may not know exactly what that degree is.
    Hospitals even use strips for this even in cases where they take blood as well, as a means of having an idea of whether someone is spilling ketones or not. So it can't just be a useless tool where we can't say very much about.
    I've had instances, when my blood sugar was higher, where I was considerably darker than medium, not all the way to high, and this actually worried me at the time. Some people advise you to call your doctor immediately if you see a level like this, and while I feel that's out of an abundance of caution, and my levels were 16-18 at the time and therefore well below the normal threshold for DKA, and I didn't have any of the symptoms of DKA either, what I did have was a lot of ketones.
    So given that I can have at least a reasonable idea of being in ketosis with all this, or not depending on what you believe, what was clear to me over time was that when I brought my ketones down, my blood sugar also tended to go down. This may indeed be caused by greater insulin secretions driving down both.
    My blood sugar lately, just to let you know, on lower carbs ranges from 10 to 12.5, and on a few more carbs is now in the range of 8 to 10.5, so pretty much 2 points lower, which is a lot (36 mg/dl).
    In any case, the difference between you and I Salim is that I need to get my blood sugar down and you do not. I have experimented with various levels of carbs from none to the over 100 that I get now. More brings my BG down, less puts it up. So that's why I say that your model of ketosis, while that works for you, may not work for everyone, and does not seem to for me.
    This is not even a matter of measurement, if you eat very low carbs and that doesn't help and in fact hurts, then you can't argue with that. I had high hopes for the low carb approach but ended up being disappointed for whatever reason. I'm still eating a fairly low carb diet and still have ketones but much less and I am doing better now.
    So of course there are still a lot of things that I don't understand about all of this and it's hard to get good info about ketosis and high blood sugar, as all the material seems to deal with DKA. There's also lots of info about ketosis but it doesn't take into account high blood sugar and hypoinsulinism. There also does not seem to be a lot of type 2's that even test for ketones even with strips, and those who do don't tend to know a lot about this. So this seems like something good to talk some more about

  2. AnnC

    Ken, I find your post very confusing because you have not defined what you mean by 'ketones'. Can you please let us know which particular ketones you are talking about in this thread?
    Thanks.

  3. smorgan

    The two conditions are not "somewhat" different or gradients on a scale. They are COMPLETELY different and are more like opposites. This has been discussed many times on this and other forums. You might try a search rather than everyone repeating everything.
    The key is not "low" insulin but grossly insufficient insulin. In other words with BG over 300, more glucose still coming in from diet and little or no insulin it is clearly insufficient. However with normal to low blood sugar (the norm on any diet which produces ketones) and the same low insulin or even lower, there is no insufficiency.
    There are other differences. It should be easy to find them in older threads or even by Googling for example [ketosis vs ketoacidosis] and the like.
    As I said elsewhere, if you want to test this on yourself, pick up a blood ketone meter. It's the only way to know for sure.

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Understand acute kidney injury (formerly called acute renal failure) with this clear explanation from Dr. Seheult of http://www.medcram.com. This series covers causes, symptoms, diagnosis and treatment of acute renal failure. The difference between pre-renal and post-renal failure, and the BUN Creatinine ratio are also illustrated. This video 1 of 3 on acute kidney injury. Speaker: Roger Seheult, MD Clinical and Exam Preparation Instructor Board Certified in Internal Medicine, Pulmonary Disease, Critical Care, and Sleep Medicine. Co-founder of http://www.medcram.com MedCram: Medical topics explained clearly including: Asthma, COPD, Acute Renal Failure, Mechanical Ventilation, Oxygen Hemoglobin Dissociation Curve, Hypertension, Shock, Diabetic Ketoacidosis (DKA), Medical Acid Base, VQ Mismatch, Hyponatremia, Liver Function Tests, Pulmonary Function Tests (PFTs), Adrenal Gland, Pneumonia Treatment, any many others. New topics are often added weekly- please subscribe to help support MedCram and become notified when new videos have been uploaded. Subscribe: https://www.youtube.com/subscription_... Recommended Audience: Health care professionals and medical students including physicians

Overview Of The Management Of Acute Kidney Injury In Adults

INTRODUCTION Acute kidney injury (AKI) is an abrupt and usually reversible decline in the glomerular filtration rate (GFR). This results in an elevation of serum blood urea nitrogen (BUN), creatinine, and other metabolic waste products that are normally excreted by the kidney. The term AKI, rather than acute renal failure (ARF), is increasingly used by the nephrology community to refer to the acute loss of kidney function. This term also highlights that injury to the kidney that does not result in "failure" is also of great clinical significance. In this topic review, the acute loss of kidney function will be referred to as AKI. The initial assessment of patients with AKI and management of the major complications of AKI are discussed here. The incidence, causes, diagnosis, and prevention of AKI are presented separately. (See "Diagnostic approach to adult patients with subacute kidney injury in an outpatient setting" and "Kidney and patient outcomes after acute kidney injury in adults" and "Possible prevention and therapy of ischemic acute tubular necrosis".) PATHOGENESIS AKI has multiple possible etiologies. Among hospitalized patients, AKI is most commonly due to either prerenal e Continue reading >>

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  1. [deleted]

    I have had a terrible time sleeping since being on Keto, specifically in the last week. I do not want to stop though, I've lost 8 lbs in 24 days, I'm starting to PR more, and there are moments of clarity where the brain fog is at a minimum.
    NOTHING seems to keep me asleep. Usually I fall asleep in seconds and wake up 4 hours later wide awake but now I cannot even fall asleep. I try not to drink too much water before bed, exercise earlier in the afternoons 2-4 times a week, keep the tv/ smartphone out of the bedroom, and give myself some wind down time. I take the lowest does of Topamax for headaches and Alteril as a sleep aid. Any advice? Does this go away? I've been on some psych meds before for sleep, but none of them are truly designed to keep you asleep, only help you fall asleep.
    If you have any suggestions, I'd really appreciate it. I'm taking in about 70-90 grams of protein per day to keep my muscle mass, but I may have to down grade as protein can keep you awake.
    Thanks for any help you can give me.

