Metabolic Acidosis Labs

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Educational video on methanol and ethylene glycol toxicity. Medical education. Not official statement of Albert Einstein College of Medicine or Maimonides Medical Center. Not meant as medical advice.

Ethylene Glycol Poisoning: A Rare But Life-threatening Cause Of Metabolic Acidosisa Single-centre Experience

Ethylene glycol poisoning: a rare but life-threatening cause of metabolic acidosisa single-centre experience Department of Internal Medicine, Division of Nephrology, Robert-Bosch Hospital, Stuttgart, Germany Author information Article notes Copyright and License information Disclaimer Received 2011 Sep 7; Accepted 2012 Jan 17. Copyright The Author 2012. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved. For permissions, please e-mail: [email protected] This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( ), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact [email protected] Intoxication with ethylene glycol happen all around the world and without rapid recognition and early treatment, mortality from this is high. In our study, we retrospectively analysed six cases of ethylene glycol intoxication in our department. We measured ethylene glycol or glycolate levels, lactate levels and calculated the osmolal and anion gap. Data from six patients admitted Continue reading >>

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  1. Praxis

    Everything you know about nutrition is wrong.

    This is me after one month of a high-fat, low-carb diet, consisting of very large amounts of bacon.
    Mostly ate eggs for breakfast every morning, then my lunches and dinners consisted of meat, cheese, and lots of veggies. And veggies fried in bacon fat. Sometimes I made bacon omlettes fried in bacon fat wrapped around cheese and veggies. Mmmm.
    I did not calorie count.
    Things I ate:
    Pork/onions/cilantro/hot sauce/sour cream wrapped in fried cheese:
    Bacon/green pepper/onion/cheese/hot sauce/sour cream frittata (fried omelette):
    Bacon wrapped jalapeno poppers:
    Oh yeah, and:
    Everything you know about nutrition is wrong.
    I highly recommend either watching the documentary "Fat Head" on Netflix or Hulu (highly entertaining after the slow initial half hour), or reading "Why We Get Fat" or "Good Calories, Bad Calories" from Gary Taubes.
    Basic gist of it is this, there is a tl;dr underneath:
    Saturated Fat intake has no correlation with heart disease. It is a myth perpetrated by a highly criticized study that became official U.S. policy in the 1950's and has only been further perpetrated by the lobbyists of grain companies who love being able to slap "healthy heart" logos on Cocoa Puffs. The Food Pyramid is similarly based on this myth.
    Excluding olive/coconut, vegetable oils like canola oil are far worse for you than saturated fat like lard/butter. Margerine is worse for you than butter. Fatty foods do not cause heart disease or an increase in "bad" cholesterol; the majority of blood cholesterol is produced by the body, only a tiny fraction of it is dietary. Your fats and cholesterol are mostly controlled by hormones. What hormone controls fat? Insulin. What stimulates insulin production? Sugar. Bread. Carbs.
    This has been thoroughly documented, but the most easy demonstration if it is "Fat Head", in which the producer replicates the fast food diet of SuperSize Me: Except he intakes no sugar (diet soda only), and minimal carbs (meaty meals, no fries ever), and has only 2000 calories a day (which is still quite a bit). Results? Weight loss and lower cholesterol, eating nothing but fast food and lots of burger meat and bacon.
    (The above is not exactly a healthy long term diet- you'd definitely want to introduce a lot more vegetables, and grass-fed home-cooked meats would be much better for you)
    So what causes heart disease? Heart disease is caused by the oxidization of bad fats. Eat antioxidants (certain veggies and fruits) and exercise to prevent that. Countries like Holland that have extremely high-fat diets (mostly cheese) and are heavy on public transit/bikes/walking have much lower heart disease than other countries.
    If you don't believe me, google "Saturated Fat Heart Disease". First few links are studies or articles debunking the link the USDA always claims. Here's the Men's Health article:
    Another good article on saturated fat:
    The official government health websites like the USDA are full of crap and based on official policy, in turn based on lobbying and dogma of the past.
    If you are interested in a near-zero carb, high-fat, rapid weight loss diet, join up with me on:
    Huge thread explaining why an almost no carb (ketogenic) diet works and is not unhealthy, tons of FAQ and science:http://lowcarbplate.com/tlcm/
    It should be noted that these kinds of diets are also optimal for low-body-fat, for those of you who are slim, work out, and want a six pack.
    But going in to ketosis- almost no carb- isn't the only way to lose weight. Any diet that reduces insulin response will cause you to lose weight. Insulin is in response to blood sugar spikes, remember; eating foods with carbs that break down slower will result in smaller insulin responses. Eating beans and fruit instead of white bread will lower your insulin response because they don't break down into sugars as fast. Avoid the refined stuff! Sugar, corn syrup, white bread. These things make you excessively fat. Whole grains, white potatoes, and other carby/starchy foods are still pretty fattening. Want to lose weight without cutting carbs? Eliminate white bread and sugar altogether, try to limit bread intake but when you do use whole grain bread, and focus on getting carbs from beans and fruit and sweet potato instead. Feel free to replace carbs with fat and protein from meat and eggs anytime you wish! It will always be less fattening.
    tl;dr: Eat less sugar, starch, and grains. Don't touch artificial vegetable oils such as canola/soybean oil. Eat all the eggs and meat you want. Feel free to cook with butter and lard. Eat lots of vegetables as opposed to fruit. Weight will fall, vitals will improve. Exercise is a multiplier.
    Will follow with comments containing additional data.
    Chug that heavy cream, folks!

