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Lactic Acidosis Diagnosis

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Lactic Acidosis

Lactic acidosis is a medical condition characterized by the buildup of lactate (especially L-lactate) in the body, which results in an excessively low pH in the bloodstream. It is a form of metabolic acidosis, in which excessive acid accumulates due to a problem with the body's metabolism of lactic acid. Lactic acidosis is typically the result of an underlying acute or chronic medical condition, medication, or poisoning. The symptoms are generally attributable to these underlying causes, but may include nausea, vomiting, rapid deep breathing, and generalised weakness. The diagnosis is made on biochemical analysis of blood (often initially on arterial blood gas samples), and once confirmed, generally prompts an investigation to establish the underlying cause to treat the acidosis. In some situations, hemofiltration (purification of the blood) is temporarily required. In rare chronic forms of lactic acidosis caused by mitochondrial disease, a specific diet or dichloroacetate may be used. The prognosis of lactic acidosis depends largely on the underlying cause; in some situations (such as severe infections), it indicates an increased risk of death. Classification[edit] The Cohen-Woods Continue reading >>

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  1. AshSimmonds

    From Amazon:
    Quote
    The Ketonix product can measure your body production of ketones (fat burn process) in your breath and is an excellent alternative to other methods such as urine strips or blood samples.
    ??The Ketonix is a one time cost and is simple to use. It has never been easier to see if you produce ketones!?
    Whats the advantage to use Ketonix instead of urine strips and blood ketone meters?
    * Urine strips indicates the excess concentration of acetoacetate in the urine. Ketonix indicates the acetone in your breath (indirectly from the concentration of acetoacetate in blood). Units are not the same, the concentration in fluid is higher due to less volume (higher density) and is measured typically in mmol/l. The concentration in gas(air) is lower due to much more volume (lower density) and is measured in nmol/l. Again, urine strips measures acetoacetate in urine, blood meters measures beta-hydroxybutyrate in blood and Ketonix measures acetone in breath (air).
    * Urine strips can only be used once. Ketonix is reusable and can be used over and over again.
    * Urine strips show a historical value of the excess production. Ketonix shows a real-time value of whats in the blood right now!
    * Urine strips tests need urine and somewhere to do the test. You can perform tests using Ketonix wherever you can access a powered USB port. We don't recommend using Ketonix in vehichles (or in any motion).
    * Urine strips need to be disposed. Ketonix should be stored in the bag that was included with the product.
    * Urine strips cost per test. Ketonix is a one-time investment!
    * Blood ketone meters measures beta-hydroxybutyrate in blood, not acetoacetate or acetone.
    * Blood ketone measure requires strips which are expensive
    * Blood ketone measure sometimes fail and cost you twice!
    * Blood ketone meter values differ between devices, even when it is the same model and brand.
    * Blood ketone meter values is measured in mmol/l, and Ketonix values in nmol/l. This is ofcourse due to the higher density of blood than air. Therefore the blood ketone concentration if beta-hydroxybutyrate is not the same as the concentration of acetone in breath. Just as the concentration of acetoacetate in urine is not the same as concntration of beta-hydroxybutyrate in blood.
    As always, we do not take any responsibility for your usage of Ketonix. You should always consult your doctor/dietician before changing/experimenting with your diet!
    In AppStore you could download the Ketonix app to calculate your ketogenic diet ratio!

