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Metabolic Acidosis Compensation Formula

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Paediatric Acid-base Disorders: A Case-based Review Of Procedures And Pitfalls

Paediatric acid-base disorders: A case-based review of procedures and pitfalls J Bryan Carmody , MD and Victoria F Norwood , MD Department of Pediatrics, Division of Pediatric Nephrology, University of Virginia, Charlottesville, Virginia, USA Correspondence: Dr J Bryan Carmody, Department of Pediatrics, Division of Pediatric Neprhology, University of Virginia, PO Box 800386, Charlottesville, Virginia 22903, USA. Telephone 434-924-2096, e-mail [email protected] , [email protected] Copyright 2013 Pulsus Group Inc. All rights reserved Acid-base disorders occur frequently in paediatric patients. Despite the perception that their analysis is complex and difficult, a straightforward set of rules is sufficient to interpret even the most complex disorders provided certain pitfalls are avoided. Using a case-based approach, the present article reviews the fundamental concepts of acid-base analysis and highlights common mistakes and oversights. Specific topics include the proper identification of the primary disorder; distinguishing compensatory changes from additional primary disorders; use of the albumin-corrected anion gap to generate a differential diagnosis for patients Continue reading >>

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  1. Injecto

    I can't seem to find anything that backs this up. I know that high BG will damage them over time (duh!!), but what about ketones?

  2. fgummett

    Ketone bodies are water-soluble compounds that are produced as by-products when fatty acids are broken down for energy. They are a vital source of energy during fasting -- such as overnight.
    The brain gets its energy from ketone bodies when insufficient glucose is available. In the event of low blood glucose, most other tissues have additional energy sources besides ketone bodies (such as fatty acids), but the brain does not.
    Remember that when you are not fasting, the body can use Amino Acids (from dietary Protein) to synthesize Glucose (Gluconeogenesis).
    Any production of Ketones is called ketogenesis, and this is necessary in small amounts. When even larger amounts of ketone bodies accumulate such that the blood's pH is lowered to dangerously acidic levels, this state is called ketoacidosis. This happens in untreated Type I diabetes (DKA).
    In short, the human body has evolved over the millennia to burn either Glucose or Fatty Acids -- think of these as the short-term fuel and longer-term reserve, respectively.
    So if it is normal to burn Fatty Acids and produce Ketones why would they be harmful unless they accumulate to dangerous levels? Yes I know... we always get the "dangerous levels" lecture but consider that BG can be toxic at high enough levels... that does not mean it is bad for us at any level

  3. REDLAN

    can we get the production of ketones correct??
    The primary cause of ketogenesis in the body is.....
    gluconeogenesis from dietary protein, when there is insufficient dietary glucose to fill the body needs, aka the ketogenic diet.
    The process of gluconeogenesis utilises a key component of the citric acid cycle (oxaloacetate), which blocks the oxidation of Acetyl CoA. Fatty acid (and glucose oxidation) require their conversion to Acetyl CoA. It is Acetyl CoA which is converted to ketone bodies and this process occurs pretty exclusively in the liver (also happens in the kidney)
    Normally oxidation of fatty acids does NOT produce ketone bodies, even during fasting overnight, as usually there are more than sufficient stores of glycogen.
    - starvation is an entirely different matter. Fasting for longer than a day or so can be sufficient for ketogenesis to start.
    Astrocytes in the brain can produce ketone bodies in response to hypoglycemia, but this will not provide adequate protection in the event of hypoglycemia caused by insulin overdose.
    The simple reason why ketogenesis as caused by a ketogenic diet is probably safe is because ketones only transiently rise in response to food, and the levels sustained should not be sufficient to disturb the body's buffer system.
    if however you spent long periods without food, or lacking insulin then that is a very different matter.
    I can't find anything definitive about ketones and kidney function - the only thing of note is an association with kidney stones for children on ketogenic diets to control epilepsy - but this could be due to the components of the diet (high protein) rather than ketones. There are no long term safety studies on ketogenic diets, but they are though to be safe (probably).
    Those on this forum on low carbohydrate diets 50g to 120g of carbs probably do not experience ketogenesis to any significant degree. Significant ketogenesis only occurs at <30g.

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this will be a series of lectures to illustrate in simple and precise way how you can manage acid-base imbalance in practical step by step approach.

