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Dose Of Sodium Bicarbonate In Metabolic Acidosis

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Intravenous Sodium Bicarbonate

Robin Gross, William Peruzzi, in Critical Care Medicine (Third Edition) , 2008 Intravenous sodium bicarbonate (NaHCO3) solution is an appropriate intervention for reversing metabolic acidemia, provided that lung and cardiac function are adequate. NaHCO3 solution adds HCO3 to the blood only after the CO2 load inherent in the NaHCO3 solution is eliminated by the lungs. When NaHCO3 solution is administered to a patient with acute ventilatory failure (respiratory acidosis), the Paco2 usually increases, and pH decreases because the CO2 load cannot be eliminated. As illustrated in Figure 14-8, low cardiac output may be a limiting factor in CO2 excretion. When NaHCO3 solution is administered to a patient with very poor cardiac output, the venous blood shows a paradoxical respiratory acidosis. When NaHCO3 is administered intravenously to correct severe metabolic acidemia, it is essential to quantify the abnormality as a guide to therapy. A simple way to calculate the amount of bicarbonate to administer is: mmol HCO3 = base deficit (mmol/L) ideal weight (kg) 0.25 (L/kg) where 0.25 represents the volume of distribution of the bicarbonate. It is generally prudent to administer one half to on Continue reading >>

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  1. martinus

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  2. [deleted]

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  3. sutrigoo

    Spectacular! This follows the exact procedure in the FAQ, doesn't it? Amazing!

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Sodium Bicarbonate Use

metabolic acidosis leads to adverse cardiovascular effects bicarbonate must be administered in a solution as sodium bicarbonate 8.4% solution contains 1mmol of HCO3-/mL and is very hypertonic (2,000mOsm/kg) goal of NaHCO3 administration in severe metabolic acidosis to counteract the negative cardiovascular effects of acidaemia alternatives to NaHCO3 include carbicarb, dichloroacetate, Tris/THAM Treatment of sodium channel blocker overdose (e.g. tricyclic overdose) Urinary alkalinisation (salicylate poisoning) Metabolic acidosis (NAGMA) due to HCO3 loss (RTA, fistula losses) Cardiac arrest (in prolonged resuscitation + documented severe metabolic acidosis) Diabetic ketoacidosis (very rarely, perhaps if shocked and pH < 6.8) Severe pulmonary hypertension with RVF to optimize RV function Severe ischemic heart disease where lactic acidosis is thought to be an arrhythmogenic risk hypernatraemia (1mmol of Na+ for every 1mmol of HCO3-) hyperosmolality (cause arterial vasodilation and hypotension) impaired oxygen unloading due to left shift of the oxyhaemoglobin dissociation curve removal of acidotic inhibition of glycolysis by increased activity of PFK hypercapnia (CO2 readily passes int Continue reading >>

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  1. SoxGirl02

    Its been a interesting 1.5 weeks. Last Last Frday 3/27, I thought I might have a kidney stone. I am prone to stones, so I know the sympoms etc. Friday it bothered me, Saturday it bothered me, Monday it bothered me. I went to the Urologist on this past Friday 4/3. He said there were large blood cells in my urine blah blah and I was to get a CT scan on Monday (yesterday). I get this call yesterday morning from the nurse in his office stating that I need to start Cipro immediatly becuase I deffinatly have a bladder infection, and a slight kidney infection (slight? its either infected or not infected!).
    I was exhausted yesterday, had the CT scan, came home and just crashed. 8pm woke up ate..something in my brain had me check the ketones about 9:30 last night. LARGE ketones. I start freaking because ive never had large ones....I call the doc on call and she tells me not to worry about it, its dehydration keep drinking and check in 2 hours. 2 hours it was fine.
    Today..they are back again! Am I over reacting to think that the 2 are related?

  2. gsmama

    Ketones and infection, yes!
    Are these urine ketones or blood ketones?
    Yes, you can get them from dehydration too. Very possible.
    Leslie

  3. andrea

    I agree that these can definately be related... hope you feel better soon.

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Risk factors for CKD, Measures to prevent CKD, CKD as a risk factor for Heart Attack.

Treatment Of Metabolic Acidosis In Patients With Ckd

Treatment of Metabolic Acidosis in Patients With CKD We are experimenting with display styles that make it easier to read articles in PMC. The ePub format uses eBook readers, which have several "ease of reading" features already built in. The ePub format is best viewed in the iBooks reader. You may notice problems with the display of certain parts of an article in other eReaders. Generating an ePub file may take a long time, please be patient. Treatment of Metabolic Acidosis in Patients With CKD Wei Chen, MD and Matthew K. Abramowitz, MD, MS Metabolic acidosis is a common complication of chronic kidney disease and believed to contribute to a number of sequelae, including bone disease, altered protein metabolism, skeletal muscle wasting, and progressive GFR loss. Small trials in animal models and humans suggest a role for alkali therapy to lessen these complications. Recent studies support this notion, although more definitive evidence is needed on the long-term benefits of alkali therapy and the optimal serum bicarbonate level. The role of dietary modification should also be given greater consideration. In addition, potential adverse effects of alkali treatment must be taken into Continue reading >>

