How Does Chloride Cause Metabolic Acidosis?

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Block 2, Week 8, Faculty Objective 6

Physiological Effects Of Hyperchloraemia And Acidosis

Physiological effects of hyperchloraemia and acidosis Chelsea and Westminster NHS Foundation Trust Chelsea and Westminster NHS Foundation Trust BJA: British Journal of Anaesthesia, Volume 101, Issue 2, 1 August 2008, Pages 141150, J. M. Handy, N. Soni; Physiological effects of hyperchloraemia and acidosis, BJA: British Journal of Anaesthesia, Volume 101, Issue 2, 1 August 2008, Pages 141150, The advent of balanced solutions for i.v. fluid resuscitation and replacement is imminent and will affect any specialty involved in fluid management. Part of the background to their introduction has focused on the non-physiological nature of normal saline solution and the developing science about the potential problems of hyperchloraemic acidosis. This review assesses the physiological significance of hyperchloraemic acidosis and of acidosis in general. It aims to differentiate the effects of the causes of acidosis from the physiological consequences of acidosis. It is intended to provide an assessment of the importance of hyperchloraemic acidosis and thereby the likely benefits of balanced solutions. Hyperchloraemic acidosis is increasingly recognized as a clinical entity, a new enemy within, Continue reading >>

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  1. katee82

    Hi all,
    I was wondering if anyone could explain what it means to have Keytones present in your urine?
    I went for my anti D injection the other day and whilst at the hospital they got me to do the usual urine sample and blood tests - when the nurse tested my urine she started asking all these funny questions about what i'd eaten for breakfast (quickly gobbled brioche roll thingy on way to work) then what i'd had for lunch (chicken wrap thingy and a black current smoothie)...
    I asked why and she said that i had +1 Keytones in my urine which she said is an indication that my body thinks i'm starving myself and so starts eating up its energy stores... or it means i've been really sick and vomiting loads - neither of which i've been doing as i've been eating like a horse!!!
    she said it's odd so will send it off for analysis - has anyone else had this and if so what does it mean???????

  2. Sarah10

    Hiya yes i have ketones quite regularly but i also have diabetes which they are kind of linked.
    Basically it means your body is burning up fat because it cannot get enough glucose from the blood.
    I find it all confusing though, sometimes ketones will show up (they gave me some dipsticks to test at home often) even when i have been eating.
    Sorry i dont have much advice xx

  3. katee82

    oh no! Both my parents have diabetes - dad has type 1, mum has type 2 (and had it gestationally when she was having me).
    I did mention this to the midwife (who was a student) as i remember my dad had keytone acidosis once and was really poorly in hospital and lost tonnes of weight overnight- so guessed there may be a link but she said that would usually show up as Keytones and Glucose in urine, which it hasn't.
    anyway, they looked through my notes and saw that i've never been tested for diabetes (even thought i mentioned it to my midwife at my booking appointment) but she never scehduled one...so i've got to have the GTC next week..
    so don't want diabetes!

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Hyperchloremic Acidosis

Normal albumin-corrected anion gap acidosis Hyperchloremic acidosis is a common acid-base disturbance in critical illness, often mild (standard base excess >-10 mEq/L). Definitions of hyperchloremic acidosis vary. The best are not based on chloride concentrations, but on the presence of metabolic acidosis plus the absence of significant concentrations of lactate or other unmeasured anions. 2. standard base excess less than -3 mEq/L or bicarbonate less than 22 mmol/L, 3. Albumin corrected anion gap normal (5-15 mEq/L). A normal strong ion gap is an alternative indicator of the absence of unmeasured anions, although rarely used clinically and offering little advantage over the albumin corrected anion gap. The degree of respiratory compensation is relevant. It is appropriate if PaCO2 approximates the two numbers after arterial pH decimal point (e.g. pH=7.25, PaCO2=25 mm Hg; this rule applies to any primary metabolic acidosis down to a pH of 7.1). Acidosis is severe if standard base excess is less than -10 mEq/L, or pH is less than 7.3, or bicarbonate is less than 15 mmol/L. Common causes in critical illness are large volume saline administration, large volume colloid infusions (e.g. Continue reading >>

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  1. adimeco

    CVS ketone test strips

    I was reading Atkins book and he suggested testing for ketones. I have been following lchf diet since Feb. So my first test for ketones was light purpleish or in the small to moderate range. Is this OK? I thought I would be more toward the large range?

