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Metabolic Acidosis Anion Gap

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Acid-base And Electrolyte Teaching Case Non–anion Gap Metabolic Acidosis: A Clinical Approach To Evaluation

Acid-base disturbances can result from kidney or nonkidney disorders. We present a case of high-volume ileostomy output causing large bicarbonate losses and resulting in a non–anion gap metabolic acidosis. Non–anion gap metabolic acidosis can present as a form of either acute or chronic metabolic acidosis. A complete clinical history and physical examination are critical initial steps to begin the evaluation process, followed by measuring serum electrolytes with a focus on potassium level, blood gas, urine pH, and either direct or indirect urine ammonium concentration. The present case was selected to highlight the differential diagnosis of a non–anion gap metabolic acidosis and illustrate a systematic approach to this problem. Continue reading >>

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Popular Questions

  1. teamzissous

    I made a post a little while back about having consistent bladder and or kidney pains whenever I was in ketosis. It took a while to correlate the pain with low carb (originally thought I may have a hernia, even a doctor thought so and ordered a CT scan, found nothing and gave up on me)
    One redditor (THANK YOU SoftwareMaven) suggested an acidic urine pH. After charting my pain and testing my urine with rapid response urinalysis strips I found that my urine was much too acidic, and it correlated with the pain.
    Apparently ketones tend to make your urine more acidic and you HAVE to balance out your protein/meat intake with alkalizing vegetables (fruits really help too) I've been following the PRAL food lists in order to help keep my urine more alkaline.
    It was also suggested that I try adding some baking soda (sodium bicarbonate) to some water if I was eating a particularly acidic forming meal, and IT WORKS!
    There are also some supplementary benefits of baking soda according to examine.com, it has the same benefits of supplementing with beta alanine (reduces muscle burn when taken 60-90 min before a workout) They also note that a study has shown it has no significant effect on your blood pressure, good to know.
    note: I make a point to drink a TON of water, but it is not sufficient to balance out my urine pH.
    TL;DR Thank you SoftwareMaven! Ketosis can make your urine too acidic causing kidney/bladder pain. Eat more alkalizing vegetables (and/or fruit). Also drinking baking soda and water with your acidic forming meal can also keep your pee balanced.

  2. emag

    It's interesting that acidic foods like lemon juice, orange juice, tomatoes, and vinegar all exert a base effect...

  3. happee

    What about coffee? It's pretty acidic, would it exert a base effect as well?

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