  2. Praxis

    What about teh calories?!??!11
    The calories in/out concept is terribly flawed. The body does not burn a set number of calories in the day and can ramp up its metabolism based on if it is trying to (via hormones) store and gain weight or burn it off. Insulin pushes the body to store more. If you store more, your body will tell you you are hungrier. Furthermore, if you have a small calorie deficit the body will lower metabolism by making you feel more sluggish, lowering body temperature, or a number of other ways to conserve calories.
    Eventually, as you ignore your body's hunger signals, it will grudgingly go to the fat reserves. BUT:
    (a) if you are eating poorly, you will usually lose weight slower than you would expect
    (b) if you are eating poorly, your muscles will weaken along with fat loss, because it is your muscles demanding more food since everything is being stored thanks to insulin.
    While you can calorie count to lose weight, deciding between carb restrictions and calorie counting comes down to:
    Would you rather avoid certain foods and always feel satisfied?
    Would you rather fight hunger constantly, and risk gaining the weight right back when you stop counting?
    This guy on the Reddit keto board demonstrated it by eating >3000 calories a day- on purpose, for a week- and lost eight pounds. All meals logged.
    This guy on a carnivore board force fed himself ~4000 calories a day (averaging 3800) for one month and did not gain a single pound.
    This doesn't violate thermodynamics, but it demonstrates how poor the calories in/out model is. By eating a diet that minimizes hormonal storage responses from the body, the body ramps up its metabolism to burn any excesses and goes directly to fat reserves for any deficit without complaint. The diet is explicitly muscle sparing (it eliminates all storage response) and people tend to gain muscle easily with any workout while on the diet (I've gained significantly, first time with arm definition!).
    IMO, this is actually the most feasible way to lose weight. I've done calorie counting, I've watched my roommate lose all his muscle mass along with 80 pounds calorie counting. Keto works better, for health, muscle strength, and lifestyle (I never deal with hunger, I eat whenever hungry because, as my body is not storing anything, my hunger is directly correlated with what my body needs).
    As a side note- everyone has different sensitivity to insulin. People who are resistant to insulin have bodies that produce far more insulin to react to the same amount of blood sugars. For a person who has normal insulin sensitivity, calorie counting is pretty easy to do; the body does not go in to storage mode easily. For an overweight person, eating the same amount of sugar/grains produces a much stronger storage reaction.
    My friend eats whatever he wants, and he stays skinny!
    Okay, quickie explanation.
    Insulin causes weight gain.
    Insulin is a hormone produced in response to blood sugar spikes. The bigger the spike, the bigger the insulin response. If you become resistant to insulin, your body produces more and more to react to the same amount of blood sugar, and you gain more and more weight, feel hungrier, etc, and eventually develop metabolic syndrome or if your pancreas can't keep up type 2 diabetes.
    The slower a carbohydrate breaks down in the blood, the less of a spike, so the less insulin.
    Ketosis is a way to gear your body in to burning fat very fast, because your body gears itself to using fat to replace everything. It burns fat for energy, it breaks fat in to ketones to replace glucose, etc etc.
    It's not the only way to lose weight or avoid gaining weight. Really, you will lose weight if you:
    (A) Consume less than you take in (calorie count)
    (B) Minimize insulin responses to blood sugar so your body doesn't hormonally try to store
