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Hyperchloremic Metabolic Acidosis Pathophysiology

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Drug-induced Acid-base Disorders

Abstract The incidence of acid-base disorders (ABDs) is high, especially in hospitalized patients. ABDs are often indicators for severe systemic disorders. In everyday clinical practice, analysis of ABDs must be performed in a standardized manner. Highly sensitive diagnostic tools to distinguish the various ABDs include the anion gap and the serum osmolar gap. Drug-induced ABDs can be classified into five different categories in terms of their pathophysiology: (1) metabolic acidosis caused by acid overload, which may occur through accumulation of acids by endogenous (e.g., lactic acidosis by biguanides, propofol-related syndrome) or exogenous (e.g., glycol-dependant drugs, such as diazepam or salicylates) mechanisms or by decreased renal acid excretion (e.g., distal renal tubular acidosis by amphotericin B, nonsteroidal anti-inflammatory drugs, vitamin D); (2) base loss: proximal renal tubular acidosis by drugs (e.g., ifosfamide, aminoglycosides, carbonic anhydrase inhibitors, antiretrovirals, oxaliplatin or cisplatin) in the context of Fanconi syndrome; (3) alkalosis resulting from acid and/or chloride loss by renal (e.g., diuretics, penicillins, aminoglycosides) or extrarenal (e. Continue reading >>

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  1. fubeca

    WOW!!! That is what I thought when I saw this article on Today.com and read it almost all the way through still saying "WOW!" until...well you'll see. An article in the mainstream positive (Well about 95% of it) about Keto...
    TODAY.com
    44
    What is the ketogenic diet and will it help you lose weight?
    Some venture capitalists in Silicon Valley believe this diet will help them live longer and healthier. Does it work and should you try it?

  2. NelleG

    we're going to run out of avocados if they keep this up

    ok, never mind. I actually read the article. Typical Today rubbish. No science involved.

  3. Chris_Bair

    People with heart disease or diabetes should especially stay away

    wait... what? of course a "nutritionist" would say that. Crimeny.

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What is BASAL METABOLIC RATE? What does BASAL METABOLIC RATE mean? BASAL METABOLIC RATE meaning - BASAL METABOLIC RATE definition - BASAL METABOLIC RATE explanation. Source: Wikipedia.org article, adapted under https://creativecommons.org/licenses/... license. Basal metabolic rate (BMR) is the minimal rate of energy expenditure per unit time by endothermic animals at rest. It is reported in energy units per unit time ranging from watt (joule/second) to ml O2/min or joule per hour per kg body mass J/(hkg)). Proper measurement requires a strict set of criteria be met. These criteria include being in a physically and psychologically undisturbed state, in a thermally neutral environment, while in the post-absorptive state (i.e., not actively digesting food). In bradymetabolic animals, such as fish and reptiles, the equivalent term standard metabolic rate (SMR) is used. It follows the same criteria as BMR, but requires the documentation of the temperature at which the metabolic rate was measured. This makes BMR a variant of standard metabolic rate measurement that excludes the temperature data, a practice that has led to problems in defining "standard" rates of metabolism for many mammals. Metabolism comprises the processes that the body needs to function. Basal metabolic rate is the amount of energy expressed in calories that a person needs to keep the body functioning at rest. Some of those processes are breathing, blood circulation, controlling body temperature, cell growth, brain and nerve function, and contraction of muscles. Basal metabolic rate (BMR) affects the rate that a person burns calories and ultimately whether that individual maintains, gains, or loses weight. The basal metabolic rate accounts for about 60 to 75% of the daily calorie expenditure by individuals. It is influenced by several factors. BMR typically declines by 12% per decade after age 20, mostly due to loss of fat-free mass, although the variability between individuals is high. The body's generation of heat is known as thermogenesis and it can be measured to determine the amount of energy expended. BMR generally decreases with age and with the decrease in lean body mass (as may happen with aging). Increasing muscle mass has the effect of increasing BMR. Aerobic (resistance) fitness level, a product of cardiovascular exercise, while previously thought to have effect on BMR, has been shown in the 1990s not to correlate with BMR when adjusted for fat-free body mass. But anaerobic exercise does increase resting energy consumption (see "aerobic vs. anaerobic exercise"). Illness, previously consumed food and beverages, environmental temperature, and stress levels can affect one's overall energy expenditure as well as one's BMR. BMR is measured under very restrictive circumstances when a person is awake. An accurate BMR measurement requires that the person's sympathetic nervous system not be stimulated, a condition which requires complete rest. A more common measurement, which uses less strict criteria, is resting metabolic rate (RMR).

Metabolic Acidosis

Metabolic acidosis occurs when the body produces too much acid. It can also occur when the kidneys are not removing enough acid from the body. There are several types of metabolic acidosis. Diabetic acidosis develops when acidic substances, known as ketone bodies, build up in the body. This most often occurs with uncontrolled type 1 diabetes. It is also called diabetic ketoacidosis and DKA. Hyperchloremic acidosis results from excessive loss of sodium bicarbonate from the body. This can occur with severe diarrhea. Lactic acidosis results from a buildup of lactic acid. It can be caused by: Alcohol Cancer Exercising intensely Liver failure Medicines, such as salicylates Other causes of metabolic acidosis include: Kidney disease (distal renal tubular acidosis and proximal renal tubular acidosis) Poisoning by aspirin, ethylene glycol (found in antifreeze), or methanol Continue reading >>

