Low Anion Gap Metabolic Acidosis

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Metabolic Acidosis - Endocrine And Metabolic Disorders - Merck Manuals Professional Edition

(Video) Overview of Acid-Base Maps and Compensatory Mechanisms By James L. Lewis, III, MD, Attending Physician, Brookwood Baptist Health and Saint Vincent’s Ascension Health, Birmingham Metabolic acidosis is primary reduction in bicarbonate (HCO3−), typically with compensatory reduction in carbon dioxide partial pressure (Pco2); pH may be markedly low or slightly subnormal. Metabolic acidoses are categorized as high or normal anion gap based on the presence or absence of unmeasured anions in serum. Causes include accumulation of ketones and lactic acid, renal failure, and drug or toxin ingestion (high anion gap) and GI or renal HCO3− loss (normal anion gap). Symptoms and signs in severe cases include nausea and vomiting, lethargy, and hyperpnea. Diagnosis is clinical and with ABG and serum electrolyte measurement. The cause is treated; IV sodium bicarbonate may be indicated when pH is very low. Metabolic acidosis is acid accumulation due to Increased acid production or acid ingestion Acidemia (arterial pH < 7.35) results when acid load overwhelms respiratory compensation. Causes are classified by their effect on the anion gap (see The Anion Gap and see Table: Causes of Metab Continue reading >>

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  1. [deleted]

    I've been doing a lot of searching (on this board and elsewhere) trying to understand low carb running.
    Through my searches, I've seen low carbers who have run 100 mile races, run very fast marathons, and accomplished many feats of endurance.
    What I'm trying to really wrap my head around as I begin my training is what is the real limiting factor when it comes to low carb distance running?
    Theoretically (I think), if you don't go fast enough to burn glycogen, you shouldn't have a problem running on low carb, but at what point do you begin to burn glycogen? How does one determine a proper pace for not burning through their glycogen reserves?
    I saw on the keto boards one guy did a 3:30 marathon on keto which I thought was pretty impressive; theoretically, as you get in better shape and more fat adapted you should be able to run faster and faster in low carb right? Obviously you won't be able to sprint or anything, but a 7 minute pace on a long run isn't impossible, is it?
    Hit me with some of your low carb running wisdom guys and help me to understand it all
    Also, as an aside just because I'm curious, if one was fully fat adapted and decided to carb up somewhat before a race for an extra "oomph" would there be any significant downsides to this (assuming it's only done on race day and not during training)?

  2. rickamore

    Though it's based on cycleing this should give you an idea. http://www.samiinkinen.com/post/86875777832/becoming-a-bonk-proof-triathlete-fat-chance
    Essentially on lowcarb bonking should become non-existant and the real ceiling is going to be muscle fatigue provided hydration and electrolytes are taken care of.

  3. erixsparhawk

    I've done a 2:54, another buddy has done 2:52 and my friend Anthony has done sub 2:45. Check out the RunKeto facebook discussion group. There are 775 active members posting about keto running. Strict MAF training + 10 heart beats works really well for most of us in the discussion group. Of course on race day you just run balls to the wall and throw heart rate out the window.
    edit: Some low carb pro ultra runner athletes run even faster. Zach Bitter 2:31:xx marathon, Tim Olson, Zach Gingrich?, something similar.

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A review of the differential diagnosis of an elevated anion gap metabolic acidosis, focusing predominantly on lactic acid, ketoacids, and toxic alcohols (i.e. methanol, ethylene glycol, and propylene glycol). Also includes discussion of renal failure, oxoproline, toluene, and paraldeyhyde. Use of the VA and Stanford name/logos is only to indicate my academic affiliation, and neither implies endorsement nor ownership of the included material.

