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Metabolic Acidosis Bicarbonate

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

Bicarbonate Therapy In Severe Metabolic Acidosis

Abstract The utility of bicarbonate administration to patients with severe metabolic acidosis remains controversial. Chronic bicarbonate replacement is obviously indicated for patients who continue to lose bicarbonate in the ambulatory setting, particularly patients with renal tubular acidosis syndromes or diarrhea. In patients with acute lactic acidosis and ketoacidosis, lactate and ketone bodies can be converted back to bicarbonate if the clinical situation improves. For these patients, therapy must be individualized. In general, bicarbonate should be given at an arterial blood pH of ≤7.0. The amount given should be what is calculated to bring the pH up to 7.2. The urge to give bicarbonate to a patient with severe acidemia is apt to be all but irresistible. Intervention should be restrained, however, unless the clinical situation clearly suggests benefit. Here we discuss the pros and cons of bicarbonate therapy for patients with severe metabolic acidosis. Metabolic acidosis is an acid-base disorder characterized by a primary consumption of body buffers including a fall in blood bicarbonate concentration. There are many causes (Table 1), and there are multiple mechanisms that mi Continue reading >>

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  1. bighusker7

    Hi. First some facts: 31 years old, 5'9", 265 lbs. I have been on the diet for roughly one and a half months.
    A couple of years ago I hit my highest weight of 303 lbs and was diagnosed with hypertension. I was put on Lisinopril and it helped a little bit. I decided to start the DASH diet, which is a diet designed to lower high blood pressure and one of the perks was weight loss.
    Over the course of a year on the DASH diet (which is pretty much lots of whole grains, low sodium, zero fat), my HBP was significantly better and I had lost about 30 lbs. The down side was I hated the foods. I can't stand most vegetables and eat limited fruits. It was just too much.
    After quitting the diet I kind of fell back on bad habits and started splurging on junk food. Few months later and I gained back some of the weight and my HBP was also worse. I was now at 283 lbs. This was at the start of October.
    I began keto October 1st. I currently have a daily routine of eating about 1/3 cup of sunflower seeds for magnesium and I put about 1 tsp of Nu-Salt into a Powerade Zero for my daily potassium. Other than that I eat a strict <20g carb a day diet and try to stay near my levels from the keto calculator.
    A few days ago I purchased a new blood pressure monitor and I have been getting high readings like 159/92 just now. I read through many posts that have said that keto actually has helped lower peoples hypertension, sometimes even eliminating it. I am wondering what's up with me? Why is my HBP getting worse? I should also mention I lead a pretty sedentary lifestyle with about 30 minutes of exercise bike every other day. Any help would be appreciated.
    TLDR: Previous DASH diet helped hypertension, Keto is giving me high #'s.

  2. materhern

    Try dropping your sodium intake. Thats often times a big trigger. Make sure you are drinking enough water as well. The reason for higher sodium in this diet is that you consume lots of water which tends to flush electrolytes out of your system. So if you aren't drinking lots of water there is no need for the extra sodium.

  3. kusanagisan

    What were your numbers before you started keto in October?

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What is BASAL METABOLIC RATE? What does BASAL METABOLIC RATE mean? BASAL METABOLIC RATE meaning - BASAL METABOLIC RATE definition - BASAL METABOLIC RATE explanation. Source: Wikipedia.org article, adapted under https://creativecommons.org/licenses/... license. Basal metabolic rate (BMR) is the minimal rate of energy expenditure per unit time by endothermic animals at rest. It is reported in energy units per unit time ranging from watt (joule/second) to ml O2/min or joule per hour per kg body mass J/(hkg)). Proper measurement requires a strict set of criteria be met. These criteria include being in a physically and psychologically undisturbed state, in a thermally neutral environment, while in the post-absorptive state (i.e., not actively digesting food). In bradymetabolic animals, such as fish and reptiles, the equivalent term standard metabolic rate (SMR) is used. It follows the same criteria as BMR, but requires the documentation of the temperature at which the metabolic rate was measured. This makes BMR a variant of standard metabolic rate measurement that excludes the temperature data, a practice that has led to problems in defining "standard" rates of metabolism for many mammals. Metabolism comprises the processes that the body needs to function. Basal metabolic rate is the amount of energy expressed in calories that a person needs to keep the body functioning at rest. Some of those processes are breathing, blood circulation, controlling body temperature, cell growth, brain and nerve function, and contraction of muscles. Basal metabolic rate (BMR) affects the rate that a person burns calories and ultimately whether that individual maintains, gains, or loses weight. The basal metabolic rate accounts for about 60 to 75% of the daily calorie expenditure by individuals. It is influenced by several factors. BMR typically declines by 12% per decade after age 20, mostly due to loss of fat-free mass, although the variability between individuals is high. The body's generation of heat is known as thermogenesis and it can be measured to determine the amount of energy expended. BMR generally decreases with age and with the decrease in lean body mass (as may happen with aging). Increasing muscle mass has the effect of increasing BMR. Aerobic (resistance) fitness level, a product of cardiovascular exercise, while previously thought to have effect on BMR, has been shown in the 1990s not to correlate with BMR when adjusted for fat-free body mass. But anaerobic exercise does increase resting energy consumption (see "aerobic vs. anaerobic exercise"). Illness, previously consumed food and beverages, environmental temperature, and stress levels can affect one's overall energy expenditure as well as one's BMR. BMR is measured under very restrictive circumstances when a person is awake. An accurate BMR measurement requires that the person's sympathetic nervous system not be stimulated, a condition which requires complete rest. A more common measurement, which uses less strict criteria, is resting metabolic rate (RMR).

