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Hyperchloremic Metabolic Acidosis Normal Saline

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

Hyperchloremic Metabolic Acidosis Following Total Gut Irrigation With Normal Saline In Pediatric Patients: A Rare Occurrence Bala I, Dwivedi D, Jain D, Mahajan Jk

Use of 0.9% sodium chloride for total gut irrigation (TGI) through nasogastric route is an effective method of bowel preparation in children undergoing colorectal surgeries. TGI with normal saline (NS) can result in nausea, vomiting, abdominal distension, and mild electrolyte imbalance; however, hyperchloremic metabolic acidosis has not been documented. We report two cases of hyperchloremic metabolic acidosis in children posted for colorectal surgery following TGI with NS who were successfully managed. Keywords:Acidosis, anion gap, anorectal malformation, balanced salt solution, pediatrics, rectovaginal fistula, water-electrolyte imbalance Bala I, Dwivedi D, Jain D, Mahajan JK. Hyperchloremic metabolic acidosis following total gut irrigation with normal saline in pediatric patients: A rare occurrence. Indian J Crit Care Med 2017;21:55-6 Bala I, Dwivedi D, Jain D, Mahajan JK. Hyperchloremic metabolic acidosis following total gut irrigation with normal saline in pediatric patients: A rare occurrence. Indian J Crit Care Med [serial online] 2017 [cited2018 Apr 9];21:55-6. Available from: Total gut irrigation (TGI) through nasogastric route is a rapid, safe, and effective method of bow Continue reading >>

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Popular Questions

  1. beyondthesmile

    Does keto affect blood pressure?

    I was pleasantly surprised to find that my blood pressure has dropped (a good thing). This past summer my diastolic number was always 80ish, usually a bit higher than that. I checked my blood pressure a few times a few days ago and found that my BP has dropped to 107/74 (108/75 at one point). I don't think this is just from working out because I was working out in the summer and my BP didn't change much.
    The only thing I can think of is that since starting keto I eat less processed food, which are usually laden with sodium. But could this change make a difference in such a short time?
    Does keto itself (either being in ketosis, or eating a higher fat, low carb diet) affect blood pressure? I'm not complaining, just wondering what I can attribute this positive change to

  2. CanuckTank

    you betcha, mine dropped as well. Less fat, less blood pressure.

  3. DecemberDays86

    It's two things. Like you said, the low-sodium nature of keto helps reduce blood pressure. The other thing is that your body tends to hold onto less water when you have little to no carbohydrates to burn off. This further reduces the amount of water in your body and makes your BP drop.
    My BP is usually 120/70 and on keto it can get as low as 100/60 in the morning. Stay hydrated!

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Chloride In Critical Illness

Home | Critical Care Compendium | Chloride in Critical Illness Chloride is the majoranion in the extracellular fluid (ECF) and is the second most importantcontributor to plasma tonicity The possibility of harm from hyperchloraemia, particularly in the context of fluid resuscitation with chloride-rich solutions such as normal saline, is an area of intense research interest If chloride excess is harmful it may be an important confounder in studies that suggest that positive fluid balance is harmful in ICU patients Some expert clinicians advocate the use of chloride-poor balanced salt solutions in preference to normal saline for fluid resuscitation, replacement and maintenance The major trial of buffered crystalloids versus normal saline in ICU patients, the SPLIT trial, found no difference in rates of acute kidney injury (AKI), rates of renal replacement therapy or in-hospital mortality. 133 to 202 mmol or 7.8 to 11.8 g/day for adult men (USA) 99 to 133 mmol or 5.8 to 7.8 g/day for adult women(USA) Renal excretion is the primary means of chloride elimination 180 mmol/d chloride excreted (99.1% of filtered is reabsorbed) renal proximal tubules are the major site of reabsorption dista Continue reading >>

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Popular Questions

  1. FaintIlluzion

    I know on Keto you want to have more fat then protein, but how will too much protein occasionally effect weight loss? Will it kick me off track of loosing weight? What are the negatives of getting more protein then fats in a day?

  2. thadass

    Ratios don't matter; you have no need to compare the macro-nutrients. Evaluate each macro individually.
    There is no harm at all in having more protein than fat, but there is a possible risk from having WAY too much protein. Having even a little more protein than you really need is also simply a waste of protein.
    Enter your info in the keto calculator in the side bar and:
    Stay under your net carb limit (<20g is best)
    Meet your protein goal every day
    Eat fats to satiate hunger and fill out your caloric intake (do not have too high of a caloric deficit. 20% is best for most).

