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Metabolic Acidosis Abdominal Pain Mechanism

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Metformin-associated Lactic Acidosis

OVERVIEW metformin use is associated with lactic acidosis, but it remians controversial as a disease entity MECHANISM the mechanism of lactic acidosis is uncertain Metabolic effects of metformin include: decreased gluconeogenesis increased peripheral glucose uptake decreased fatty acid oxidation CLINICAL FEATURES presence of risk factors abdominal pain nausea and vomiting fatigue myalgias altered mental status myocardial insufficiency multi-organ failure RISK FACTORS advanced age high dose renal failure (metformin is excreted unchanged in the urine) hypoxia active alcohol intake sepsis dehydration shock acidosis INVESTIGATIONS high anion gap metabolic acidosis (HAGMA) high lactate MANAGEMENT rule out other causes of lactic acidosis (sepsis, cardiogenic shock, hypoperfusion, ischaemic bowel) withdrawal of metformin RRT RRT remove metformin and correct acidosis best performed early due to large volume of distribution of metformin use hemodialysis use HCO3 buffer CONTROVERSY Some argue that metformin itself does not cause lactic acidosis, that it is actually due to the underlying conditions such as renal failure and diabetes mellitus. However, there are definite cases of lactic acidos Continue reading >>

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  1. elbruce

    Stages of DKA/Any Personal Experiences?

    After 19.5 years of Type 1 diabetes I should probably know everything about DKA but thankfully up to this point I have avoided any hint of DKA so out of sight, out of mind! I of course know the basics, the danger signs, symptoms etc. but the basic info does not tell you a lot about the progression, stages, etc. so in my mind my takeaways were "don't stay high too long, take your insulin, if you are high stay hydrated,"....good to go right?
    So yesterday around 4 AM my blood sugar started to rocket up after being normal for most of the night. Took a bolus to bring it down and when I woke around 6 my CGM said 250 but tested my blood sugar, it was 190. A little annoyed as my bolus should have brought this down but good enough to continue with my plan so I went for a 30 min run. After exercise it came down to about 150, I was happy so I did not think too much of it.
    Got it the car, ate two pieces of toast, and on my drive to work (45 minutes) my blood sugar started to rocket up! Gave myself a large bolus to bring it down and by the time I got to work it still was climbing higher and higher (over 400). Changed my infusion site (it was leaking so I probably was getting very little insulin), gave myself a bolus with a needle, drank a lot of water and just tried to focus on work. Started to come down very slowly but it was coming down and around 1230 I was down to about 150 around the same time I started feeling physically ill (lots of nausea, threw up once, lethargic) and that is when it hit me, could it be DKA? Since my blood sugar was not too bad I did not feel I was in immediate danger but I read that DKA can change your blood chemistry so I was a little worried about any cascading effects. My body felt awful, I just threw up, my stomach was upset, I didn't feel like eating. I forced myself to eat my modest lunch and closely monitored but still didn't feel good for most of the day and I left work about an hour early.
    I rode it out and I was fine but the experience just got me thinking. Has anyone ever experienced DKA? How fast did it come on? Any noticeable stages? Just curious about any personal experiences. Read that DKA can happen fast but when you are possibly experiencing it, it still surprised me at the speed of it. Don't know if I was actually experiencing DKA but it certainly seems plausible! Thoughts?

  2. Nicoletti

    Sorry, no personal experience here, but vomiting can be an early sign. And yes, DKA will change your blood chemistry to the point of metabolic acidosis. Too much acidosis is not compatible with life -- very serious stuff!
    Do you have urine keto strips? You can check ketones with them if your blood sugar is high.

  3. coravh

    I've been on the verge twice in my 50 years of D. The first time was when I was about 16 or so and I'd had the flu. One of those horrible ones making the rounds that was killing some of the elderly that caught it. I was vomiting for 3 days and on day 3 it started getting worse, rather than better (keep in mind that this was in the 70s, so horrible insulins and no home testing) so my Mom took me to the hospital. They said my blood chemistry was just starting to go "off". The second time was when I had peritonitis (so got really sick, really fast) and went to hospital in the morning. Again, this was in the days before lantus. I took my morning shot of N, and went to the ER. By midnight they had given me no insulin, hadn't tested my blood sugar in 6 hours (the nurse was refusing to) and so I called home to get my insulin. The next morning a young resident cheerfully told me that I had "been on the verge of DKA, but we saved you!!!!". I informed her that they were the ones that had pushed me there.
    As far as for myself, I know coming close I have always been pretty ill before I got close to the edge. So if you are taking a reasonable amount of insulin and still feel ok, I suspect that DKA is the last thing you need to worry about. Especially if you can keep fluids down along with your bg.
    I really doubt if you were experiencing DKA. Don't forget, the K stands for Keto (acidosis). So you have to have rampaging ketones that acidify your blood. It's not a single day process, especially with insulin on board.
    Cora

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My other research videos: Zhang, R. (2017). When to use a qualitative research design? Four things to consider. [Video File]. Retrieved from https://youtu.be/4FJPNStnTvA Zhang, R. (2017). What is a good Central Research Question? [Video File]. Retrieved from https://youtu.be/I4MfCDy7wDw Zhang, R. (2017). Research aim, research objective, research question, and investigative question. [Video File]. Retrieved from https://youtu.be/ujKIM59hy9I Zhang, R. (2016) Research Types, Research Designs, Data Collection, and Sampling. [Video File]. Retrieved from https://youtu.be/WY9j_t570LY SUBSCRIBE To My Channel For More Research Videos https://goo.gl/8f64I9 What's the difference between 'research aim', 'research objective', 'research question', and 'investigative question'? To reference this video in APA: Zhang, R. (2017). Research aim, research objective, research question, and investigative question. [Video File]. Retrieved from https://youtu.be/ujKIM59hy9I Please LIKE this video if you enjoyed it. Otherwise, there is a thumb-down button, too... :P MY SOCIAL MEDIA PAGES https://www.facebook.com/ranywayz https://nl.linkedin.com/in/ranywayz https://www.twitter.com/ranywayz Music files retrie

