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Metabolic Acidosis Mnemonic

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This video is about ROME Respiratory Metabolic Acidosis Alkalosis

Solution To "a Disoriented, Nauseated Car Wreck Victim"

Solution to "A Disoriented, Nauseated Car Wreck Victim" This is the solution to a case we presented recently. You may review the case at The patient has an increased anion gap acidosis. 2. Delta gap calculation = (observed gap - expected gap) + observed bicarbonate = (33 - 12) + 5 = 26. Thus, the patient started out with a normal bicarbonate (this excludes an underlying metabolic acidosis or alkalosis). 3. Winter's equation = 1.5 (calculated bicarbonate) + 8 (+ or -) 2 [expected pCO2] = 1.5 (2) + 8 = 11. This suggests that the hyperventilation is appropriate for the degree of metabolic acidosis. We use the mnemonic KILU for remembering the differential of anion gap acidosis: Ketoacidoses (diabetic, alcoholic, starvation) Ingestions (salicylates, ethylene glycol, methanol and, less commonly, iron and isoniazid) Anion gaps > 25 occur primarily with diabetic ketoacidosis, lactic acidosis, ethylene glycol, and methanol. In consideration of the stable vital signs and normal blood sugar, the physicians appropriately considered an ingestion. They ordered a serum osmolality. This supports a likely ingestion with either ethylene glycol or methanol. The positive calcium oxalate crystals mad Continue reading >>

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Popular Questions

  1. Saraleesaralee

    Is it possible to stay on ketogenic diet for life-long?

    I have been on ketogenic diet for 2 weeks. It controls my blood sugar level really well. However I am not over weight. And I am worried about potential long term side effects of the diet. For example, high LDL level, steoporosis, auto immune disease, too much weight loss, vesicular stiffness. I was wondering if there is anyone in this forum has been on ketogenic diet for years? And do you experience any side effects from the diet?

  2. Aaron1963

    I've been on a strict ketogenic diet for 6 months, and was doing LCHF for much of the 5 months prior to that but didn't make any attempts at it being ketogenic so I may have been in and out of ketosis some during that period. I now have a blood ketone meter and remain in ketosis according to it.
    I did suffer excessive weight loss initially. I lost about 40kg (about 90 lbs.), and it ended up sending me from being very obese to being underweight. But I've always eaten very little protein, which I continued to do, plus I was doing intermittent fasting, sometimes not eating anything for days at a time. Once I stopped the intermittent fasting and concentrated on getting adequate protein, my weight went back up to my ideal weight and stabilized there. I've heard from several people that you really need to watch your protein when doing a ketogenic diet being it's easy for excess to hinder weight loss and/or increase your BG.
    I have had a few issues while doing a ketogenic diet, but not 100% sure which if any can be attributed to ketosis vs. some other factor. First off, as winter was approaching I got extremely cold all the time, especially my fingers and toes, but even my whole body was cold. I thought it might have been the caffeine I was getting as part of my ketogenic diet involves drinking lots of coffee with HWC, coconut oil, and butter. I switched to decaf and the problem pretty much went away, but I don't know if it was the caffeine, the ketosis, the massive weight loss (lack of body fat), something else, or a combination of factors.
    I've also had excessive itching and a rash. That's normal for me during the winter months, but this year it started a bit early, went longer, and was much worse than normal. I think it may very well have been my usual sensitivity to the cold dry weather, aggravated by toxins released during my rapid weight loss, and perhaps ketones being emitted through the skin. It's just recently started to clear up and the rash is gone and most of the itching.
    I got keto-breath for a week or two when I first concentrated on going keto. It was very noticeable, but disappeared after that and no issues anymore with my breath.
    This diet is very sustainable for me. I tried my whole adult life to diet to lose weight and was never successful. This time I wanted to lose weight, but my primary focus was controlling my BG, meaning reducing carbs down to a low-carb level, which caused me to gravitate naturally to a LCHF diet. For the first time I have no desire to go back to my old way of eating. I love this diet and it's completely satisfying. So I killed two birds with one stone - got my BG under control, down to non-diabetic levels, and got my weight down to ideal. Plus with the huge benefits (IMHO) of having my body use ketones rather than glucose, I'm totally sold on this way of eating for the rest of my life and have absolutely no worries about not being able to stick to my diet. I really have no strong urges for carbs anymore, and only end up going off the plan rarely due to social pressures or inadvertently eating hidden/unknown carbs.
    My LDL has gone up, but I've heard from others that usually it's benign large fluffy LDL that typically goes up when on a ketogenic diet. And my body is still adjusting. Also I've heard that LDL by itself is not a good measure of risk. So I'm not worried about it, but will keep an eye on things. I also have taken my ketogenic diet to an extreme, hitting a KR of 3.0 or higher almost everyday, and sometimes up to 4.0 or more. Not sure if eating much more fat than necessary for ketosis affected my LDL any or not. Initially my LDL dropped significantly as well as my trigs, but both increased at my last doctor's visit. I may try a more normal KR in the future while monitoring my blood ketones to verify I stay in ketosis and see if there's any difference in my BG, cholesterol, or other tests.
    I did also suffer from other typical symptoms during my keto adaptation phase. Most went away within about two weeks. But it's just been here at the 6-month mark where my BG numbers suddenly stabilized with very little change, and quite low, and overall I just feel absolutely fantastic. I feel like I'm bursting with energy and joined a gym and suddenly love running and working out whereas I hated them all my life.
    Well, I don't have years of experience with ketosis to report anything to you about that. Other than I've heard lots of other people with years of experience and not heard of anyone having any real side effects other than the things I've mentioned. However some people do find ketosis isn't for them and give up very soon. For those that feel it is working for them and stick with it, seems there's no significant side effects. But I'll let the others who've been in ketosis for longer than me speak for themselves.

