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Metabolic Acidosis In Patients With Sepsis: Epiphenomenon Or Part Of The Pathophysiology?

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In this video we discuss the progression of a systemic infection including systemic inflammatory response syndrome, sepsis, severe sepsis, septic shock and multi organ dysfunction syndrome.

Hypomagnesemia In Critically Ill Sepsis Patients | Velissaris | Journal Of Clinical Medicine Research

Journal of Clinical Medicine Research, ISSN 1918-3003 print, 1918-3011 online, Open Access Article copyright, the authors; Journal compilation copyright, J Clin Med Res and Elmer Press Inc Volume 7, Number 12, December 2015, pages 911-918 Hypomagnesemia in Critically Ill Sepsis Patients Dimitrios Velissarisa, Vassilios Karamouzosa, Charalampos Pierrakosb, Diamanto Arethac, Menelaos Karanikolasd, e aInternal Medicine Department, University Hospital of Patras, Rion 26500, Greece bIntensive Care Department, Brugmann University Hospital, Brussels 1030, Belgium cDepartment of Anesthesiology, Pyrgos General Hospital, Pyrgos, Greece dDepartment of Anesthesiology, Washington University School of Medicine, St. Louis, MO, USA eCorresponding Author: Menelaos Karanikolas, Department of Anesthesiology, Washington University School of Medicine, St. Louis, MO, USA Manuscript accepted for publication October 01, 2015 Short title: Hypomagnesemia in Critical Illness doi: Magnesium (Mg), also known as the forgotten electrolyte, is the fourth most abundant cation overall and the second most abundant intracellular cation in the body. Mg deficiency has been implicated in the pathophysiology of many dis Continue reading >>

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Popular Questions

  1. DTinLA

    So I've been researching ketosis today and how it relates to the HCG Diet, and I came across this article. It only talks briefly about the connection, but what I found of most importance are the symptoms of entering into ketosis - pretty much those things we on the diet complain about in the first week.
    Anyway, just thought I'd pass it along. I found it helpful AND encouraging to know that while the first 7 days of VLCD can be brutal for some, it's a sign that our bodies are entering into...FAT BURNING!! lol
    HCG Diet & Ketosis: What's the Connection?
    You have probably heard the term "Ketosis" thrown around a lot lately but few really know what it is or why you might want to be "in Ketosis". Quite simply Ketosis is a process where our body begins burning fat for energy. Ketones (ketone bodies) are molecules created during the fat burning process that our body then uses for energy in place of glucose from the carbohydrates in our diet.
    So if a person changes their diet from a normal American high glycemic diet (High Carb & High Sugar diet) to a diet that does not replenish the bodies glycogen stores, the body goes begin to enter ketosis. It can take about 48hrs for the body to make the switch from glucose to ketones which is why the first few days of low carb, low glycemic diets can be somewhat challenging.
    Some ketones (acetoacetate and ß-hydroxybutyrate) are used for energy in the body with some organs notably the heart and kidneys actually prefering ketones to glucose. However one type of ketone molecule, called acetone, is not used by the body and is excreted in the urine and breath (which can sometimes cause a breath odor). The acetone that is excreted in the urine can be detected using a test strips commonly called by the brand name Ketostix. Available at most drugstore these test strips can be used to test if your body has entered into a state of Ketosis. Keeping track while dieting can be very helpful and can be a great source of encouragement.
    Why have I heard that Ketosis is a bad thing?
    There has been a great deal of misinformation over the years about the levels of glucose required by the body. This has led to concerns that those on low carb diets or so called Ketogenic Diets are in danger of not having enough glucose in their bodies. However, there is quite simply too much medical, dietary, and anthropological evidence that people on reduced carbohydrates diets are not negatively impacted by the lack of high glucose levels and in many ways even benefit from it. As such it is hard to accept the glucose level concerns as valid.
    It is interesting that our bodies can't break fat down into glucose but they can convert some of the protein we eat into glucose. It does so with out causing sudden fluctuations in blood glucose levels.
    What does this mean for the HCG Diet?
    The HCG Diet is classified as a Ketogenic Diet due to its strict dietary restrictions that cuts out virtually all carbohydrates.
    What can I expect from being "in Ketosis"?
    Weight Loss, to put it simply. However during the first 2-5 days you may experience some bothersome ketosis symptoms such as:
    - Tiredness or fatigue
    - Leg Cramps
    - Headache
    - Feeling thirsty all the time
    - Bad breath
    - Metallic taste in the mouth
    - Weakness
    - Dizziness
    - Nausea or stomach ache
    - Sleep problems
    However, you can do things to help lessen the symptoms:
    1. DRINK LOTS AND LOTS OF WATER!!! Since excess Ketones are flushed out through the urine the more you urinate the less Ketones are built up in your blood. This in turn with trigger your body to burn more fat to make more Ketones and thus result in more weight loss. So the put it crudely "The more you Pee the more weight you Lose!"
    2. Snack Regularly and spread out your meals though the day.
    3. Take a quality Multi Vitamin Supplement and Mineral Supplement daily.
    Read more: http://www.articlesbase.com/weight-l...#ixzz10aGOGbGQ
    Under Creative Commons License: Attribution