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  1. Shama

    I was diagnosed as t1 four weeks ago. I was admitted to hospital with BGLs of 19 and ketones were 5.5, so I was DKA.
    I spent 24 hours in emergency while they brought down my ketones to zero then spent another 8 days in hospital getting stabilised and learning how to inject insulin etc.
    My question is: how long does it take to fully recover from DKA? I went back to work yesterday and was exhausted after 7 hours (including a short lunchbreak). I deliberately didn't do very much; just got through my backlog of emails and did a bit of reading. When I got home, I perked up a bit after dinner. Today, it was the same at work but tonight I am SO tired I can barely walk and I can't do *anything* other than sit and watch tv. I can't keep doing this. I need to be able to function at least a bit in the evenings, and this is without me doing my usual job of answering complex (and long) phone calls and emails. Is this normal??
    I wasn't in a coma (I walked into emergency). I lost 3kg in the fortnight before I was admitted despite eating heaps, and lost more weight before that. I had a lot of muscle pain and muscle cramps before diagnosis, and couldn't walk up a hill without having to stop all the time to catch my breath. (plus the classic insatiable thirst and peeing heaps)
    When I first got out of hospital I basically just tried to get on with normal life and started exercising, ie a 20 minute walk most days. Then I carried lots of heavy boxes (long story) over several days. I was fine at the time then lost some stamina late last week. The DE (after I'd done all this exercise, not before!) said now was not the time to hit the gym, just as a throwaway comment. I didn't ask her to elaborate but did scale back my daily walks a bit.
    I'm going to ring the DE or endo tomorrow to see if this is normal and if I need more time before going back to work (I'm not driving yet, hubby can't afford to take time off to pick me up early each day and the bus home involves two 15 minute walks each end and a 45 minute bus ride). But I would like to know other people's experiences with DKA recovery, particularly if it was a pre-diagnosis one with several weeks of symptoms.
    Thanks in advance :)

  2. Magenta76

    Hi Shama, sucks that you have to be here, but glad that you found us!!
    I, unfortunately, have a LOT of experience with DKA's... (something like 9 or 10 in 13 years of diagnosis) Each of them the recovery time has been different.
    My diagnosis, I have no idea what my level of ketones was, I know my BSL was 30something, and I was incredibly ill, and weighed something ridiculous like 50kgs.... with hindsight I was probably presenting symptoms at least 2 or 3 months before I was diagnosed.
    After my diagnosis, I took the probably set standard, month off. I went back to work as a chef after that, I don't really remember what it felt like, I was 22 so I probably was not too bad. I think we all would have different recovery times to anything and everything, so I don't think anyone could give you a straight answer on how long it will take for your body to go back to "normal". Talk to your HP's but take it day by day would be the best bet. Not really helpful, I know, but can't say any more than that.
    My last DKA was extremely severe. We're talking coma, organ failure type stuff. That was 18 months ago. My body is still recuperating from that one. I know that for me, each time I have a DKA, the whole episode is worse, and I take longer each time to get better. I just wish I discovered and knew about all the triggers for me. Stress is a large factor for about half of mine, which unfortunately means that when I get the all clear to work again, I have to change my career.
    Good luck with everything, and I hope you are feeling better soon. Try not to overdo it. Your body would still be adjusting. Let it. :)

  3. tantan

    Hi Shama,
    I have a similar story to you. I was diagnosed about 4 years ago, with ++++ ketones (whatever that means), a BGL of 32.7, and weight loss of 9kg in the preceding 3 and a half weeks. My understanding is that DKA involves the body basically chewing up fat because the lack of insulin means it can't access the glucose in your body, even if you're eating lots of it! So a lot of that weight loss is coming from storage (and we all need some fat storage for normal functioning! :-) ). At the end of the day, it will take a body awhile to replenish those stores, work properly again, and get back to the state it was at prior to diagnosis (and prior to the weeks leading up to diagnosis).
    I can't remember how long it took me to recover fully. I was diagnosed several weeks before Christmas, which was a massively busy time at the company where I was working. The doctor at the hospital gave me a medical certificate for at least a week off, but I actually only took about two days. However, I only worked shorter days for at least a week, maybe two, once I went back. I wasn't allowed to drive, so my co-worker would pick me up in the morning on her way to work, and my husband would pick me up in the afternoon when he finished at his work (which was always about 1-2 hours earlier than my usual finishing time). I found that I felt better in the mornings, so that worked for me.
    I think the best one can do for one's body after something like DKA is to eat healthily and get plenty of sleep!
    All the best!
    Tanya

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