Serum Anion Gap In Conditions Other Than Metabolic Acidosis

INTRODUCTION Determination of the serum anion gap (AG) is primarily used in the differential diagnosis of metabolic acidosis [1-4]. (See "Approach to the adult with metabolic acidosis", section on 'Physiologic interpretation of the serum anion gap'.) However, the serum AG can also become abnormal in other conditions, a finding that may be of diagnostic importance [1-5]. CALCULATION OF THE ANION GAP AND NORMAL VALUES The serum anion gap (AG) is calculated from the following formula: Serum AG = Measured cations - measured anions Since Na is the primary measured cation and Cl and HCO3 are the primary measured anions (calculator 1): Continue reading >>

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    I already have the PrecisionXtra made by Abbott. It will test both ketones and glucose - but not on the same strip!!
    You buy glucose strips separate and they are like other brands where you usually buy 50-100 at a time, and maybe a bit higher $$ than average glucose.
    Ketone strips are usually easier to buy online (EBay, Amazon, etc). They are usually 10 to a box and price runs $2-3 per strip - or cheaper maybe in Canada. They are a different foil pack color so you can either go by color or by the fact that glucose or Ketone are clearly printed on whichever one you are looking at. In addition, I have seen Ketone strips "cheaper" but they are closer to their expiration date. So you watch out for that.
    To my mind, the PrecisionXtra tests too high for glucose. Or else the old model I had (freestyle, also by Abbott, glucose only, a hand me down from my stepdad) was not working properly and read Low and/or I'm still in denial.
    What's that saying - there is no river in denial??
    So I have been going nuts trying to analyze the prices for the Nova Max Plus equipment, which from all appearances, will do the same as my PrecisionXtra but cheaper. Some will sell just the meter itself and I prolly don't need a new lancet specifically. EBay seems to have the cheapest just for the box of Ketone strips. So I may by the meter from Amazon or from the NovaMax website, and buy the strips from eBay. Or I may get the whiz-bang "free" meter with your choice of 2 box configurations - 2 boxes of ketone strips (total of 20 strips); 2 boxes of glucose (total 100 glucose strips); or 1 box Ketone (10) strips and 1 box of glucose (50) --- all three combos land at $39.98 or some such (and I am pretty much repeating what someone else said earlier here, or in another thread, sorry, more as confirming that I wasn't crazy since someone else had same info.)... thinking I may just do it that way, and then plan to buy replacement strips from the eBay vendors.
    Decisions decisions...
    Then I want to compare with the PrecisionXtra and see what my numbers are...
    Proverbs 31:17 She girds herself with strength,
    And strengthens her arms.

    December Minutes: 1,479






  2. RITA1956

    What is the site to get it? It's a different meter than one a diabetic uses to check for glucose level right?
    Rita--Topsham,Maine--Eastern Time
    5% Weight Loss Challenge - Rowdy Rebels
    -You can find positive or negative in any situation depending on what you're looking for.
    -Nothing can taste as good as skinny and healthy is going to feel. *Psst, my version of skinny is me in size 12 jeans.

    current weight: 223.0






  3. TRACY6659

    So I have questions about the blood testing for ketones. Are you using the standard diabetic testing supplies? The meter looks the same, but are there different types of test strips? or is it the same and there is a different reading you look for? obviously I'm confused
    * Tracy *

    current weight: 287.0






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Ever wondered what on earth the Anion Gap was all about? Yeah us neither. But when you've got yourself a metabolic acidosis, this is a good place to start. If you liked this, why not subscribe? And more importantly, let us know what you'd like to see us cover next.

Anion Gap

Pathophysiology sample values BMP/ELECTROLYTES: Na+ = 140 Cl− = 100 BUN = 20 / Glu = 150 K+ = 4 CO2 = 22 PCr = 1.0 \ ARTERIAL BLOOD GAS: HCO3− = 24 paCO2 = 40 paO2 = 95 pH = 7.40 ALVEOLAR GAS: pACO2 = 36 pAO2 = 105 A-a g = 10 OTHER: Ca = 9.5 Mg2+ = 2.0 PO4 = 1 CK = 55 BE = −0.36 AG = 16 SERUM OSMOLARITY/RENAL: PMO = 300 PCO = 295 POG = 5 BUN:Cr = 20 URINALYSIS: UNa+ = 80 UCl− = 100 UAG = 5 FENa = 0.95 UK+ = 25 USG = 1.01 UCr = 60 UO = 800 PROTEIN/GI/LIVER FUNCTION TESTS: LDH = 100 TP = 7.6 AST = 25 TBIL = 0.7 ALP = 71 Alb = 4.0 ALT = 40 BC = 0.5 AST/ALT = 0.6 BU = 0.2 AF alb = 3.0 SAAG = 1.0 SOG = 60 CSF: CSF alb = 30 CSF glu = 60 CSF/S alb = 7.5 CSF/S glu = 0.4 The anion gap[1][2] (AG or AGAP) is a value calculated from the results of multiple individual medical lab tests. It may be reported with the results of an Electrolyte Panel, which is often performed as part of a Comprehensive Metabolic Panel.[3] The anion gap is the difference between the measured cations (positively charged ions) and the measured anions (negatively charged ions) in serum, plasma, or urine. The magnitude of this difference (i.e., "gap") in the serum is often calculated in medicine when attempting t Continue reading >>