  2. RoseyPosey

    Thanks DT!!! First time I have read something like that. They should change the bad breath thing though. It should just say you will become a fire breathing dragon. Lol.

  3. grammy1952

    Not everyone hits ketosis in the protocol. I don't. Ketosis really has nothing to do with the hcg diet. It still works whether you are in ketosis or not.

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The patient at risk and resuscitation team (PAART) at the Royal Free are celebrating both the success of an app they have developed to help fight the disease and being awarded for a national Nursing Times award. The following film demonstrates the six interventions for patients who are suffering severe sepsis. The steps are patient receives oxygen, intravenous antibiotics and fluid resuscitation, have blood cultures taken and fluid balance and blood lactate measured. The number one aim of our staff is to provide world class care to every patient, every day. However the trust has recognised that sepsis is sometimes hard to diagnose and the six medical interventions need to be delivered quickly, in a high pressure environment -- that is why a tool such as the app is a valuable bedside aid.

Metabolic Acidosis In Patients With Sepsis: Epiphenomenon Or Part Of The Pathophysiology?

Metabolic acidosis in patients with sepsis: epiphenomenon or part of the pathophysiology? Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA 1526, USA. To review the mechanisms of metabolic acidosis in sepsis. Articles and published reviews on metabolic acidosis in sepsis. Sepsis affects millions of patients each year and efforts to limit mortality have been limited. It is associated with many features one of which is acidosis which may be a result of the underlying pathophysiology (e.g. respiratory failure, shock, renal failure) or may also result from the way in which we manage critically ill patients. Lactic acidosis identifies septic patients at risk and aggressive fluid resuscitation (along with inotropes and blood in some patients) to reverse acidosis and improve venous oxygen saturation will improve mortality. However, most patients with severe sepsis or septic shock receive 0.9% saline and therefore may develop hyperchloraemic acidosis as a consequence of their resuscitation. Therefore alterations in acid-base balance are almost always in the background in the management of patients with sepsis. What is unknown is whether acid Continue reading >>

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  1. manohman

    Why can't fat be converted into Glucose?

    So the reason cited is that beta oxidation/metabolism of fats leads to formation of acetyl coa, a 2 carbon molecule, and that because of that it cannot be converted back into glucose.
    Why exactly is that the case?
    If Glucogenic amino acids can be converted into citric acid cycle intermediates and then turn back into glucose via gluconeogensis, then why cant Fatty Acids which yield Acetyl Coa. Can't you just have Acetyl Coa enter the citric acid cycle and produce the same intermediates that the glucogenic amino acids creat?

