Lactic Acidosis Ddx

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Causes Of Lactic Acidosis

INTRODUCTION AND DEFINITION Lactate levels greater than 2 mmol/L represent hyperlactatemia, whereas lactic acidosis is generally defined as a serum lactate concentration above 4 mmol/L. Lactic acidosis is the most common cause of metabolic acidosis in hospitalized patients. Although the acidosis is usually associated with an elevated anion gap, moderately increased lactate levels can be observed with a normal anion gap (especially if hypoalbuminemia exists and the anion gap is not appropriately corrected). When lactic acidosis exists as an isolated acid-base disturbance, the arterial pH is reduced. However, other coexisting disorders can raise the pH into the normal range or even generate an elevated pH. (See "Approach to the adult with metabolic acidosis", section on 'Assessment of the serum anion gap' and "Simple and mixed acid-base disorders".) Lactic acidosis occurs when lactic acid production exceeds lactic acid clearance. The increase in lactate production is usually caused by impaired tissue oxygenation, either from decreased oxygen delivery or a defect in mitochondrial oxygen utilization. (See "Approach to the adult with metabolic acidosis".) The pathophysiology and causes Continue reading >>

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  1. hmb13

    I'm on Day 7 and feeling like crap. I've had a blazing headache pretty much continuous since Day 2. At first I thought it was due to the caffeine withdrawal, but now that I'm on Day 7, it can't possibly be that. In addition, my head just feels like it's in a fog -- I can't concentrate or focus very well, my energy levels are incredibly low, my mouth feels like cotton and I'm drinking water constantly, and for the past couple days I've started to feel minor chest pains (like someone is squeezing my heart).
    My cousin, who is a nurse, warned me this cleanse might send me into ketosis, which can become acidosis, and both conditions are unhealthy and put stress on the liver. Can someone please explain? Are my symptoms a sign of ketosis or acidosis? I was doing the Whole30 to hopefully change my relationship with food (always an adversarial relationship before -- restriction mentality) and to cleanse my gut from inflammatory foods, but so far it's just making me feel terrible. I had probably a 75% compliant diet before starting Whole30, so this hasn't been a huge shift for me -- what I'm experiencing *isn't* just "carb flu".
    Here's what my typical meals have been:
    -1 cup coffee (black)
    -2 eggs & 2-3 slices of bacon, or 1/2 sweet potato & 2-3 slices bacon, or 1 C. spaghetti squash w/1/3 c. browned ground pork & sauteed sweet peppers (for any of these, I would use 1/2 tsp. or so of coconut oil in the pan)
    -1/2 - 3/4 c. berries & bananas
    -Salad of mixed greens, assorted fresh veggies, 1/2 c. browned ground pork w/homemade balsamic vinagrette
    Afternoon snack
    -Handful of nuts, a piece of fruit, or fresh veggie slices
    **Sometimes I'm so ravenous by the time I get home, I have to have another snack of a hard-boiled egg the minute I walk in the door in order to have enough energy to cook dinner
    I've been cooking a lot of the meals from the WellFed book -- Moroccan Meatballs over spaghetti squash with cumin carrots on the side, or Salmon a l'Afrique du Nord with Brussels Sprouts. Last night I had grilled lamb & veggie kabobs.
    I've also been taking fermented cod liver oil supplements every day (I'm Vit D deficient).
    Can someone please help? Do I just need to stick it out a while longer, or am I doing something wrong? I'm becoming ineffective at work between this constant headache and the low energy levels. My cousin is begging me to at least eat gluten-free oats or white rice so I get some energy that is more easily available to my brain.
    Help before I give this up completely!

