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Metabolic Acidosis Causes

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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. hmb13

    I'm on Day 7 and feeling like crap. I've had a blazing headache pretty much continuous since Day 2. At first I thought it was due to the caffeine withdrawal, but now that I'm on Day 7, it can't possibly be that. In addition, my head just feels like it's in a fog -- I can't concentrate or focus very well, my energy levels are incredibly low, my mouth feels like cotton and I'm drinking water constantly, and for the past couple days I've started to feel minor chest pains (like someone is squeezing my heart).
    My cousin, who is a nurse, warned me this cleanse might send me into ketosis, which can become acidosis, and both conditions are unhealthy and put stress on the liver. Can someone please explain? Are my symptoms a sign of ketosis or acidosis? I was doing the Whole30 to hopefully change my relationship with food (always an adversarial relationship before -- restriction mentality) and to cleanse my gut from inflammatory foods, but so far it's just making me feel terrible. I had probably a 75% compliant diet before starting Whole30, so this hasn't been a huge shift for me -- what I'm experiencing *isn't* just "carb flu".
    Here's what my typical meals have been:
    Breakfast
    -1 cup coffee (black)
    -2 eggs & 2-3 slices of bacon, or 1/2 sweet potato & 2-3 slices bacon, or 1 C. spaghetti squash w/1/3 c. browned ground pork & sauteed sweet peppers (for any of these, I would use 1/2 tsp. or so of coconut oil in the pan)
    -1/2 - 3/4 c. berries & bananas
    Lunch
    -Salad of mixed greens, assorted fresh veggies, 1/2 c. browned ground pork w/homemade balsamic vinagrette
    Afternoon snack
    -Handful of nuts, a piece of fruit, or fresh veggie slices
    **Sometimes I'm so ravenous by the time I get home, I have to have another snack of a hard-boiled egg the minute I walk in the door in order to have enough energy to cook dinner
    Dinner
    I've been cooking a lot of the meals from the WellFed book -- Moroccan Meatballs over spaghetti squash with cumin carrots on the side, or Salmon a l'Afrique du Nord with Brussels Sprouts. Last night I had grilled lamb & veggie kabobs.
    I've also been taking fermented cod liver oil supplements every day (I'm Vit D deficient).
    Can someone please help? Do I just need to stick it out a while longer, or am I doing something wrong? I'm becoming ineffective at work between this constant headache and the low energy levels. My cousin is begging me to at least eat gluten-free oats or white rice so I get some energy that is more easily available to my brain.
    Help before I give this up completely!

  2. Robin Strathdee

    First question: Do you exercise? If you do, there's no way your carb intake is enough to support your activity levels. If you don't, you could possibly be okay, but if you're used to a higher carb intake then your body is probably freaking out. I would suggest making sure you have a starchy carb at every meal and see if that helps your energy levels smooth out. The Whole30 is not intended to be a specifically low carb program, and from what I understand ketosis and ketoacidosis come from an extreme absence of carbohydrate in the diet (I'll check in with Melissa for confirmation).
    Second question: Could you be coming down with an illness? It's really common for all the changes in your body during a Whole30 to temporarily lower your defenses and make you a little more susceptible to nasty little bugs.
    I'm going to pass this question on to Melissa, too, in case she has anything to add.

  3. Emily

    I agree with your cousin that you need more carbs, but get them from sweet potatoes, spaghetti squash, acorn squash, butternut squash, pumpkin (I love this time of year) instead of grains. And hang in there- you are right in the toughest part.

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Acid/base Disorders: Metabolic Acidosis

Are there clinical practice guidelines to inform decision-making? Does this patient have metabolic acidosis? Metabolic acidosis is generally defined by the presence of a low serum bicarbonate concentration (normal range 22-28 mEq/L), although occasionally states can exist where the serum bicarbonate is normal with an elevated anion gap (e.g., patients with a lactic acidosis who have received a bicarbonate infusion or patients on hemodialysis). In general, a metabolic acidosis is associated with a low urine pH but depending on the presence or absence of a respiratory alkalosis, this may also be normal or elevated. Thus, a patient can have an acidosis but not be acidemic. Metabolic acidoses occur when there is excess acid in the plasma. In the basal state, the body generates about 12,000 to 13,000 mmol of carbon dioxide (CO2), and 1-1.5 mmol per kilogram body weight of nonvolatile acid. The body has a large buffering capacity, with CO2-HCO3 as the major buffer system. The two major routes of acid excretion are the lungs (for CO2) and the kidneys (for nonvolatile acids) A metabolic acidosis can be caused by three major mechanisms: 1) increased acid production; 2) bicarbonate loss; an Continue reading >>

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Popular Questions

  1. Laurie_CA

    Does it matter how soon after waking up...