  2. David Burke


    Originally Posted by adimeco
    I was reading Atkins book and he suggested testing for ketones. I have been following lchf diet since Feb. So my first test for ketones was light purpleish or in the small to moderate range. Is this OK? I thought I would be more toward the large range? Any indication o the ketone urine strips means your in ketosis. The amount shown on the strips is just excess ketones that your body isn't using for fuel. As these are just go/no-go indicators they aren't the best choice. But a good cost effective way to check.

  3. adimeco

    Thank you! Are you saying as long as its shows I am in small to moderate ketosis it is all that really matters?

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Whether due to bicarbonate loss or volume repletion with normal saline, the primary problems is in hyperchloremic metabolic acidosis hcl ammonium chloride loading, reabsorption proximal tubule reduced, part, because of hyperchloraemic acidosis, anion gap (in most cases). Administration of ns will decrease the plasma sid causing an acidosis this patient also had a normal anion gap hyperchloremic metabolic (hcma). Googleusercontent search. Normal anion gap (hyperchloremic) acidosis semantic scholar. Hyperchloremic metabolic acidosis is it clinically relevant? (pdf hyperchloremic in diabetes mellitus. Hyperchloremic acidosis wikipedia. Treatment of acute non anion gap metabolic acidosis ncbi nih. Aug 4, 2016 a normal ag acidosis is characterized by lowered bicarbonate concentration, which counterbalanced an equivalent increase in plasma chloride concentration. Acid base physiology 8. Hyperchloraemic metabolic acidosisdepartment of medicine. Mechanism of hyperchloremic metabolic acidosis. Hyperchloremic acidosis background, etiology, patient education emedicine. Respiratory acidosis alkalosis as with the hyperchloremic may result from chloride replacing lost bicarbonate. Although it ca

Hyperchloremic Acidosis

Author: Sai-Ching Jim Yeung, MD, PhD, FACP; Chief Editor: Romesh Khardori, MD, PhD, FACP more... This article covers the pathophysiology and causes of hyperchloremic metabolic acidoses , in particular the renal tubular acidoses (RTAs). [ 1 , 2 ] It also addresses approaches to the diagnosis and management of these disorders. A low plasma bicarbonate (HCO3-) concentration represents, by definition, metabolic acidosis, which may be primary or secondary to a respiratory alkalosis. Loss of bicarbonate stores through diarrhea or renal tubular wasting leads to a metabolic acidosis state characterized by increased plasma chloride concentration and decreased plasma bicarbonate concentration. Primary metabolic acidoses that occur as a result of a marked increase in endogenous acid production (eg, lactic or keto acids) or progressive accumulation of endogenous acids when excretion is impaired by renal insufficiency are characterized by decreased plasma bicarbonate concentration and increased anion gap without hyperchloremia. The initial differentiation of metabolic acidosis should involve a determination of the anion gap (AG). This is usually defined as AG = (Na+) - [(HCO3- + Cl-)], in whic Continue reading >>

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  1. duranie

    ketones in urine

    Ok so should I worry, if so how much. My ketones have been neutral since about 1 weeks after starting insulin therapy, however I've just tested and they're on the "faible" pink. What should I do?, I don't want to make a huge thing out of something that might not be??

  2. l0vaduck

    Nothing to worry about. Just keep an eye on it.
    Most people get traces of ketones now and again, is it a long time since you last ate?
    Only time to worry is if your blood sugar's high with it and you can't get it down. Even then weak ketones aren't going to hurt you.

  3. Caraline

    Yup, like Duck says just keen an eye on it. If you are otherwise well, it is likely nothing to worry about. You can have trace or small amounts of ketones for a number of reasons, some quite innocent... like getting a bit dehydrated, fasting, skipping meals, eating a very low carb diet. Even non diabetic folk can spill ketones & is not uncommon in people following diets like Atkins.

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