    Calorie counting is hard as heck because you basically have to ignore all of your body's cravings. Plus, calorie counting isn't all that healthy if you eat poorly- you just end up depriving muscle.
    B is a matter of eating to avoid insulin spikes. That doesn't mean low carbohydrates necessarily- you can just eat carbohydrates that release slow.
    If you look up diets like the Engine 2 diet, for example- it's a vegetarian diet. Yet people lose weight on it. Why? Because you're only allowed to eat things that have slow-releasing blood sugars, to simplify. Most good vegetarian weight-loss diets will still ban or restrict sugars, grains, and starches.
    If your body never builds an insulin resistance, you can basically not worry about what you eat as long as you try to avoid sugar (which is what builds an insulin resistance in the first place) and refined white bread.
    Fruit still has sugar. But it's not the same blood-sugar-spiking sugar you get in a Coca-Cola.
    In other words-
    If you're already fat, you *might* need to cut down on fruit, but only if you've eliminated all refined sugar, grains, and white starches first. Fruit is waaaaay down on the priority list. If you've eliminated sugar and grains and still aren't losing weight, then look at fruits...or if you want to lose weight fast and cut out all sugar.
    If you're skinny, sure, eat all the fruit you want. You're not resistant to insulin, the nonrefined sugar is probably not going to make you resistant to it, and fruit has lots of good nutrients. Your body'll break it down and call it good.
    I want to lose weight without changing my habits, help!
    You're going to have a tough time here. But, eliminating sugar is a great start.
    Remember the guy in SuperSize Me that ate nothing but Big Macs and was skinny? Remember how everyone just seemed shocked by it and no explanation was offered?
    The documentary Fat Head basically tests this out- the guy goes on 30 days of low-carb McDonalds Binging! He orders double-patty-burgers with cheese, does not order fries, and only drinks diet sodas and tea. Spoiler: He loses weight.
    Kill the sugar and white bread first.
    But Praxis! I just read that there was a Harvard Study that said red meat makes you die!
    This study is absolutely terrible and bad science. Have you actually read the study, as opposed to the terrible headlines it makes?
    It's an observational study, not a controlled study.
    They basically just tracked the diet of a few thousand people and found that people who said they avoided Red Meat were 20% likely to die over the 20 year period.
    That's it.
    Correlation is not causation.
    Observational studies are supposed to be used to generate a hypothesis that should then be lab tested. These jokers decided to publish conclusions off of an observational study.
    If I told you that smokers were slightly more likely to die of liver failure in an observational study, would you instantly conclude smoking causes liver failure? The reality is that the smokers were also more likely to be drinkers, and alcohol causes liver failure. The people who smoked less also drank less because they were less prone to addictive behaviors.
    Same deal. The correlation is tiny- 20%. If four non-red-meat-eaters died during the study, then five red meat eaters died during the study. Furthermore, people who explicitly say they avoid red meat are likely people who actually stick with a diet, and thus more health-conscious in general. And further than that, there's no differentiation between "red meat" and "processed meat", and you have to remember that cheap processed meats are usually cooked in unhealthy vegetable oils at fast food restaurants, so there's probably a correlation between the "red meat eaters" and just poor diet choice in general.
    To quote the actual study:
    "Men and women with higher intake of red meat were less likely to be physically active and were more likely to be current smokers, to drink alcohol, and to have a higher body mass index".
    That's right, folks, the people who identified themselves as meat eaters in the study included more fat, sedentary, smoking alcoholics than the other group. It's actually pretty amazing that they only had a slightly higher mortality rate!
    But, of course, using the logic this study used, we can also conclude that red meat intake causes smoking.
    If I wanted to try a keto diet, what do I do?
    As long as you are eating less than 20g of carbs a day (not counting fiber as a carb), you are in ketosis.
    Just check the label of what you're eating, see how many carbs it has, subtract the fiber from the total, and make sure your total for the day is under 20g.
    If you feel crappy, do the following:
    * Up fat intake; you want fat to make up the majority of your diet, not protein
    * Up your potassium intake- you can get this from leafy green vegetables and avocado.
    * Eat more salt, ketosis depletes salt
    * Drink more water, fat metabolization uses more water so you will need to drink a lot more
    * Avoid vegetable oils, they're bad for you. Except Olive/Coconut oil
    As a general rule:
    * Meat has no carbs, red meat/poultry/fish all included
    * Eggs have no carbs
    * Leafy vegetables are mostly fiber, and you need them for vitamins, so eat a lot of them
    * Nuts are low carb, high fat, especially almonds. But they do have carbs so don't go crazy
    * Fruit has carbs from sugar, occasional berries or tomatoes are okay but for the most part minimize fruit
    * Milk is loaded with carbs from lactose However, the lactose breaks down when it is turned in to cream or cheese. Cream and cheese are both low carb. Low-fat or sweetened cheeses are usually bad, so only eat full fat cheeses.
    I generally eat stuff like steak, chicken, fish, and occasional bacon, with broccoli/spinach/kale/avocado/bok choy/romaine lettuce/cabbage for vegetables (usually steamed in butter or drizzled in olive oil), and lots of cheese, olives, and almonds for snacks.
    Bacon is more of a treat, it has more omega-6 fats than I'd prefer...they're not fattening, but they're inflammatory, which is not good for you. Less inflammatory than vegetable oils though, those things are loaded with omega-6. Omega-3's are good for you, and saturated fats and monounsaturated fats are fine for you.
    Eat till you're satisfied. You'll find that since your body stops storing fat in ketosis you have much less appetite.
    When your body has carbohydrates, they turn in to blood sugars. If your blood sugar spikes, your body releases hormones designed to encourage your body to store it as fast as possible, because high blood sugars can be poisonous.
    So you store more food instead of using it, and feel hungry again faster.
    How strong the "storage effect" of insulin lasts depends on your individual insulin resistance, that's why some people get fat and some stay skinny eating the same foods.
    Most people feel cruddy if they don't have enough blood sugar, but if you deprive yourself of glucose the body eventually manufactures a replacement (ketones) from breaking down fat.
    So, that's the "hack"; switch your body to not using glucose (from blood sugar) and using fat instead, and eliminate the carbs that makes the body store. Body stops storing fat. Appetite drops significantly. You lose weight rapidly.
    Almost all of the low carb diets (Atkins, South Beach, etc) have an "induction phase" that is basically the same thing as keto; you go in to ketosis. This is just getting rid of the extra rules those diets use and saying, "eat what you want, just stay in ketosis by not having carbs, and be aware that if you feel crappy it's because your body is lacking in x, so you should probably eat more vegetables/salt/drink more water."