  2. AshSimmonds

    Got mine delivered this week, landed is about $100 bucks.
    Interesting little device, it was only mid last year that the idea of such a thing becoming commercially available was really gaining traction - now all of a sudden there's this one which seems to be first to market.
    It has four LEDs, each one representing a range of acetone/ketones on your breath:
    Blue - none or trace: 0-150 nmol/L
    Green - low: 150-400 nmol/L
    Yellow - medium: 400-930 nmol/L
    Red - high: 930+ nmol/L
    There Are Four Lights
    When I first plugged it in it took over half an hour before it was ready to take a reading, I emailed the manufacturer and they said initial "burn in" time for the sensor can vary depending on stuff (climate/etc). Subsequent plug-ins have had the device ready to rock within a minute or so - often within 20 seconds.
    I've been blowing a consistent green-yellow for the last couple days, except for today as last night we watched The Wolf Of Wall Street and I had some popcorn/prawn crackers/beer/wine so am currently not particularly ketogenic until my glucose/glycogen disspates again somewhat.
    For the moment I'm content with these coloured ranges, as when you test blood ketones you take that decimal number and end up just categorising it as low/med/high to yourself anyhoo.
    As of right now though there's a dearth of data about breath ketones and the correlation with serum ketones, so throughout February I'm looking at doing my own extensive testing and recording to add a little N=1 anecdata to the shallow pool.
    Here it is - later I'll chuck up a vid of it in action (I went to the movies and drank beer/wine ate popcorn/prawn crackers last night so I'll wait for any residual carbs/glycogen to diminish).

  3. AshSimmonds

    The only paper I know of comparing breath ketones to blood and urine, and sadly it's only a 12 hour study and it only measures the very low end of ketosis:
    http://ajcn.nutrition.org/content/76/1/65.full
    Quote
    Breath acetone is a reliable indicator of ketosis in adults consuming ketogenic meals
    ...
    The objective was to determine which index, breath acetone or urinary acetoacetate, is more strongly related to the plasma ketones acetoacetate and ?-hydroxybutyrate.
    ...
    After fasting overnight for 12 h, 12 healthy adults consumed 4 ketogenic meals over 12 h. Blood, breath, and urine samples were collected hourly. Blood was analyzed for plasma acetoacetate and ?-hydroxybutyrate, breath for acetone, and urine for acetoacetate.
    ...
    Plasma acetoacetate was best predicted by breath acetone ... Plasma ?-hydroxybutyrate was equally predicted by breath acetone and urinary acetoacetate
    Quote
    Mean (±SEM) changes in breath acetone, plasma acetoacetate (AcAc), plasma ?-hydroxybutyrate (?-HBA), and urinary acetoacetate. n = 12 subjects per time point. *Significantly different from 0 h (fasting), P < 0.05. The vertical dashed lines indicate the time points at which a ketogenic meal was consumed.

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in this videoclip dr. Pietro Addamo and dr Simona Polemi illustrate metabolic and pathophysiological pathways that lead to lactic acidosis caused by metformin. The short video ends with a case report.

Mala: Metformin-associated Lactic Acidosis

By Charles W. O’Connell, MD Introduction Metformin is a first-line agent for type 2 diabetes mellitus often used as monotherapy or in combination with oral diabetic medications. It is a member of the biguanide class and its main intended effect is expressed by the inhibition of hepatic gluconeogenesis. In addition, metformin increases insulin sensitivity, enhances peripheral glucose utilization and decreases glucose uptake in the gastrointestinal tract. Phenformin, a previously used biguanide, as withdrawn from the market in the 1970’s due its association with numerous cases of lactic acidosis. Metformin is currently used extensively in the management of diabetes and is the most commonly prescribed biguanide worldwide. The therapeutic dosage of metformin ranges from 850 mg to a maximum of 3000 mg daily and is typically divided into twice daily dosing. It is primarily used in the treatment of diabetes but has been used in other conditions associated with insulin resistance such as polycystic ovarian syndrome. MALA is a rare but well reported event that occurs with both therapeutic use and overdose states. Case presentation A 22-year-old female presents to the Emergency Departmen Continue reading >>

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  1. manohman

    Why can't fat be converted into Glucose?

    So the reason cited is that beta oxidation/metabolism of fats leads to formation of acetyl coa, a 2 carbon molecule, and that because of that it cannot be converted back into glucose.
    Why exactly is that the case?
    If Glucogenic amino acids can be converted into citric acid cycle intermediates and then turn back into glucose via gluconeogensis, then why cant Fatty Acids which yield Acetyl Coa. Can't you just have Acetyl Coa enter the citric acid cycle and produce the same intermediates that the glucogenic amino acids creat?