  2. Czarcasm

    manohman said: ↑
    So the reason cited is that beta oxidation/metabolism of fats leads to formation of acetyl coa, a 2 carbon molecule, and that because of that it cannot be converted back into glucose.
    Why exactly is that the case?
    If Glucogenic amino acids can be converted into citric acid cycle intermediates and then turn back into glucose via gluconeogensis, then why cant Fatty Acids which yield Acetyl Coa. Can't you just have Acetyl Coa enter the citric acid cycle and produce the same intermediates that the glucogenic amino acids creat?
    Click to expand... Both glucose and fatty acids can be stored in the body as either glycogen for glucose (stored mainly in the liver or skeletal cells) or for FA's, as triacylglycerides (stored in adipose cells). We cannot store excess protein. It's either used to make other proteins, or flushed out of the body if in excess; that's generally the case but we try to make use of some of that energy instead of throwing it all away.
    When a person is deprived of nutrition for a period of time and glycogen stores are depleted, the body will immediately seek out alternative energy sources. Fats (stored for use) are the first priority over protein (which requires the breakdown of tissues such as muscle). We can mobilize these FA's to the liver and convert them to Acetyl-CoA to be used in the TCA cycle and generate much needed energy. On the contrary, when a person eats in excess (a fatty meal high in protein), it's more efficient to store fatty acids as TAG's over glycogen simply because glycogen is extremely hydrophilic and attracts excess water weight; fatty acids are largely stored anhydrously and so you essentially get more bang for your buck. This is evolutionary significant and why birds are able to stay light weight but fly for periods at a time, or why bears are able to hibernate for months at a time. Proteins on the other hand may be used anabolically to build up active tissues (such as when your working out those muscles), unless you live a sedentary lifestyle (less anabolism and therefore, less use of the proteins). As part of the excretion process, protein must be broken down to urea to avoid toxic ammonia and in doing so, the Liver can extract some of that usable energy for storage as glycogen.
    Also, it is worth noting that it is indeed possible to convert FA's to glucose but the pathway can be a little complex and so in terms of energy storage, is not very efficient. The process involves converting Acetyl-CoA to Acetone (transported out of mitochondria to cytosol) where it's converted to Pyruvate which can then be used in the Gluconeogenesis pathway to make Glucose and eventually stored as Glycogen. Have a look for yourself if your interested: http://www.ploscompbiol.org/article/info:doi/10.1371/journal.pcbi.1002116.g003/originalimage (and this excludes the whole glycogenesis pathway, which hasn't even begun yet).
    TLDR: it's because proteins have no ability to be stored in the body, but we can convert them to glycogen for storage during the breakdown process for excretion. Also, in terms of energy, it's a more efficient process than converting FA's to glycogen for storage.

  3. soccerman93

    This is where biochem comes in handy. Czarcasm gives a really good in depth answer, but a simpler approach is to count carbons. The first step of gluconeogenesis(formation of glucose) requires pyruvate, a 3 carbon molecule. Acetyl Co-A is a 2 carbon molecule, and most animals lack the enzymes (malate synthase and isocitrate lyase) required to convert acetyl co-A into a 3 carbon molecule suitable for the gluconeogenesis pathway. The ketogenic pathway is not efficient, as czarcasm pointed out. While acetyl co-A can indeed be used to form citric acid intermediates, these intermediates will be used in forming ATP, not glucose. Fatty acid oxidation does not yield suitable amounts of pyruvate, which is required for gluconeogenesis. This is part of why losing weight is fairly difficult for those that are overweight, we can't efficiently directly convert fat to glucose, which we need a fairly constant supply of. Sorry, that got a little long-winded

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Temporal Trends In Acute Renal Dysfunction Among Critically Ill Patients According To I/d And -262a > T Ace Polymorphisms

Multiple organ failure syndrome and acute renal dysfunction share many of physiologic factors involved in their development. Recent studies correlate the susceptibility to organ dysfunction in critically ill patients with genetic inheritance. Many of them consider ACE gene could be a possible candidate to elucidate a genetic predisposition or a genetic risk factor. We aimed to examine the effects of I/D and -262A > T ACE polymorphisms in the renal function in severely ill southern Brazilians patients. A multi-organic worldwide known failure score, the SOFA (sequential organ failure assessment), was used to determine the basal health state at first day (ICU admission). Considering admission SOFA score and trend of renal function (measured by daily renal SOFA scores, with daily measure of serum creatinine and diuresis), we hypothesize that ACE polymorphisms could influence in the trend of renal function in ICU patients. A total of 153 critically ill adult patients (79 men) were included in this study. We monitored the patients daily during their entire ICU and post-ICU (hospital) stay (measured from the ICU admission day to a maximum of 224 days). We observed progression to renal fa Continue reading >>

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Popular Questions

  1. MisterKudo

    I've been in ketosis for 3 months and just got a head cold. Should I stay in ketosis? What is the best and tastes way to kick this cold? Thanks!

  2. anbeav

    The cold will resolve on its own. Keto is a way of eating, I don't view it as something I choose to ditch or not everyday. Just like a vegetarian doesn't start eating meat when sick, I would start to think of keto as something you don't just ditch. Just curious, what would be the benefit of going out of ketosis? Anyway, drink fluids to stay hydrated, rest and get your nutrition- soups, mashed cauliflower, mashed avocado. Feel better.

  3. MisterKudo

    Not sure how it would benefit of not which is why I ask. I struggle with the decision to stay in ketosis or not. I just love some foods so much.

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