  3. Praxis

    If you want more information, best basic book I've read is "Why We Get Fat", and "Fat Head" on Netflix/Hulu is the documentary you should watch.

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In this presentation from the Nursing Track of the 2016 Advances in Inflammatory Bowel Disease, Crohn's & Colitis Foundation of America's Clinical & Research Conference, Maureen Kelly discusses IBD nurse and advanced practitioner roles in the treatment of inflammatory bowel disease (IBD). Earn CME credit for this activity at the following location: http://elc.imedex.com/ELC/Specialty-S... 2016 Imedex, LLC.

Effect Of Topiramate On Acidbase Balance: Extent, Mechanism And Effects

Effect of topiramate on acidbase balance: extent, mechanism and effects 1Departments of Pharmacology, The University of Liverpool, Liverpool, UK 2Departments of Neurological Sciences, The University of Liverpool, Liverpool, UK 1Departments of Pharmacology, The University of Liverpool, Liverpool, UK 2Departments of Neurological Sciences, The University of Liverpool, Liverpool, UK Professor Munir Pirmohamed, Department of Pharmacology, The University of Liverpool, Ashton Street, Liverpool L69 3GE, UK. Tel: + 44 151 794 5549 Fax: + 44 151 794 5540 E-mail: [email protected] Received 2009 Apr 2; Accepted 2009 Jul 27. Copyright Journal compilation 2009 The British Pharmacological Society This article has been cited by other articles in PMC. Topiramate is licensed for the treatment of epilepsy and for migraine prophylaxis, but is also used off-licence for a wide range of indications. With the increasing use of topiramate, reports have emerged that topiramate can cause metabolic acidosis in some patients. It does this by impairing both the normal reabsorption of filtered HCO3 by the proximal renal tubule and the excretion of H+ by the distal renal tubule. This combination of defects is ter Continue reading >>

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  1. niah

    So I started a high protein low carb lifestyle exactly 7 days ago. I have cut out all fruit, starches, dairy etc. I will reintroduce fruit at the 14 day mark. Anyway, I feel like a bottomless pit the last two days. I am not craving carbs. It's peanut butters or protein pancakes or meat etc. I am having less of a three meal a day and more eating eating eating. Like I had lunch at 11:25 ish came home ( now 3 o clock ) had beef with tahini and devoured that and three protein pancakes. lol. I feel like I can't get enough...... Am I in ketosis now or something?

  2. j3nn

    Well, ketosis does mimic starvation so maybe your body is freaking out and thinks you're trying to kill it? Lol

  3. Drumroll

    It thinks you're trying to KILL it? Oh come on j3nn, you know better.
    I'm not sure if the OP is in ketosis just yet though, as one of the primary symptoms of ketosis is a blunting of the hunger signals. Also seems like he/she might be eating too much protein to get into ketosis. If that's a goal, some dialing back on protein might be necessary.
    Also, OP, don't let people scare you by telling you ketosis is bad, or stressful, or dangerous or that low-carb is somehow "damaging" to your body. It's a perfectly natural state to be in if that is your goal. Some people do better when in ketosis than others do, it doesn't work for everyone, but that is no reason not to try it out for yourself! Don't let the fearmongerers scare you away from giving it a try if you want to. A key component of the Primal Blueprint is experimenting for yourself and finding out where you feel the best/most healthy.

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Whether due to bicarbonate loss or volume repletion with normal saline, the primary problems is in hyperchloremic metabolic acidosis hcl ammonium chloride loading, reabsorption proximal tubule reduced, part, because of hyperchloraemic acidosis, anion gap (in most cases). Administration of ns will decrease the plasma sid causing an acidosis this patient also had a normal anion gap hyperchloremic metabolic (hcma). Googleusercontent search. Normal anion gap (hyperchloremic) acidosis semantic scholar. Hyperchloremic metabolic acidosis is it clinically relevant? (pdf hyperchloremic in diabetes mellitus. Hyperchloremic acidosis wikipedia. Treatment of acute non anion gap metabolic acidosis ncbi nih. Aug 4, 2016 a normal ag acidosis is characterized by lowered bicarbonate concentration, which counterbalanced an equivalent increase in plasma chloride concentration. Acid base physiology 8. Hyperchloraemic metabolic acidosisdepartment of medicine. Mechanism of hyperchloremic metabolic acidosis. Hyperchloremic acidosis background, etiology, patient education emedicine. Respiratory acidosis alkalosis as with the hyperchloremic may result from chloride replacing lost bicarbonate. Although it ca