  2. Czarcasm

    manohman said: ↑
    So the reason cited is that beta oxidation/metabolism of fats leads to formation of acetyl coa, a 2 carbon molecule, and that because of that it cannot be converted back into glucose.
    Why exactly is that the case?
    If Glucogenic amino acids can be converted into citric acid cycle intermediates and then turn back into glucose via gluconeogensis, then why cant Fatty Acids which yield Acetyl Coa. Can't you just have Acetyl Coa enter the citric acid cycle and produce the same intermediates that the glucogenic amino acids creat?
    Click to expand... Both glucose and fatty acids can be stored in the body as either glycogen for glucose (stored mainly in the liver or skeletal cells) or for FA's, as triacylglycerides (stored in adipose cells). We cannot store excess protein. It's either used to make other proteins, or flushed out of the body if in excess; that's generally the case but we try to make use of some of that energy instead of throwing it all away.
    When a person is deprived of nutrition for a period of time and glycogen stores are depleted, the body will immediately seek out alternative energy sources. Fats (stored for use) are the first priority over protein (which requires the breakdown of tissues such as muscle). We can mobilize these FA's to the liver and convert them to Acetyl-CoA to be used in the TCA cycle and generate much needed energy. On the contrary, when a person eats in excess (a fatty meal high in protein), it's more efficient to store fatty acids as TAG's over glycogen simply because glycogen is extremely hydrophilic and attracts excess water weight; fatty acids are largely stored anhydrously and so you essentially get more bang for your buck. This is evolutionary significant and why birds are able to stay light weight but fly for periods at a time, or why bears are able to hibernate for months at a time. Proteins on the other hand may be used anabolically to build up active tissues (such as when your working out those muscles), unless you live a sedentary lifestyle (less anabolism and therefore, less use of the proteins). As part of the excretion process, protein must be broken down to urea to avoid toxic ammonia and in doing so, the Liver can extract some of that usable energy for storage as glycogen.
    Also, it is worth noting that it is indeed possible to convert FA's to glucose but the pathway can be a little complex and so in terms of energy storage, is not very efficient. The process involves converting Acetyl-CoA to Acetone (transported out of mitochondria to cytosol) where it's converted to Pyruvate which can then be used in the Gluconeogenesis pathway to make Glucose and eventually stored as Glycogen. Have a look for yourself if your interested: http://www.ploscompbiol.org/article/info:doi/10.1371/journal.pcbi.1002116.g003/originalimage (and this excludes the whole glycogenesis pathway, which hasn't even begun yet).
    TLDR: it's because proteins have no ability to be stored in the body, but we can convert them to glycogen for storage during the breakdown process for excretion. Also, in terms of energy, it's a more efficient process than converting FA's to glycogen for storage.

  3. soccerman93

    This is where biochem comes in handy. Czarcasm gives a really good in depth answer, but a simpler approach is to count carbons. The first step of gluconeogenesis(formation of glucose) requires pyruvate, a 3 carbon molecule. Acetyl Co-A is a 2 carbon molecule, and most animals lack the enzymes (malate synthase and isocitrate lyase) required to convert acetyl co-A into a 3 carbon molecule suitable for the gluconeogenesis pathway. The ketogenic pathway is not efficient, as czarcasm pointed out. While acetyl co-A can indeed be used to form citric acid intermediates, these intermediates will be used in forming ATP, not glucose. Fatty acid oxidation does not yield suitable amounts of pyruvate, which is required for gluconeogenesis. This is part of why losing weight is fairly difficult for those that are overweight, we can't efficiently directly convert fat to glucose, which we need a fairly constant supply of. Sorry, that got a little long-winded