  2. Robin Strathdee

    First question: Do you exercise? If you do, there's no way your carb intake is enough to support your activity levels. If you don't, you could possibly be okay, but if you're used to a higher carb intake then your body is probably freaking out. I would suggest making sure you have a starchy carb at every meal and see if that helps your energy levels smooth out. The Whole30 is not intended to be a specifically low carb program, and from what I understand ketosis and ketoacidosis come from an extreme absence of carbohydrate in the diet (I'll check in with Melissa for confirmation).
    Second question: Could you be coming down with an illness? It's really common for all the changes in your body during a Whole30 to temporarily lower your defenses and make you a little more susceptible to nasty little bugs.
    I'm going to pass this question on to Melissa, too, in case she has anything to add.

  3. Emily

    I agree with your cousin that you need more carbs, but get them from sweet potatoes, spaghetti squash, acorn squash, butternut squash, pumpkin (I love this time of year) instead of grains. And hang in there- you are right in the toughest part.

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In this episode of 5 Minute Physiology I tackle: Lactate. I cover common myth's, what it actually is, what it actually does, and what's coming in the future of lactate research. Intended for all backgrounds & education levels. Head over to my website www.AndyGalpin.com for more videos like this! If this enticed your appetite for knowledge, check out the extended, 25 Min or 55 Min Physiology on Lactate!


To detect high levels of lactate in the blood, which may be an indication of lack of oxygen ( hypoxia ) or the presence of other conditions that cause excess production or insufficient clearing of lactate from the blood; this test is not meant to be used for screening for health status. When you have symptoms such as rapid breathing, nausea, and sweating that suggest a lack of oxygen or an abnormal blood pH (acid/base imbalance); when a health practitioner suspects that you may be experiencing sepsis , shock, heart attack , severe congestive heart failure , kidney failure , or inadequately treated (uncontrolled) diabetes ; when a health practitioner suspects that you have inherited a rare metabolic or mitochondrial disorder A blood sample drawn from a vein in your arm; sometimes a blood sample collected from an artery and, rarely, a sample of cerebrospinal fluid collected from the spine You may be told to rest prior to sample collection. Rarely, fasting may be required. You may be able to find your test results on your laboratory's website or patient portal. However, you are currently at Lab Tests Online. You may have been directed here by your lab's website in order to provide yo Continue reading >>

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  1. Ralph

    yes you read right..
    the bad stuff with a lot of net carbs and sugars.
    but let's start at the beginning..
    i am with atkins for 1.5 years now and lost 17 kg in a year, just to try lifetime atkins and going a bit too far with the daily calories and gain 10kg again in a few months..
    i am without flour, sugar and starches for a longer time (about 4 years now) and lost 40 kg altogether, needed atkins for the rest of it though.
    i'm at 86 kg right now, started with 120 kg 4 years ago and was down to 78 kg.
    so the time had come to start over again, but this time not with phase 1 and 20 net carbs, because i couldn't stay with that anyway, i was always starved out, headaches, no voice when speaking to other people, no power, exhausted and tired all the time. so this time it's the new 40 carbs max (20-25g carbs from vegetables and stuff and 17g of carbs from honey).
    then i read about loosing weight with honey and how honey would burn fat.
    well i guess you get a big "that won't work with atkins because of the sugars! it will block the ketose!".. but wait..
    here's the plan that has been worked out in a lot of studies, there are books about it, i just ordered them and will read more about that and try it out longer.
    but so far it works very good for me.
    plan is simple: 1 Tablespoon (21g) of pure organic non-produced and cold fabricated honey just before sleeping.
    the fructose will be stored in your liver over night, and that's where the magic happens.
    burning fat needs glucose to work, in other words ketose only works with carbs. not sugary carbs, but carbs, in the end all carbs are converted to glucose anyway, and where does fat burning happen ? in your liver, where too much fructose also gets converted to fat!
    the trick is to stay low carb all day, up to 20g carbs (not net carbs) and fuel your fat burning liver with fructose just before going to bed so it has enough fuel to really burn a lot of fat through the night, when about 70 % of the fat burning takes place.
    the glucose in honey is low glycemic (index of 20 on the blood sugar and insuline) so you don't need to be frightened, it won't stop your ketose, 21g of honey is 6.3g of low glycemic glucose, 8.4g of fructose that gets stored in your liver and converted to glucose to fuel ketose over night and not converted to fat (you would need full glycogen tanks in your body, thats about 70g of fructose and 130g of glucose, but with atkins, they are emptied) and 2.1g of polysaccharides (low glycemic glucose).
    your body burns about 4g of glucose per hour minimum (even if you're on low carb, it will build 4g of glucose from protein then), so with a total of 16.8g sugar your body will have empty glucose tanks in the morning and will have burned about 7.5g-9g of fat per hour also. that's about 66g of fat per 8 hour sleep, 462g of fat in a week just by sleeping with a tblsp of honey.
    without honey the ketose will not work that well, you will still burn fat, but not that amount because ketose needs glucose, and your body will need to get it from somewhere. you can drink a protein drink before bed, but converting protein to glucose will take time and it will spread all over your body and not specifically in your liver where the fuel is needed for ketose. so you will have less power for ketose and burn less fat than with honey.
    i tried this for a week now and works really good. i lost 2kg (a good 4 lbs) in just 3 days (i know a lot of it is water at the start), but so far it does not interfere with atkins and the low carb function of your body. you won't loose your atkins advantage.
    i'll look how this goes on and will read the books written on this topic my Mike McInnes in the next weeks, but honey at night won't make you crave for carbs while you're sleeping and it doesn't anyway because it's low glycemic and doesn't raise your blood sugars with a tblsp (21g), at least it doesn't for me and it's known not to.
    just make sure you stay away from produced honey, that's just glucose fructose syrup, nothing more, stripped of all vitamins, minerals, antioxidants, hormones, enzymes, and the molecule structure that makes it low glycemic.
    just wanted to share this with you.
    maybe someone here already has experience with all organic honey and atkins ?
    [ed. note: Ralph (1506227) last edited this post 2 years, 4 months ago.]