  2. DownhillYardSale

    I've been on some psych meds before for sleep, but none of them are truly designed to keep you asleep, only help you fall asleep.
    Why?
    If this is the case keto isn't the cause of your sleep problems.
    I'm immediately looking towards stress/anxiety.

  3. DownhillYardSale

    You do not need to have mental health issues for stress/anxiety to affect your sleep.
    Any significant changes recently other than completely changing your diet?

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What is prerenal acute kidney injury? Acute kidney injury (AKI) describes when the kidneys aren't functioning optimally, usually brought about within a few days. Prerenal causes include those in which there's a lack in adequate blood flow to the kidneys. Find more videos at http://osms.it/more. Study better with Osmosis Prime. Retain more of what youre learning, gain a deeper understanding of key concepts, and feel more prepared for your courses and exams. Sign up for a free trial at http://osms.it/more. Subscribe to our Youtube channel at http://osms.it/subscribe. Get early access to our upcoming video releases, practice questions, giveaways and more when you follow us on social: Facebook: http://osms.it/facebook Twitter: http://osms.it/twitter Instagram: http://osms.it/instagram Osmosis's Vision: Empowering the worlds caregivers with the best learning experience possible.

Acute Kidney Injury: A Guide To Diagnosis And Management

Acute kidney injury is characterized by abrupt deterioration in kidney function, manifested by an increase in serum creatinine level with or without reduced urine output. The spectrum of injury ranges from mild to advanced, sometimes requiring renal replacement therapy. The diagnostic evaluation can be used to classify acute kidney injury as prerenal, intrinsic renal, or postrenal. The initial workup includes a patient history to identify the use of nephrotoxic medications or systemic illnesses that might cause poor renal perfusion or directly impair renal function. Physical examination should assess intravascular volume status and identify skin rashes indicative of systemic illness. The initial laboratory evaluation should include measurement of serum creatinine level, complete blood count, urinalysis, and fractional excretion of sodium. Ultrasonography of the kidneys should be performed in most patients, particularly in older men, to rule out obstruction. Management of acute kidney injury involves fluid resuscitation, avoidance of nephrotoxic medications and contrast media exposure, and correction of electrolyte imbalances. Renal replacement therapy (dialysis) is indicated for re Continue reading >>

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  1. AddictedtoCatFace

    I have been on and off keto for about a year now. Started at 5'10 and 210 and down to 165. I normally eat a vegan diet and have no problem getting and maintaining and erection. I've noticed though when I'm deep into Keto that I feel great, no brain fog and lots of energy but I've been have issues keeping an erection or in general getting turned on without direct stimuli. I've researched around and it seems other people have experienced this as well.
    I'm wondering if I may just be too low of carb. I am thinking about integrating some healthy carbs back into my diet such as beans or something of that sort. My conundrum is like sex and have a partner that does too but I also do not what to go out of keto as I feel confident, out going, and generally great while on it.
    If anyone has had this and found anything to help please let me know! Thank you.
    UPDATE: (maybe NSFW but i'll try to keep it G rated): First of all if you have never eaten a meatless / dairy free diet do not ask someone who is if they are getting enough protein. There is a thing called google if you truly care then research, there are tons of resources and books on the subject, but I highly honestly don't think you will. Protip: maybe ask about B12, as it's hard to find in a vegan diet, I take supplements just incase because it can wreck havoc if you are deficient though it's very hard to be deficient in it.
    Now the possibly NSFW part(tl;dr at end): So took the advice of ate a little more, took double dose of vit d(even though I get a good amount of sun here in Southern OR), and put a little carbs in(split a can of chili with my SO). Usually I am around the lower end of 30-50 carbs. I upped it to about 75. Last night had a little fun time with the lady(she also having a harder time getting aroused). It went well but was still sort of a weaker erection than the norm. So I wake up at 5 am with a cat head and paw resting on my erection. I move him off and spoon him instead trying to go back to sleep. My SO wakes up to pee, feeling a bit sick(sore throat, not sure from carbs or coincidence as it happened while integrating more). I tell her I can't sleep and tell her whats going on and that I'm going to relieve said erection. I pee and waste some time browsing reddit/check email all while still maintaining. This started at 6:00 am. About 6:20 I'm like, "oh yeah I need to take care of this". 6:40 business handled but still erect. Stayed that way until about 7:00 am, as I wrote this it started going down... guess my brain needed to borrow some power.
    TL;DR: Increased calories, vit d, and carbs. Woke up with cat cuddling erection. Maintained for 2 hours.

  2. erixsparhawk

    Calorie issue! Just one day a week with a massive keto refeed where you stuff yourself with fat and protein. Will fix your libido problem.

  3. anbeav

    Yup, high deficits will kill libido

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