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A 65-year-old man with past medical history of schizophrenia complains of vomiting for the past 24 hours. He reports feeling very hot for several days, but denies other symptoms including abdominal pain, chest pain, and shortness of breath. You are unable to obtain further details as he is having trouble hearing the questions. Vital signs: temperature 101°F, heart rate 130/min, respiratory rate 35/min, blood pressure 120/80 mm Hg, pulse oximetry 100% on room air. You would also expect this patient to have: A respiratory alkalosis with a metabolic acidosis. A respiratory acidosis with metabolic alkalosis. A 40-degree right axis deviation manifested by a terminal r wave in AVR on ECG. An intracranial hemorrhage on CT scan of the brain. An elevated lithium level. Answer Explanation : Aspirin intoxication caused a mixed acid base disturbance. Stimulation of the central respiratory center in the medulla leads to a respiratory alkalosis. Metabolic acidosis can be severe and is caused via several mechanisms. Uncoupling of oxidative phosphorylation leads to an increase in oxygen use and CO2 production. Pyruvate and lactate are by-products of anaerobic respiration. Increased CO2 increases Continue reading >>

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  1. ketocurious193

    So I have a packet of sugar free mints that say they contain like 97g of carbs but it's all in Polyols. However when I use mfp it's telling me each mint is like 2g carb. Is mfp counting polyols as carb - carbs or do polyols not actually count as 0 or what is going on here?

  2. aleehagen

    I read a good rule of thumb is to count each sugar alcohol as .5 in regards to your daily intake to be on the safe side.
    I don't personally eat sugar free candy, but my SO does and she can "go to town" on them and that's one reason I just avoid them all together. Never mind the "after" effects of eating too many...

  3. ketocurious193

    ok thanks :)
    yeah like it's just a pack I picked up kind of randomly (fancied a mint) and then realised the discrepancy before I ate any. I've been fine so far on all other sweeteners without falling into binging or it increasing cravings for actual sugar so hopefully a mint after a meal won't ruin me.

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

Chronic Metabolic Acidosis Destroys Pancreas

Peter Melamed and Felix Melamed Biotherapy Clinic of San Francisco, USA *Corresponding Author: Biotherapy Clinic of San Francisco 2215 Post Street, Suite 1, San Francisco, CA 94115, USA Phone 1 415 3776643 Fax 1 415 4093909 [email protected] Visit for more related articles at JOP. Journal of the Pancreas Abstract One primary reason for the current epidemic of digestive disorders might be chronic metabolic acidosis, which is extremely common in the modern population. Chronic metabolic acidosis primarily affects two alkaline digestive glands, the liver, and the pancreas, which produce alkaline bile and pancreatic juice with a large amount of bicarbonate. Even small acidic alterations in the bile and pancreatic juice pH can lead to serious biochemical/biomechanical changes. The pancreatic digestive enzymes require an alkaline milieu for proper function, and lowering the pH disables their activity. It can be the primary cause of indigestion. Acidification of the pancreatic juice decreases its antimicrobial activity, which can lead to intestinal dysbiosis. Lowering the pH of the pancreatic juice can cause premature activation of the proteases inside the pancreas with the pot Continue reading >>

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  1. ab.er.rant

    I just came back from a series of test to check my heart palpitations. The doctor didn't see anything obvious that could directly cause palpitations, so the implication seems to be that it's more related to my diet change (been a month since I started moderate low-carb) and bodily adjustments.
    My blood test came back a bit high on uric acid, and the doctor said a low-carb diet has a tendency to cause it. So essentially I'm told that I'm at a risk of developing high blood pressure. I wasn't diagnosed as having gout since I have no joint problems. The doctor also suggested that I could simply be not eating enough, causing elevated levels.
    Anyone has a similar experience? It seems that I should eat less meat and more veges.

  2. muzza3

    Hi @ab.er.rant
    Can't help personally but was interested so had a look. This seemed credible and had some suggestions.
    http://www.naturalremedies.org/uric-acid/
    Cheers

  3. chri5

    ab.er.rant said: ↑
    I just came back from a series of test to check my heart palpitations. The doctor didn't see anything obvious that could directly cause palpitations, so the implication seems to be that it's more related to my diet change (been a month since I started moderate low-carb) and bodily adjustments.
    My blood test came back a bit high on uric acid, and the doctor said a low-carb diet has a tendency to cause it. So essentially I'm told that I'm at a risk of developing high blood pressure. I wasn't diagnosed as having gout since I have no joint problems. The doctor also suggested that I could simply be not eating enough, causing elevated levels.
    Anyone has a similar experience? It seems that I should eat less meat and more veges.
    Click to expand... Hi, if I was you I would make sure you are drinking plenty of water as this helps to flush uric acid. I used to be prone to gout attacks but since going lchf I haven`t had one in well over a year so I am a little sceptical of lchf causing high uric acid levels. Best of luck anyway, Chris.

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