  2. Ellen

    Honey is sugar...period
    If glucose is needed to burn fat, since all carbs are turned to glucose, it wouldn't matter whether it was honey or anything else...and the idea of low carb is that glycogen stores are used up forcing the body to turn to fat for fuel. Honey will replenish glycogen stores in the liver (and muscles if you have enough) and the body will turn to this first as a fuel source.
    It's unlikely to take you out of ketosis because you aren't having enough. One tbsp contains around 17g carbs. Added to 20g a day on Atkins takes you to mless than 40. Most people will stay in ketosis under 40.
    4lbs is not unusual in three days at the start, so basically what you are doing is staying below 40 carbs which will take you into ketosis, losing water at the beginning g which you do on Atkins anyway, But instead of spending your carbs on wholesome food which keeps you satisfied (which you ncoukdnt have been doing the first time round or you woukdnt have been hungry, - and the other symptoms you describe are classic salt depletion symptoms) you are choosing to spend half your daily carb intake on sugar.
    No, sorry, not convinced.
    [ed. note: Ellen (172174) last edited this post 2 years, 4 months ago.]

  3. James

    Hi Ralph welcome to the forum and congratulations on your huge weight loss.
    I have to say though that my experience on phase 1 with 20 g carbs a day has not been exhausting. I do eat about 450 g of greens and atkins freindly veg a day though . and put salt in food as well.
    the honey thing sounds interesting though . keep us posted . It would be nice to have a tablespoon of honey at night though , especially on some greek yohgurt with nuts.