    ...you should test your BGL?
    I'm wondering now if I should be testing myself sooner than I have been. Before my 10 year old started back to school last week, I was waking up later and not always testing myself the second I got up. Since I've been getting up earlier to help him get ready for school, I've been trying to make sure I test myself sometime before I leave to take him to school (within an hour's time). If I wait later, the numbers seem to be lower. Maybe I've been higher in the mornings than I realized because I haven't been testing right away when I get up?
    Also, sometimes, there is some anxiety getting my son to stay on task in the mornings or I'm worried about a homework assignment or test (he is in a GATE/Accelerated class and they are digging in with tons of homework, projects and tests already. UGH) and I've noticed that my numbers are higher on those days.
    I'm just confused now about how to accurately measure my morning levels. Help?

  2. Richard157

    Hi Laurie, I think you should test at the time you get up. If you are a little low then you can have a small snack to keep from going lower while you are rushing around helping your son get ready for school. Then you should test again at least 20 minutes before driving. If you are low then you need glucose tablets. They will work and raise your blood sugar in the 20 minutes before you drive your car. Make note of how many carbs you eat and when. Keep the records for comparison the next day(s).
    Good luck to you and your son!
    Richard

  3. Laurie_CA

    Thanks, Richard.
    I guess I should've been a bit more specific. When I say my levels are lower if I wait longer before I test in the morning, I meant that in a good way! I'm still trying to get my levels lowered as a relative newbie (diagnosed a little over a month ago as T2). Within the last two weeks I finally came down to a rough average of 131-128 in the a.m. So, I want it to go lower. But my main concern is that it may actually be HIGHER since I may wait to test.
    Is testing within a half hour after getting up too late? I just want to make sure I'm not kidding myself that they are in that range I mentioned and not higher.
    Again, thank you!

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Approach To The Adult With Metabolic Acidosis

INTRODUCTION On a typical Western diet, approximately 15,000 mmol of carbon dioxide (which can generate carbonic acid as it combines with water) and 50 to 100 mEq of nonvolatile acid (mostly sulfuric acid derived from the metabolism of sulfur-containing amino acids) are produced each day. Acid-base balance is maintained by pulmonary and renal excretion of carbon dioxide and nonvolatile acid, respectively. Renal excretion of acid involves the combination of hydrogen ions with urinary titratable acids, particularly phosphate (HPO42- + H+ —> H2PO4-), and ammonia to form ammonium (NH3 + H+ —> NH4+) [1]. The latter is the primary adaptive response since ammonia production from the metabolism of glutamine can be appropriately increased in response to an acid load [2]. Acid-base balance is usually assessed in terms of the bicarbonate-carbon dioxide buffer system: Dissolved CO2 + H2O <—> H2CO3 <—> HCO3- + H+ The ratio between these reactants can be expressed by the Henderson-Hasselbalch equation. By convention, the pKa of 6.10 is used when the dominator is the concentration of dissolved CO2, and this is proportional to the pCO2 (the actual concentration of the acid H2CO3 is very lo Continue reading >>

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  1. BACONBURGER

    From "Ketopia"
    First off, we need to understand what ketostix actually measure, and more importantly, what they don’t. Generally speaking, ketostix measure excess ketones in your urine. They are considered excess, because they are removed from your serum and shunted to your urine by your kidneys. Their caloric content is thereby wasted.
    Of the three types of ketones (acetate, acetoacetate, and beta-hydroxybutyrate) produced by your body, ketostix only measure acetoacetate. This is extremely important to understand, because it turns out that your body produces different quantities of these different types of ketones depending on how long you’ve been in ketosis. If you’ve been in ketosis for a while, you’re going to see a reduction in the “intensity” of what you register on your ketostix for two reasons:
    A change in the relative volume of the ketones produced/present in your body
    A reduction in the volume of ketones in your urine as your kidneys reduce the amount they secrete
    Don't TRY----DO!
    over 50 lbs lost, zeroing in on goal
    Zero Carb for Life!

    current weight: 178.5



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  2. MISSSVJS

    Actually my doctor told me the ketostix really aren't very accurate. The more accurate method of testing whether or not you are in ketosis is with a meter like this. storefront.novacares.com/sto
    refront/ They work like a glucose meter - in fact this one will also test glucose, but it will also test for ketosis. The only problem is that the strips are kind of expensive.

    December Minutes: 272



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  3. KARMEXO

    thank you all for the responses and info, I bought my strips at kroger for 15 dollars and I think there are 50 in the bottle.
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    current weight: 335.0



    375

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