Metabolic Acidosis

Metabolic acidosis is a condition that occurs when the body produces excessive quantities of acid or when the kidneys are not removing enough acid from the body. If unchecked, metabolic acidosis leads to acidemia, i.e., blood pH is low (less than 7.35) due to increased production of hydrogen ions by the body or the inability of the body to form bicarbonate (HCO3−) in the kidney. Its causes are diverse, and its consequences can be serious, including coma and death. Together with respiratory acidosis, it is one of the two general causes of acidemia. Terminology : Acidosis refers to a process that causes a low pH in blood and tissues. Acidemia refers specifically to a low pH in the blood. In most cases, acidosis occurs first for reasons explained below. Free hydrogen ions then diffuse into the blood, lowering the pH. Arterial blood gas analysis detects acidemia (pH lower than 7.35). When acidemia is present, acidosis is presumed. Signs and symptoms[edit] Symptoms are not specific, and diagnosis can be difficult unless the patient presents with clear indications for arterial blood gas sampling. Symptoms may include chest pain, palpitations, headache, altered mental status such as sev Continue reading >>

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  1. khewell

    Keytones??

    Every once in a while ( about once or twice a week) I get a metallic / onion taste in my mouth. Could this be from Keytones?
    And
    Exactly what does keytones mean and why do most diabetics get them?

  2. KTCwyo

    First, it is ketone not keytone.
    Ketones produce a fruity smell when they are very high. If you have ever been around someone who has drank a LOT of alcohol they small like ketones the next day. Acetone, like what you buy at the store or in fingernail polish remover, is a common ketone.
    Ketones are produced in T1 diabetics when they enter what is called ketoacidosis. This is very dangerous. T2 diabetics don't suffer from ketoacidosis nearly as much. I once had glucose values in the 400s and had a trace of ketones in my urine.
    People on low carb diets break down the fats into ketones and they can show up in their urine. In this group ketones is favorable -- it means that they are in a metabolic state that causes weight lose.
    I have had medications cause metallic tastes.

  3. ForEverYoung

    Originally Posted by khewell
    Every once in a while ( about once or twice a week) I get a metallic / onion taste in my mouth. Could this be from Keytones?
    And
    Exactly what does keytones mean and why do most diabetics get them? I'm just learning about ketones. I believe they start when your blood sugar gets so high that water starts EXITING from cells, and its so high that glucose can't get into your cells due to the dehydration properties of having high blood sugar. Ketones are one of the SHORT TERM dangers/effects of having high blood sugar.
    There is a thread here something along the lines of "feeling drunk?", you might want to read it.
    I'm no expert, but I have read that the mettalic taste is usually from Metformin, but I could be wrong.
    Hopefully others will chime in.
    Are you taking metforming?