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I've been trying to figure out how the Gerson therapy can reverse cancer when it does not incorporate ketosis. When you look at disease from the lactic acidosis standpoint then it makes sense that a vegan based therapy can be clinically equivalent to ketosis which can be high animal fat and moderate protein. Please Like, Share, and Subscribe! -Dr. Schmidt You have already taken the first step to better your health by watching my video! Next, I recommend that you join our Long Distance Patient Program so that you can get diet modification and supplement recommendations designed specifically for you by me or one of my fellow practitioners in our Ann Arbor, Michigan office. You have to be a patient of our office in order to receive supplements, per our distribution agreement with the producer of the Standard Process brand supplements. Becoming a Long Distance Patient as outlined below allows you that access. In order to be part of our online patient program, you would purchase an annual membership for $200. This membership includes an initial 30 minute phone appointment with me or one of our practitioners. At that time, the practitioner will make a recommendation to you for diet modifications, supplements and the quantities that you should take. After the phone call, you are able to order supplements for a year, as needed, directly from our website and our app. We will then promptly ship the supplements out to you. Follow up phone calls with your practitioner are $125 for a 20 minute phone/SKYPE appointment. If you would like to move forward and take advantage of this opportunity, please call: (734) 302-7575 or email [email protected] to schedule your phone appointment, and make the $200 payment. You can reach us by phone Monday through Saturday 9am-5pm EST. To learn more about our office and clinical practice, go to: http://thenutritionalhealingcenter.com Since not everyone is fortunate enough to live within driving distance of Ann Arbor, Michigan, and many feel that an telephone/online consultation is not enough to meet their clinical needs, I am happy to offer you our Long Distance Patient Travel Package. The package is comprised of a series of appointments with myself or another practitioner that are time sensitive, and a time allowance of 48-72 hours in our beautiful city is required. Not only are your health issues of concern thoroughly evaluated, but you receive a comprehensive full body evaluation, two different computerized cardiac health tests, a great deal of teaching and health education, and leave with a program of diet modification and supplement support that the practitioner is confident will improve your health and quality of life. This program can initiate your relationship with our clinic, and be followed up with telephone/online consultations, or it can be incorporated into your already existing program with our clinic to further enhance the program you already have in place. The cost for the Long Distance Travel Package is $560 and includes everything mentioned above. We also have a relationship with a lovely landmark hotel conveniently located less than 2 miles from our office, that offers a reduced nightly rate to our patients. In the meantime, if you are truly interested in what we have to offer, please watch these 5 important videos of mine: https://www.youtube.com/playlist?list... We look forward to helping you feel your best! If you find my info helpful, please visit my Patreon page. https://www.patreon.com/drdarrenschmi... This statement has not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure or prevent any disease. UCC 1-308 without prejudice.

Acute Lactic Acidosis - General Practice Notebook

Lactic acid is the end product of anaerobic glycolysis. Lactate is in equilibrium with pyruvate, anaerobic conditions increasing the normal 10:1 lactate:pyruvate ratio. The concentration of lactate in the blood is usually less than 1 mM, but rise physiologically after severe exercise to as high as 10 mM. Lactic acidosis should be suspected in patients with a high anion gap metabolic acidosis, when uraemia and ketoacidosis have be excluded. Home| About us| Facebook| Contact us| Authors| Help| FAQ This site is intended for the use of healthcare professionals only. A licensed medical practitioner should be consulted for diagnosis and treatment of any and all medical conditions. Copyright 2016 Oxbridge Solutions Ltd. Any distribution or duplication of the information contained herein is strictly prohibited. Oxbridge Solutions Ltd receives funding from advertising but maintains editorial independence more... GPnotebook stores small data files on your computer called cookies so that we can recognise you and provide you with the best service. If you do not want to receive cookies please do not use GPnotebook. Continue reading >>

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  1. Saraleesaralee

    Is it possible to stay on ketogenic diet for life-long?

    I have been on ketogenic diet for 2 weeks. It controls my blood sugar level really well. However I am not over weight. And I am worried about potential long term side effects of the diet. For example, high LDL level, steoporosis, auto immune disease, too much weight loss, vesicular stiffness. I was wondering if there is anyone in this forum has been on ketogenic diet for years? And do you experience any side effects from the diet?