  3. furball64801

    Hi and welcome to DD I know of a guy called no more carbs that was on it over 2 yrs. It is possible he is still on it, that chat site closed down but he was going strong on it.

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Acid-base Differential Diagnosis

This patient's elevated blood pH and decrease in PaCO2 is consistent with acute respiratory alkalosis. Respiratory acid-base disorders are caused by primary changes in PaCO2, whereas metabolic acid-base disorders are due to primary changes in the concentration of HCO3-. A primary rise in PaCO2 or a fall in plasma HCO3- reduces the pH (acidemia), whereas the opposite increase the pH (alkalemia). Patients suffering from pneumonia can have tachypnea due to hypoxia. Increased minute ventilation reduces arterial CO2, an acid, resulting in alkalosis. A slight decrease in bicarbonate level may be seen due to early renal compensation. Answer 1: Normal pH range is 7.35-7.45. This patient's pH is outside this range, which indicates an acid-base disturbance. Answer 2: A decreased pH and an decrease in HCO3- would be consistent with metabolic acidosis. Answer 3: An elevated pH and an increase in HCO3- would be consistent with metabolic alkalosis. Answer 4: Respiratory acidosis results from decreased alveolar ventilation, which causes increased arterial CO2 levels. Continue reading >>

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Popular Questions

  1. KittenSynn

    > Pregnancy - Ketosis - WHY NOT??

    Why is ketosis bad for pregnancy?? I am hoping to start the longest thread on here and pick brains of all you mommas havin' bebes. :)
    I currently have lost 33 pounds in the past 11 weeks on this wonderful WOE and after the next 30 pounds we are going to try and conceive our third and final baby.
    Problem? I might be pregnant right now... :( lol (which is fine, we're ready)
    Question? Why are 'ketones' bad for the baby??? I have read and read and read and read every single article, website, and post about pregnancy and ketosis.... the end result all I know is "Tsk tsk tsk.. stay out of ketosis... and up carbs so you're not spilling ketones...."
    WHY???? NO ONE HAS SAID WHY??
    Yes, I think I came across ONE study where some children were tested at kindergarten age and the ones whose mother's were in ketosis while carrying had lower test scores... in KINDERGARTEN!
    This was not a low carb study, but rather a study on starvation.
    Were these mothers following a HEALTHY low carb diet? NO
    Were they in monitored ketosis on purpose? Probably not
    Could they have been smoking crack and that's why they weren't eating right? Yes (it said nothing like that was controlled)
    Are pregnant women that are NOT low carbing in ketosis OFTEN during pregnancy anyway?? YES, during morning sickness when they can't hold anything down. I'm sure they are.
    And, then there's the Eskimos... I have read, too, that they are constantly in ketosis and using protein and fat for fuel because they have NO carbs where they are.... are Eskimoe babies brain damaged?? I should think not.
    WHEW, can you tell I'm frustrated?? I just want someone to say "HEY, I was in ketosis and HERE"s what happened to my poor child" and then I won't even consider it, but no one is there to say that.
    AAAARGH, please, help !
    Thanks a ton,
    Kitten