Hyperchloremic Acidosis

Normal albumin-corrected anion gap acidosis Hyperchloremic acidosis is a common acid-base disturbance in critical illness, often mild (standard base excess >-10 mEq/L). Definitions of hyperchloremic acidosis vary. The best are not based on chloride concentrations, but on the presence of metabolic acidosis plus the absence of significant concentrations of lactate or other unmeasured anions. 2. standard base excess less than -3 mEq/L or bicarbonate less than 22 mmol/L, 3. Albumin corrected anion gap normal (5-15 mEq/L). A normal strong ion gap is an alternative indicator of the absence of unmeasured anions, although rarely used clinically and offering little advantage over the albumin corrected anion gap. The degree of respiratory compensation is relevant. It is appropriate if PaCO2 approximates the two numbers after arterial pH decimal point (e.g. pH=7.25, PaCO2=25 mm Hg; this rule applies to any primary metabolic acidosis down to a pH of 7.1). Acidosis is severe if standard base excess is less than -10 mEq/L, or pH is less than 7.3, or bicarbonate is less than 15 mmol/L. Common causes in critical illness are large volume saline administration, large volume colloid infusions (e.g. Continue reading >>

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  1. Carlos Danger

    Can someone very generally describe how the brain consumes ketoacids/ketone bodies when blood glucose has been completely depleted?

  2. Jayachandran

    Human body is a glucose driven machine which intake carbohydrates and converts to glucose. Energy is yielded from the glucose and glucose is stored as glycogen. When the carbohydrate intake is somehow reduced then body will shift its mechanism and uses the fatty acids to produce energy. Liver synthesis ketones from fatty acids in our diet or from body fat. Ketones(acetoacetate and acetone) are released into the blood, which is absorbed by the brain and synthesis energy from it through their mitochondria.
    The brain gets a portion of its energy from ketone bodies when glucose is less available (e.g., during fasting, strenuous exercise, low carbohydrate, ketogenic diet and in neonates). In the event of low blood glucose, most other tissues have additional energy sources besides ketone bodies (such as fatty acids), but the brain has an obligatory requirement for some glucose. After the diet has been changed to lower blood glucose for 3 days, the brain gets 25% of its energy from ketone bodies.After about 4 days, this goes up to 70% (during the initial stages the brain does not burn ketones, since they are an important substrate for lipid synthesis in the brain). Furthermore, ketones produced from omega-3 fatty acids may reduce cognitive deterioration in old age. Reference
    When the body starts using the fatty acids for energy production, one problem arises in the brain and that is the blood-brain barrier( barrier that separates the circulating blood from the brain extracellular fluid in the central nervous system )Brain cannot use long chain fatty acids because they cannot cross the blood-brain barrier due to their bondage with albumin. As ketones are medium chain fatty acids which can effectively cross the barrier. So brain uses the ketones for energy production by a process called as ketosis. The ketone bodies are then incorporated into acetyl-CoA and used in the citric acid cycle.
    The citric acid cycle – also known as the tricarboxylic acid (TCA) cycle or the Krebs cycle – is a series of chemical reactions used by all aerobic organisms to generate energy through the oxidation of acetate derived from carbohydrates, fats and proteins into carbon dioxide and chemical energy in the form of adenosine triphosphate (ATP). Reference
    Metabolic pathways to produce energy

  3. inf3rno

    Actually there is fatty acid transport through the BBB. Maybe the rate of this transport is not enough, I don't know, I think it does not really matter.
    What really happens here, that the liver prepares the fatty acids, so the brain can use them more easily in the form of ketoacids to produce energy.
    fatty acid catabolism shared between the liver and the brain - ref

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