  2. Aaron1963

    I've been on a strict ketogenic diet for 6 months, and was doing LCHF for much of the 5 months prior to that but didn't make any attempts at it being ketogenic so I may have been in and out of ketosis some during that period. I now have a blood ketone meter and remain in ketosis according to it.
    I did suffer excessive weight loss initially. I lost about 40kg (about 90 lbs.), and it ended up sending me from being very obese to being underweight. But I've always eaten very little protein, which I continued to do, plus I was doing intermittent fasting, sometimes not eating anything for days at a time. Once I stopped the intermittent fasting and concentrated on getting adequate protein, my weight went back up to my ideal weight and stabilized there. I've heard from several people that you really need to watch your protein when doing a ketogenic diet being it's easy for excess to hinder weight loss and/or increase your BG.
    I have had a few issues while doing a ketogenic diet, but not 100% sure which if any can be attributed to ketosis vs. some other factor. First off, as winter was approaching I got extremely cold all the time, especially my fingers and toes, but even my whole body was cold. I thought it might have been the caffeine I was getting as part of my ketogenic diet involves drinking lots of coffee with HWC, coconut oil, and butter. I switched to decaf and the problem pretty much went away, but I don't know if it was the caffeine, the ketosis, the massive weight loss (lack of body fat), something else, or a combination of factors.
    I've also had excessive itching and a rash. That's normal for me during the winter months, but this year it started a bit early, went longer, and was much worse than normal. I think it may very well have been my usual sensitivity to the cold dry weather, aggravated by toxins released during my rapid weight loss, and perhaps ketones being emitted through the skin. It's just recently started to clear up and the rash is gone and most of the itching.
    I got keto-breath for a week or two when I first concentrated on going keto. It was very noticeable, but disappeared after that and no issues anymore with my breath.
    This diet is very sustainable for me. I tried my whole adult life to diet to lose weight and was never successful. This time I wanted to lose weight, but my primary focus was controlling my BG, meaning reducing carbs down to a low-carb level, which caused me to gravitate naturally to a LCHF diet. For the first time I have no desire to go back to my old way of eating. I love this diet and it's completely satisfying. So I killed two birds with one stone - got my BG under control, down to non-diabetic levels, and got my weight down to ideal. Plus with the huge benefits (IMHO) of having my body use ketones rather than glucose, I'm totally sold on this way of eating for the rest of my life and have absolutely no worries about not being able to stick to my diet. I really have no strong urges for carbs anymore, and only end up going off the plan rarely due to social pressures or inadvertently eating hidden/unknown carbs.
    My LDL has gone up, but I've heard from others that usually it's benign large fluffy LDL that typically goes up when on a ketogenic diet. And my body is still adjusting. Also I've heard that LDL by itself is not a good measure of risk. So I'm not worried about it, but will keep an eye on things. I also have taken my ketogenic diet to an extreme, hitting a KR of 3.0 or higher almost everyday, and sometimes up to 4.0 or more. Not sure if eating much more fat than necessary for ketosis affected my LDL any or not. Initially my LDL dropped significantly as well as my trigs, but both increased at my last doctor's visit. I may try a more normal KR in the future while monitoring my blood ketones to verify I stay in ketosis and see if there's any difference in my BG, cholesterol, or other tests.
    I did also suffer from other typical symptoms during my keto adaptation phase. Most went away within about two weeks. But it's just been here at the 6-month mark where my BG numbers suddenly stabilized with very little change, and quite low, and overall I just feel absolutely fantastic. I feel like I'm bursting with energy and joined a gym and suddenly love running and working out whereas I hated them all my life.
    Well, I don't have years of experience with ketosis to report anything to you about that. Other than I've heard lots of other people with years of experience and not heard of anyone having any real side effects other than the things I've mentioned. However some people do find ketosis isn't for them and give up very soon. For those that feel it is working for them and stick with it, seems there's no significant side effects. But I'll let the others who've been in ketosis for longer than me speak for themselves.

  3. furball64801

    Hi and welcome to DD I know of a guy called no more carbs that was on it over 2 yrs. It is possible he is still on it, that chat site closed down but he was going strong on it.

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