Metabolic Acidosis In Sepsis 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.

Relationship Between Oxygen Demand And Oxygen Supply In Severe Sepsis

Relationship Between Oxygen Demand and Oxygen Supply in Severe Sepsis Severe sepsis is characterized by an increase in oxygen demand, which is related to the inflammatory response to severe infection or other types of serious injury. This inflammatory process is simultaneously responsible for the peripheral alterations associated with sepsis. The pathophysiology of the alterations in systemic oxygen extraction is complex and can include: (a) microvascular obstruction by the activated cellular elements, (b) the release of various circulating mediators, and (c) alterations in endothelial cells resulting in a reduction in arteriolar tone, an abnormal distribution of blood flow, and the formation of peripheral edema that may compress the microvasculature and increase the diffusion gradient for oxygen from the capillaries to the mitochondria. Septic ShockSevere SepsisLactic AcidosisTissue HypoxiaAdult Respiratory Distress Syndrome These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves. This is a preview of subscription content, log in to check access Unable to display preview. Download Continue reading >>

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  1. Raviv

    I'd take it with a grain of salt.
    Yes, exercising too much can raise your cortisol and cause your body to cling to its fat stores for dear life.
    But I'm not sure I'd say 10,000 steps a day would be considered excessive. It's really close to what someone who is is naturally active would do.
    So they have the right theory - "chronic cardio" stalls weight loss - but I don't think it applies in this situation.
    FitBit One
    "You should really wear a helmet."
    5K 9/2015 - 36:59.57

  2. HeatherRayne

    Thank you for your reply!
    That sparks another question for me. I have to walk on the treadmill at least 90 mins at 3-3.5mph (this is just where my endurance is at this point...was MUCH lower only a couple of months ago) in order to get to 10k...this includes daily activities around the house/grocery store, etc. I know I get frustrated because I am not where I was before surgery or where most people I know are...but this seems like A LOT of walking for a mere 10k. It seems in the past week or so it has gotten to where I have to work harder for the same amount of steps. I don't get it. Nothing has changed.

  3. HeatherRayne

    As an example - yesterday I went grocery shopping and to physical therapy. Also did several loads of laundry (up and down a flight of stairs). This was on top of 105 mins on the treadmill. I only logged 10,380 steps. Very frustrating.

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Sepsis can be a dangerous complication of almost any type of infection, including influenza, pneumonia and E. coli; urinary tract infections; bloodstream infections from wounds; and abdominal infections. Steve Peters, M.D., a pulmonary and critical care physician at Mayo Clinic in Rochester, Minn., explains sepsis symptoms and risk factors, the difference between severe sepsis and septic shock, and how sepsis is typically treated. For more information, see the Mayo Clinic News Network.

Week 4 - Pathophysiology Of Sepsis, Shock

What defines sepsis (something + something)? infection + systemic inflammatory response (SIRS) temperature > 38 C or <36 C, HR > 90 bpm, respirations > 20/min, WBC count >12,000/mm3 or <4000/mm or >10% immature neutrophils sepsis with >1 sign of organ failure - respiratory, hepatic, hematologic, CNS, metabolic acidosis What are the signs of neurologic organ failure? altered consciousness, confusion, psychosis What are the signs of respiratory organ failure? tachypnea, PaO2 <70 mmHg, SaO2 <90%, PaO2/FiO2 < 300 What are the signs of hepatic organ failure? jaundice, increased enzymes, decreased albumin, increased PT What are the signs of cardiovascular organ failure? tachycardia, hypotension, altered CVP, altered PAOP What are the signs of renal organ failure? What are the signs of coagulation (organ) failure? decreased platelets, increased PT/APTT, decreased protein C, increased D dimer sepsis with signs of end organ profusion deficiency: MAP < 65 mmHg or lactate > 4 mmol/L Is severe sepsis increasing or decreasing in incidence? Why is the incidence of sepsis increasing? aging population, increased use of immunomodulating therapy, longer survival in cancer patients, increased transp Continue reading >>

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  1. kryptomancer

    Experienced fasters: How long does it take you to reach ketosis?

    It seems that it takes about 3 days for the average person to get into a state of ketosis when fasting.
    For those of you who are veterans of fasting, especially longer fasts (5+ days), how long does it take you to get into ketosis?
    I'm curious about this due to this guy going into ketosis in only 2 days on his second 5 day fast. Was wondering if it was due to the avocado or his body just adapting faster.