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A lecture on the differential diagnosis of a normal anion gap metabolic acidosis, focusing on renal tubular acidosis, but also covering diarrhea, saline infusion, hyperkalemia, kidney failure, and ureteral diversion

Normal Anion Gap Acidosis

Terry W. Hensle, Erica H. Lambert, in Pediatric Urology , 2010 Nonanion gap acidosis occurs in situations in which HCO3 is lost from the kidney or the gastrointestinal tract or both. When this occurs, Cl (along with Na+) is reabsorbed to replace the HCO3; this leads to the hyperchloremia, which leaves the anion gap in normal range.10 Diarrhea causes a hyperchloremic, hypokalemic metabolic acidosis. Treatment depends on the severity of the acidosis incurred. In mild to moderate acidosis (pH >7.2), fluid and electrolyte replacement is often all that is required. Once adequate renal perfusion is restored, excess H+ can be excreted efficiently, restoring the pH to normal. In severe acidosis (pH <7.2), the addition of intravenous bicarbonate may be needed to correct the metabolic deficit. Before bicarbonate is administered, a serum potassium level should be obtained. The addition of bicarbonate can worsen hypokalemia, leading to neuromuscular complications. Hyperchloremic acidosis also occurs with renal insufficiency and renal tubular acidosis.9,20 Katherine Ahn Jin, in Comprehensive Pediatric Hospital Medicine , 2007 As in any condition, the first priority in management is stabilizing Continue reading >>

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    Question 1
    30 seconds

    Which is NOT one of the three types of carbohydrates?


    Question 2
    10 seconds

    Carbohydrates can be divides into 2 general sections. The sections are:

    Single and compound
    Simple and complex
    Single and complex

    Simple and compound
    Question 3
    10 seconds

    What is the primary function of carbohydrates in your body?

    Speed up chemical reactions.
    Give immediate energy.
    Help to store energy.

    Build cell walls in plants.
    Question 4
    30 seconds

    These are all properties of a disaccharide EXCEPT:

    made up of two sugars
    2 monosaccharides joined by dehydration synthesis

    ratio of 1:2:1
    Question 5
    30 seconds

    These are all properties of a monosaccharide EXCEPT:

    simple sugar
    1:2:1 ratio
    double sugar

    used for energy
    Question 6
    30 seconds

    What molecule is this


    Question 7
    30 seconds

    What type of carbohydrate is this?


    it isn't a carbohydrate
    Question 8
    30 seconds

    What type of carbohydrate is this?


    it isn't a carbohydrate
    Question 9
    30 seconds

    C6H12O6 is the molecular formula for what carbohydrate?


    Both glucose and fructose
    Question 10
    30 seconds

    How do the number of H atoms compare to the number of O atoms in a carbohydrate?

    There are TWICE as many H
    They are the same amount
    There are THREE times as many H

    There are TWICE as many O
    Question 11
    30 seconds

    What are the monomers of carbohydrates


    Question 12
    30 seconds

    Sucrose is a combination of glucose and fructose. Sucrose is an example of a-


    Question 13
    30 seconds

    Which of following are storage polysaccharides?

    starch and glucose
    chitin and cellulose
    starch and glycogen

    chitin and glycogen
    Question 14
    30 seconds

    When monomers are linked together, _____. This is called ____.

    A water is lost; dehydration synthesis
    A water is added; dehydration synthesis
    A water is lost; hydrolysis

    A water is added; hydrolysis
    Question 15
    30 seconds

    Which polysaccharides are found in plants only?

    glycogen and chitin
    glycogen and cellulose
    starch and cellulose

    chitin and starch
    Question 16
    30 seconds

    All monomers are connected by __


    Question 17
    30 seconds

    The scientific name for table sugar is ___


    Question 18
    30 seconds

    We need carbohydrates for ___

    genetic information

    Question 19
    30 seconds

    What elements are all biomolecules composed of?


    Question 20
    30 seconds

    What is the ratio of hydrogen to oxygen in carbohydrates?