Additional Step In Abg Analysis

Michelle Kirschner , RN, MSN, APRN, CNP, CCRN The article Assessing Tissue Oxygenation (June 2002:2240) contains a comprehensive overview of arterial blood gas analysis, which will prove to be a valuable resource for nurses and other healthcare professionals in the intensive care environment. The steps outlined are useful in determining an acid-base imbalance involving either the metabolic or respiratory systems and the effectiveness of attempted compensation. However, severely ill patients who develop multiple organ failure frequently present with several acid-base abnormalities occurring simultaneously. Therefore, I routinely add an additional step in the analysis of arterial blood gases to determine if another primary acid-base process is present. The purpose of the additional step is to determine the expected compensation for the primary disorder. If the actual compensation falls within the calculated range, then a second disorder does not coexist. If the calculated value does not match the measured value, then a mixed disorder is present or compensation has not had time to occur. The expected compensation is calculated by using one of 4 formulas based on the primary process: Continue reading >>

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  1. coreycorndog

    I posted to r/askscience for the hell of it but really this answer is all I needed.

  2. tinkan

    I think it's a pretty straight-forward yes. There is no other energy source other than stored fat and metabolic processes are conserved amongst all animals. The bear must rely on metabolizing the fat stores and that will involve ketosis (the brain likes ketones, it doesn't/can't use FFA - this is why people say the brain prefers glucose but it's really a misnomer. There are no lipid stores in the brain and free fatty acids are not soluble enough in the blood nor are they going to be able to cross the blood brain barrier. This physical barrier means brain cells can not rely on FFA for energy. Thus, FFA are converted in a more blood soluble fat energy molecule, the ketone. In short, the brain does not "require" glucose to function. It just needs time to adapt to ketone usage.)
    Just be forewarned AskScience harbors some anti-keto sentiments that we know to be false (such as loving to bring up the ketoacidosis reason or kidney troubles). But they would probably give you a better answer than us.

  3. Sporkfortuna

    IIRC, Bear recycles his urine during the long winter months.
    "Stuck in a cave, better..."

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Intro To Arterial Blood Gases, Part 2

Arterial Blood Gas Analysis, Part 2 Introduction Acute vs. Chronic Respiratory Disturbances Primary Metabolic Disturbances Anion Gap Mixed Disorders Compensatory Mechanisms Steps in ABG Analysis, Part II Summary Compensatory Mechanisms Compensation refers to the body's natural mechanisms of counteracting a primary acid-base disorder in an attempt to maintain homeostasis. As you learned in Acute vs. Chronic Respiratory Disturbances, the kidneys can compensate for chronic respiratory disorders by either holding on to or dumping bicarbonate. With Chronic respiratory acidosis: Chronic respiratory alkalosis: the kidneys hold on to bicarbonate the kidneys dump bicarbonate With primary metabolic disturbances, the respiratory system compensates for the acid-base disorder. The lungs can either blow off excess acid (via CO2) to compensate for metabolic acidosis, or to a lesser extent, hold on to acid (via CO2) to compensate for metabolic alkalosis. With Metabolic acidosis: Metabolic alkalosis: ventilation increases to blow off CO2 ventilation decreases to hold on to CO2 The body's response to metabolic acidosis is predictable. With metabolic acidosis, respiration will increase to blow off CO Continue reading >>

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  1. tereolivia

    Should my heart palpitations worry me?

    I was recently diagnosed with diabetes type 2. I've been dealing with heart palpitations for years. I took tests (as a teen) and my heart came out normal. They told me not to worry about it. This past year I developed a cough when I laugh or overexert myself. The cough has gone away within two weeks of exercise. But I still feel breathless at times. But oddly enough I only feel breathless when I become aware of my breathing. I've had dizzy spells, but nothing major. I don't know if it's anxiety.
    My mother passed away from cancer last year and we rushed her to the hospital because she couldn't breathe. I'm now afraid of not being able to breathe.
    I asked my doctor to do a heart test and he said he'd do one when I go back in a month to check how stable my sugar has been.
    Edit: fixed autocorrect errors

  2. furball64801

    Since were not heart docs maybe schedule with a specialist I have had that off an on for50 yrs and passed all tests.

  3. AnnieP

    Definitely check with the doctor. Heart palpitations can be caused by all sorts of things, some bad, some neutral. Best to get it checked out and know for sure.

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