  2. Glarsie

    You should be in ketosis once your liver glycogen stores are depleted. In a fast this should occur in 24-48hrs after your last meal and will be influenced by your insulin sensitivity (which affects you basal insulin level) and the amount of glycogen in your liver (ie what you ate leading up to the fast). It's entirely possible (some would argue desirable) to be in ketosis before fasting. Nutritional ketosis generally starts when you have a betahydroxybuterate level greater than .5 mmol/L which can't be accurately measured through urine ketostix which only show excreted acetoacetate (not blood concentrations of BHB). You can turn those keto sticks dark purple just by restricting fluid intake and becoming slightly dehydrated or equally make them not register by drinking half a gallon of water.
    Ketosis is brought on by a lack of carbohydrates/insulin and not by the presence of fat.
    Eat under 20g of net carbs per day (don't count fibre) for 3 days and you will be in ketosis. You will probably be in ketosis sooner, but 3 days is pretty true for everyone.
    Remember that as you produce ketones you will start to use them as well as free fatty acids for fuel (less is excreted in urine and blood levels don't increase indefinitely). In the end ketones will be used primarily for your brain and other tissues not able to use FFA while glucose will be reserved for cells that can only use glucose (eg red blood cells and some parts of the brain). The breakdown of triglycerides into FFAs also releases glycerol that is converted into glucose to supply the now reduced demand for glucose. This doesn't happen as soon as you produce ketones but over a few days as your levels increase.
    Edit: nutritional ketosis defined as starting at .5 rather than .3 mmol/l

  3. kryptomancer

    this should occur in 24-48hrs after your last meal
    Actually in the link I posted it took 3 days initially for the guy to go into ketosis, then on the second time through it only took him 2. I'm very interested in to why this was as I am planning on doing a series of longer fasts and want to make it as easy as possible.
    and will be influenced by your insulin sensitivity
    So perhaps the reason why the 2nd fast was quicker to get into ketosis with due to increased insulin sensitivity from his initial fast?
    and the amount of glycogen in your liver (ie what you ate leading up to the fast).
    This is my current plan: eat under 20g carbs for two days, start water fasting on the third and lifting heavy squats and dead lifts; then taking apple cider vinegar before bed.

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Measuring a serum lactate is crucial in the early recognition and ongoing management of a patient with suspected sepsis. This video defines normal and abnormal lactate levels and provides an overview of the management of a raised serum lactate in patients with sepsis- one of the leading causes of death in hospitals worldwide.

Understanding Lactate In Sepsis & Using It To Our Advantage

You are here: Home / PULMCrit / Understanding lactate in sepsis & Using it to our advantage Understanding lactate in sepsis & Using it to our advantage Once upon a time a 60-year-old man was transferred from the oncology ward to the ICU for treatment of neutropenic septic shock. Over the course of the morning he started rigoring and dropped his blood pressure from 140/70 to 70/40 within a few hours, refractory to four liters of crystalloid. In the ICU his blood pressure didn't improve with vasopressin and norepinephrine titrated to 40 mcg/min. His MAP remained in the high 40s, he was mottled up to the knees, and he wasn't making any urine. Echocardiography suggested a moderately reduced left ventricle ejection fraction, not terrible but perhaps inadequate for his current condition. Dobutamine has usually been our choice of inotrope in septic shock. However, this patient was so unstable that we chose epinephrine instead. On an epinephrine infusion titrated to 10 mcg/min his blood pressure improved immediately, his mottling disappeared, and he started having excellent urine output. However, his lactate level began to rise. He was improving clinically, so we suspected that the lactat Continue reading >>

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  1. fatklr

    I have noticed a few people (myself included) wondering how drinking Bacardi and Diet Pepsi (w/Splenda) would affect being in ketosis. Can anyone out there give me any information on this? I know alcohol is not permitted during induction, but bacardi and diet coke/pepsi is supposed to have 0 carbs. My question is...why wouldn't clear spirits be permitted if they don't have any carbs?

  2. readyfreddy

    A few thoughts:
    1 if you have your bacardi with a diet coke it will be 1 carb, not 0 as you count each diet coke (package of splenda etc) as 1 carb.
    There is no drinking on induction for a number of reasons:
    1. Your body burns alcohol for fuel first. So if you are in ketosis and burning fat (the goal) but you drink, you will stop burning fat until you have burned off all the alcohol.
    2. Alcohol messes with some people's blood sugar, leading to sugar/off plan food cravings after drinking.
    3. Alcohol lowers your inhibitions and makes you more likely to cheat.
    That said, I drink occasionally while on induction but make sure I count it in my carbs. (Ie 5 oz dry white wine = 3, vodka/bacardi silver with soda water = 0)
    You can try it out and see how it makes you feel!

  3. sandyfanny

    Although most alcohols (rum, vodka, gin, etc.) have 0 carbs, they are eventually metabolized as sugar...or at least that's the way I understand it. For most of us, they don't help us lose weight on Induction.

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