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  1. HolyDoja

    please share your story and how it has helped you in school/work/life.
    I used to be very closed minded and just thought about myself. After few months of doing keto for the first time, it opened my mind to be more empathetic and emotionally open with people. I cannot explain in words the difference in how I think but it is huge. Also I got mostly A's in my 2nd year of college when I was doing keto - up from mostly B's and C's from the previous year. I put my mother on a non-keto but a lot better diet than what she was eating before and she was soo happy and energetic during those times. All in all keto has been almost like a miracle for me in a certain way. How has it affected your life other than your waistline?

  2. [deleted]

    It's been a tremendous boost in my mental processing, emotional instabilities, and overall day-to-day lucidity.
    Actually, last year I made a post about this. -- About being diagnosed at sixteen years old with paranoid schizophrenia and how this diet has really allowed me to gain a clarity that I've never quite seen since the start of the illness.
    I had intended to update towards the end of the year--after having completed twelve consecutive months and finished my loss--but I stepped away from the diet during a particularly stressful and incorrect time in my life; because of that sense of loss, I just never found myself having the same sense of lucidity as it became a pattern to break the diet before I reached the same sense of well-being and unobstructed thinking.
    Generally, as I've repeated the diet this year as I did the last, the sense of clearness of thought only really begins to occur after the second month, and continues onward as you become fully adapted to the diet. For instance, the past two weeks or so, I've seemingly begun the same process. It just doesn't seem to work until this mark for whatever reason.
    I journal and keep a lot of data about my experiences on all of this. I'm hoping it'll be of some use to the right people down the road, because I've started to draw some conclusions here and there during all of this...
    The most vital thing I've learned is that the benefits, for me, start as you're finally becoming fully adapted to the diet. I've done keto over the course of several years, but those attempts were on and off and I never really found myself attaining this feeling during those attempts. This means that it's absolutely in my best interest not to allow myself to break the diet even once, as it means I'll likely break it soon, as that same sense of self is gone...
    I have examples and data here and there. Charts, personal journals, and the sort; it's remarkably obvious when I'm clear-headed and when I'm apparently not. Last year, before ushering a big life decision, I broke the diet before leaving the state and moving in with someone. Ultimately I blame that single breakage for ushering more lapses not even more than four weeks later. I had lost the sense of mind and mentally I was checked right on out, making bad decisions from that point on, until the year came to an end.
    It's really unsafe and wrong of me to say some of these things, but...
    Ultimately, the lack of whatever I'm not consuming on this diet has become the normal state of being. I don't find paranoia to be a thing. I don't have cravings or thoughts about hurting myself. I can think clear and unobstructed thoughts, more-so than any medication I've had previously.
    But for me, consuming whatever I'm not consuming on this diet is something like going off the normal rails and becoming sick again. It's really quite scary. I crave drinking and self destruction. I think and obsess about suicide or some really dark and unsubstantiated delusions.
    Whatever it is, something there causes just enough emotional instability to cloud my judgement and that leads me to causing more damage. I'm hoping the data I'm collecting will shed some light, maybe. I'd be willing to repeat the process to the right people.
    I'll likely be writing a greater and more in depth perspective towards the end of summer, something for those that find it as fascinating as I do, once I arrive my goal weight and begin to speak with people that study the diet and how it can affect people that suffer from mental illness.
    TL;DR: It's absolutely the closest thing to a wonder-drug for me. But the benefits seem to occur over time and peak once adapted. Breaking the diet, for me, pretty much starts the process over and I'm far more likely to fail during that phase.

  3. HolyDoja

    so would you say that somebody doing CKD would experience slightly less mental benefits than someone doing just normal KD with no re-feeds?

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