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  1. kaazoom

    I recently had my Hba1c tests and it was over 9 . The doctor increased my metformin from 1 tablet twice a day to 2 tablets twice a day. I was told to start by increasing the morning dose and after 2 weeks increase my evening dose. I have had a lot of stomach discomfort, and terrible indigestion since increasing the does. I work up the other morning in extreme pain like I was having a heart attack. The pain went after taking antacids. Indigestion is something I get every now and then, but it is usually due to eating something I should avoid. This day I don't think I had eaten anything that would cause it. But I had increased my evening dose of metformin, so I was and am on 4 tablets a day. I have had more general discomfort than usual, muscle pains and more breathlessness.The difficult is I have other health problems so knowing which one is caused by which is a nightmare.
    I also tend to let myself get dehydrated at night as I have bladder problems which I having investigations for at the moment. If I don't stop drinking about at about 7pm I end up waking numerous times to go to the loo. The only drink I have after 7pm is a few sips of water to help swallow my medications.
    Sorry for being so long winded. My main question is does lactic acidosis come on suddenly, or does it build up over days or weeks?
    Paul

  2. destiny0321

    Hi. If you find your metformin could be causing problems which it did with me runs,breathing problems and generally really poorly go back to your gp I did and I was put on me form in slow release which is much gentler on the stomach hope this helps you destiny
    Sent from the Diabetes Forum App

  3. kaazoom

    Thanks.
    I've got to see my GP next week about something else so I will talk to him about it. I don't think I have lactic acidosis, I was curious about whether it was sudden or gradual onset. I saw something on the TV yesterday that said patients are risking their health because they don't read the information sheets that come with their medication. So I had a look at mine. It gave a number of symptoms to watch out for including severe indigestion,muscle spasms etc it said if you have any of these symptoms when taking Metformin to go immediately to the nearest hospital A&E because these symptoms can be signs of lactic acidosis. I don't think what I'm experiencing is severe enough for A&E.
    I had muscle spasms, pains and a number of the other symptoms list prior to my diabetes diagnose due to other illnesses, and they can vary in severity. They seem to have got somewhat worse since my metformin was increased, but it could just be coincidence. The indigestion and stomach problems are particularly bad. My feeling is my body is taking time to adapt to them. i will ask my doctor if I can change to a slow release version.
    Paul

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Hyperchloremia (high Chloride Levels)

Hyperchloremia is an electrolyte imbalance that occurs when theres too much chloride in the blood. Chloride is an important electrolyte that is responsible for maintaining the acid-base (pH) balance in your body, regulating fluids, and transmitting nerve impulses. The normal range for chloride in adults is roughly between 98 and 107 milliequivalents of chloride per liter of blood (mEq/L). Your kidneys play an important role in the regulation of chloride in your body, so an imbalance in this electrolyte may be related to a problem with these organs. It may also be caused by other conditions, like diabetes or severe dehydration , which can affect the ability of your kidneys to maintain chloride balance. The symptoms that may indicate hyperchloremia are usually those linked to the underlying cause of the high chloride level. Often this is acidosis , in which the blood is overly acidic. These symptoms may include: Like sodium, potassium, and other electrolytes, the concentration of chloride in your body is carefully regulated by your kidneys. The kidneys are two bean-shaped organs located just below your rib cage on both sides of your spine. They are responsible for filtering your blo Continue reading >>

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  1. What_the_Anus

    Hi, I've been on the keto diet for about 67 days now;
    Cut to the chase: My cousin got gout and it scared me to do a blood test since i might have one to many chicken in my diet lol. Anyway here's the results.
    The nurse said it's wayyy to high for a young age (20) like me to have that kind of cholesterol and especially concerned with the LDL cholesterol level. My uric acid is also quite high which is sadly expected. She also said that it's weird my glucose level is low but i have trace amount of glucose in my urine. So what do i now? Should i continue on keto or just pick a normal low calorie diet? I was thinking of continuing keto till the end of the year and reach my goal body fat % but maybe it's not worth risking my health?
    My typical diet goes like this:
    Lunch/Brunch:
    2 Chicken thighs (cooked with ghee / vegetable oil)
    1 egg
    Brown butter sauce
    Occasional diet coke
    Dinner (soup):
    Spinach
    + 2 eggs
    + 1 smooth egg tofu (<10g carbs)
    + 1 Fish cake (<10g carbs)
    Occasional +Australian beef
    I'm in college so I tend to just cook with whatever I can buy cheapest and easiest lol.

  2. gogge

    On average keto lowers triglyceride levels by about 20 mg/dl. That you have a triglyceride level of 280+ mg/dl likely just means that you didn't fast long enough before the test and need to retake the test while fasting for 12+ hours. If you did fast for 12+ hours you either had worse numbers before starting keto, maybe NAFLD, or that you have some underlying issue, perhaps genetics like familiar hypertriglyceridemia or that you respond very badly to keto.
    Either way you need to do a second test while fasted, just drink water don't eat anything for 12 hours before the test. If your values are still this bad you can either try and wait it out, if it's NAFLD another test in a few months should show better numbers, or quit keto and see if things improve.
    US numbers:
    Total: 379 mg/dl
    HDL: 33 mg/dl
    LDL: 290 mg/dl
    Trigs: 283 mg/dl

  3. ketogenicendurance

    I would recommend reading Cholesterol Clarity. If you are doing Keto properly and strictly, cholesterol is rarely an issue.
    I presume the nurse had no idea what keto is or that you were doing it?
    Also what vegetable oil are you using?

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