    Question 21
    30 seconds

    What elements make up carbohydrates?

    carbon, nitrogen, hydrogen, oxygen
    carbon, oxygen, phosphours
    carbon, nitrogen, oxygen

    carbon, hydrogen, oxygen
    Question 22
    30 seconds

    Glucose is

    fruit sugar
    table sugar
    blood sugar

    milk sugar
    Question 23
    30 seconds

    What type of reaction is shown below?
    monomer + monomer --> polymer + water


    Question 24
    30 seconds

    What type of reaction is shown below?
    glucose + fructose <-- sucrose + water


    Question 25
    30 seconds

    This process removes a water molecule in order to bond monomers together:

    Dehydration Synthesis

    Question 26
    30 seconds

    Hydrolysis literally means

    To join with water
    To split with oil
    To split with water

    To join with oil.
    Question 27
    30 seconds

    Humans store energy in their body in the form of


    Question 28
    30 seconds

    This compound is used as a protective covering in animals, especially crustaceans and insects


    Question 29
    30 seconds

    Which of the following words is incorrectly matched with its meaning?

    Di = Two
    Mono = One
    Poly = Four

    Tri = Three
    Question 30
    30 seconds

    Which are enzymes?

    simple carbohydrates
    proteins that speed up chemical reactions
    lipids that make up the cell membrane

    a building block of DNA
    Question 31
    30 seconds

    DNA and RNA are examples of...

    nucleic acids

    Question 32
    30 seconds

    This is one job proteins do NOT have in the body

    storing genetic information
    speed up chemical reactions

    transport things through cell membrane
    Question 33
    30 seconds

    Unsatured fats are healthier for you. Which is an example of an unsaturated fat?

    olive oil

    Question 34
    30 seconds

    True or false: you can get protein from plants.

    Question 35
    30 seconds

    Another name for fats and oils


    nucleic acids
    Question 36
    30 seconds

    Phospholipids are most important to the function of

    Fatty Acid Construction
    Cell Membrane Formation
    Organ Cushioning

    Meat Marbling
    Question 37
    30 seconds

    Lipids have no uniform structure, but instead share this common characteristic

    All contain fatty acids
    All are oils
    All are hydrophobic

    All are polar
    Question 38
    30 seconds

    One of the building blocks of lipids, the triglyceride, is composed of

    3 Fatty Acids and 3 Glycerol
    1 Fatty Acid and 3 Glycerol
    3 Fatty Acids and 1 Glycerol

    1 Fatty Acid and 3 Glycerol
    Question 39
    30 seconds

    Which type of fat has straight fatty acid chains?

    Monounsaturated fat
    Polyunsaturated Fat
    Saturated Fat

    Question 40
    30 seconds

    This fat is solid at room temperature, meaning it also builds up plaque in your cardiovascular system.

    Monounsaturated Fat
    Polyunsaturated Fat
    Saturated Fat

    Trans Fat
    Question 41
    30 seconds

    In 2008, McDonald's changed their French Fry oil formula by removing what?

    Monounsaturated Fat
    Polyunsaturated Fat
    Saturated Fat

    Trans Fat
    Question 42
    30 seconds

    The monomer of a nucleic acid is

    Amino Acid

    Triglyceride (3 Fatty Acids and 1 Glycerol)
    Question 43
    30 seconds

    Which of the following is NOT found in a nucleotide

    Amino Acid
    Pentose Sugar
    Nitrogen Base

    Phosphate Group
    Question 44
    30 seconds

    The purpose of nucleic acids is to store

    Genetic Information

    Question 45
    30 seconds

    Which of the following is an example of nucleic acids?


    Question 46
    30 seconds

    The monomer of a protein is

    Amino Acid

    Triglyceride (3 Fatty Acids and 1 Glycerol)
    Question 47
    30 seconds

    Enyzmes are a very important type of protein used to

    Build bones in skeleton
    Send hormonal signals throughout body
    Speed up chemical reactions

    Photosynthesize glucose in plants
    Question 48
    30 seconds

    Which of the following is NOT a function of proteins

    Assist in blood clotting
    Fight infections and diseases
    Assist in the processing of glucose

    None of the above
    Question 49
    30 seconds

    Dehydration synthesis is

    Joining two molecules together following the removal of water molecule
    Separates two molecules by removal of water molecule
    Joining two molecules together by adding a water

    When you need to drink more water

    Question 50
    30 seconds

    Are starches simple or complex?

    Complex PLAY LIVE
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