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In this video I discuss what is metabolic rate, how to calculate metabolic rate, and how to calculate calories burned, and how many calories burned in a day. I also discuss basal metabolic rate, and resting metabolic rate. Transcript (partial with notes) In this video, I am going to show you the formula on how to calculate your calories burned in a day (metabolic rate). And give some examples. Lets start off with the term metabolic rate. In this video we are defining metabolic rate as the amount of calories you would burn off in a day (24 hours) while at rest. So, not moving around or being active. In the fitness community, There are 2 popular formulas to calculate this. BMR, basal metabolic rate, and RMR, resting metabolic rate. BMR is taken after 8 hours of sleep and 12 hours of fasting. RMR is taken under less restrictions, and has been shown to be statistically more accurate. Lets look at a couple of examples. Here we have kyle and Samantha, and their metrics are here. Kyle is 44 yrs old, is 58 tall, and weighs 160 pounds. Samantha is 33 yrs old, 54 tall, and weighs 126 pounds. The RMR equation for men is (4.55 x Weight in pounds) + (15.88 x Height in inches) - (5*age) + 5, for women the equation is (4.55 x Weight in pounds) + (15.88 x Height in inches) - (5*age) -161. When we plug in Kyles and Sams #s, we see that Kyles RMR is 1592.84 cal/day, and Sams is 1263.62 cal/day. So, after rounding up, this tells us that if Kyle and Sam were to sit around all day, they would need 1583 and 1264 calories per day to maintain their weights. We know that neither Kyle or Samantha are going to sit around all day. So there is a multiplication factor that we must use next. It is based on each of their lifestyles. The factor is as follows 1.200 = sedentary (little or no exercise) 1.375 = lightly active (light exercise/sports 1-3 days/week, approx. 590 Cal/day) 1.550 = moderately active (moderate exercise/sports 3-5 days/week, approx. 870 Cal/day) 1.725 = very active (hard exercise/sports 6-7 days a week, approx. 1150 Cal/day) 1.900 = extra active (very hard exercise/sports and physical job, approx. 1580 Cal/day) Lets say Kyle is very sedentary, so if we multiply his RMR by 1.2 we have .1911.6 cal/day. Now, Samantha is in the very active category, so we need to multiply her RMR by 1.725, and we get2180.4 cal/day . So, based on these calculations Kyle can consume 1912 calories per day to maintain his current weight, and Samantha can consume 2180 calories per day to maintain her weight. Now, You can use the RMR equation and lifestyle multiplication factor to calculate your baseline. Drawbacks A few of things I need to mention. First, this and any other formula used to calculate your metabolic rate is just an estimate. There is a margin for error. Second, muscle mass is very important. Lets look at Kyle, and Jack, who both weigh the same. However, Jack has much more muscle mass than K, since muscle burns more calories than fat, J will have a higher metabolic rate. Third, the type of diet ( for example consuming whole vs processed foods) is not factored either. Bottom Line I dont believe that counting calories is a path to successfully sustaining weight loss in the long run. However, Using the RMR formula and the lifestyle multiplication factor is extremely helpful in increasing your awareness to how many calories you need to consume per day. Which In turn can lead to a higher awareness of how quickly calories you consume add up. Other sources... http://www.scientificpsychic.com/heal... http://www.ncbi.nlm.nih.gov/pubmed/15...

Metabolic Acidosis Treatment & Management

Approach Considerations Treatment of acute metabolic acidosis by alkali therapy is usually indicated to raise and maintain the plasma pH to greater than 7.20. In the following two circumstances this is particularly important. When the serum pH is below 7.20, a continued fall in the serum HCO3- level may result in a significant drop in pH. This is especially true when the PCO2 is close to the lower limit of compensation, which in an otherwise healthy young individual is approximately 15 mm Hg. With increasing age and other complicating illnesses, the limit of compensation is likely to be less. A further small drop in HCO3- at this point thus is not matched by a corresponding fall in PaCO2, and rapid decompensation can occur. For example, in a patient with metabolic acidosis with a serum HCO3- level of 9 mEq/L and a maximally compensated PCO2 of 20 mm Hg, a drop in the serum HCO3- level to 7 mEq/L results in a change in pH from 7.28 to 7.16. A second situation in which HCO3- correction should be considered is in well-compensated metabolic acidosis with impending respiratory failure. As metabolic acidosis continues in some patients, the increased ventilatory drive to lower the PaCO2 m Continue reading >>

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  1. LadyBugs

    Hi all,
    I guess when I first posted this I should have followed my original plan of counting 99 carbs and not go under. I read from some here that 99 was too much so I lowered my count to 40-60 carbs a day. It only took me 6 weeks to lose 20 lbs but I just got out of hospital because my blood pressure was plummeting to 80's over 40's and I was so weak and dizzy I could not even do anything. Dr said I had protein in my urine and it most likely was from not eating enough carbs which were over taxing my kidneys. Now I have to go to a kidney specialist. Please everyone be careful because some of us should not be on low carb diet to the point it can damage our kidneys. And who can tell who this will happen to until it does. I will definitely make sure my daily carb count is now over 100 carbs. Actually whatever my Dr says this time around. Scared me to death!!! Everyone just be careful !!!! Ask your Dr first I learned the hard way how important that is.
    Laura

  2. Bobi-p

    I never had any problems with protein in my urine from LC eating, I think that there might be another reason for your misfortune.

  3. LadyBugs

    Please Bobi I went to a reputable Dr and I trust his expertise . Be careful about the advice given. Not you in particular just all of should remember we are not Drs. I am convinced he knows his stuff. Regardless I intend to listen to him as he has not failed in being thorough and correct in diagnosing me for 30 some years and knows my medical history more than anyone I know. But thanx for trying.

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