  3. dernnn

    Just curious, why can't you have too high of a deficit? The keto calculator puts me at 1700 for 20% deficit, and I find it a struggle to get to about 1200 calories. (On keto for a week FWIW)

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Renal Fellow Network: "dilutional Acidosis"

Though this is to some degree controversial, volume expansion with normal saline has been associated with the development of a hyperchloremic, non-anion gap metabolic acidosis. What are the mechanisms associated with saline expansion-induced metabolic acidosis? The rationale for why a metabolic acidosis should develop in response to saline infusion is not immediately apparent, as there should not be any excess protons being delivered in the infusate. There are three potential mechanisms which have been cited: 1. One of the earliest explanations for this phenomenon was simply that bicarbonate ions are diluted by the isotonic fluid, and acidosis occurs as a result. Thus, this entity is sometimes referred to as "dilutional acidosis." 2. The "Stewart approach" to acid-base metabolism rejected the dilutional explanation above, reasoning that BOTH bicarbonate ions and protons would be diluted by saline infusion equally, and therefore could not be the reason for the development of acidosis. Instead, a concept called "strong ion difference" (SID) is introduced to explain this: in order to maintain electroneutrality in the presence of diluting fluid, water must dissociate, providing excess Continue reading >>

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  1. MathWiz

    I wasn’t sure which section I should post this in, my strategy is what I call the 4–2–1 plan, I fast 2 day non consecutive days a week, eat a low carb but not calorie restricted diet 4 days a week to keep the fat burning benefits of ketosis going and then I give myself 1 day a week to indulge and eat whatever I want, usually a Saturday pasta dinner and wonderful dessert. I also walk 4 to 6 miles a day during the week and 10 to 12 miles on Saturday.
    Low Carb plans such as Atkins can be very effective for some people including me, many people who start a low carb diet experience get what’s called the “ketosis flu” or the “induction flu” in the first few days while the body is adapting to burning ketones instead of glucose.
    The basic symptoms are:
    – Headaches
    – Nausea
    – Upset stomach
    – Lack of mental clarity (brain fog)
    – Sleepiness
    – Fatigue
    It’s called the “ketosis flu” for a reason: you feel sick. I’ve gone through it and it wasn’t a pleasant experience. Fortunately it only lasted 2 days but then suddenly I woke up feeling much better, less hungry and my energy level was really high and consistent throughout the day!
    The first time I thought to myself: “What the heck am I doing? I feel like I’m going to die!” but I persevered and when it was over I didn’t regret a thing because what I had gained mentally and physically was 100% worth it.
    For those of you that are going through the ketosis flu, don’t give up! I know you feel like it’s never going to get better but stick with it and you´ll be so happy you did! I’m telling you, waking up refreshed for the first time in years, not getting the afternoon “blah” feeling and stuffing my face with carbs to try to boost my energy is the best side effect of the low carb diet I’ve experienced. Okay, losing weight while eating good food, feeling full and satisfied is great too.
    First you have to understand why your body is reacting this way. Your body’s been burning glucose for energy so it’s basically full of enzymes that are waiting to deal with the carbs you eat, but now the body needs to make new enzymes that burn fat for fuel instead of carbs, and the transition period causes the flu-like symptoms.
    There are some things you can do to lessen the symptoms of the ketosis flu and to make it go away sooner (to force the body to transition sooner) Ok, let’s get to the good part – what to do:
    First of all – you’re probably dehydrated. Drink PLENTY of water while you’re on a low carb diet, and then drink some more.
    Watch your electrolytes. When the body is getting rid of excess insulin from your former carb-crazy diet you´ll lose lots of fluids that have been retained in your body. This causes the rapid weight loss most people see in their first few days of ketosis, it’s mostly water, sorry. When you lose all the retained water you also lose electrolytes like sodium, magnesium and potassium. When you’re lacking them you´ll feel like crap so when you’re feeling really ill on the ketosis flu try things like chicken/beef broth and look for foods rich in these minerals. Take a multi-vitamin and a multi-mineral.
    Ok, here is where people throw the red flag – Eat more fat – Yup, I said MORE fat. Have some butter, just not on a roll, eat some bacon and eggs for breakfast, just skip the potatoes and toast. This will force your body to hurry up the transition. You´ll think this is crazy and think you´ll never get lose weight eating this way, but you will.
    Don’t eat too much protein – The body can transform protein into glucose so if you eat too much of it in the first days it will slow down the transition. Go for fatty meat and cheese if you can, add fat to protein shakes etc.
    Drink water, replenish electrolytes (sodium, magnesium, potassium) with food and supplements, drink broth, eat fat and not too much protein.
    I hope this helps, and have a great day
    Charles

  2. rockyromero

    @mathwiz
    ” Take a multi-vitamin and a multi-mineral.”
    I have been forgetting to take a multi-vitamin on fast days. Thanks for the reminder.
    “Eat more fat – Yup, I said MORE fat. ”
    I will have avocado more often.

  3. AussieJess

    Thanks for that info, very interesting

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