  2. RosaAlta

    Not a doctor, but I was just pregnant. ;)
    I don't think it's the ketosis itself so much as the fact that, while you're in ketosis, you're burning off fat and losing weight. Pregnancy is not the time to be losing weight. Even very overweight people are still advised to gain while pregnant (although they are told to keep the gain down, like 15 lbs. instead of the average 25-35). Your baby needs your fat stores. The baby also needs you to eat a healthy, nutrient-rich, varied diet. It seems to me that Atkins maintenance (with maybe a few added things like milk) would be perfect for this.
    I ate like a pig in an ice cream shop for most of my pregnancy. I tried to eat "healthy" foods, but I didn't stop myself from eating a bunch of crap as well. I gained 42 lbs. My doctor told me that the pregnancy itself (baby, extra blood, extra breast tissue, etc.) weighs 26 lbs. on average. Anything you gain on top of that is just fat. Sure enough, I lost exactly 26 lbs. practically in the delivery room (okay, it was really within 3 weeks of birth). Now I'm here to take care of the rest.
    I'm telling you this because I'd wager that if you followed a maintenance-level, healthy low-carb plan during your pregnancy your gain would be right around 26 lbs. That would make your post-partum rebound much easier than most people's.
    My $0.02, sorry if it was too long. :)

  3. KittenSynn

    Yes, I agree with everything you have said, thank you. But, I was 190 when I got pregnant with my last son and my doctor DID tell me to NOT gain any weight!!! Not even the 26 lbs. So, essentially he was telling me to lose weight... because after delivery I would have been less.
    To his dismay I gained 14 lbs... (I only gained 15 with my first child) and lost it immediately after the pregnancy. I gained all of my weight (a hefty 253) eating constantly AFTER the birth of both of my children :cry: . I didn't find this WOL until 11 weeks ago.
    I am genuinely thinking that my diet now is WAY healthier (with supplements) than most pregnant women not on this WOL eat.
    I would still love to hear answers to my specific "What happens if" questions. I ALSO WANNA HEAR FROM ALL YOU MOMMAS WHO STAYED IN KETOSIS... I KNOW YOU'RE OUT THERE! LOL
    Thanks for your .02 cents though! :)

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Anion gap usmle - anion gap metabolic acidosis normal anion gap metabolic acidosis

The New Goldmark Mnemonic For Anion Gap Metabolic Acidosis From Em Cases

This is the link to Best Case Ever 56 Anion Gap Metabolic Acidosis [link is to the podcast and shownotes] from Emergency Medicine Cases . The case discussion of a 65 yr old woman who presented to the emergency department appearing only mildly ill clinically but turned out to have complex metabolic derangements. The case discussion is approximately 21 minutes long and totally worth listening to. But this post is just about the GOLDMARK mnemonic for differential diagnosis of metabolic acidosis AND aboutthe differential diagnosis of an osmolar gap. Anion gap = [Na +] ([Cl -] + [HCO 3 ]) (normal is 12 2) from General Formulas of emedicine.medscape.com Osmolal gap = measured osmoles calculated osmoles (normal is < 10) from General Formulas of emedicine.medscape.com [Calculated] Osmoles = (2 x [Na +]) + (glucose/18) + (BUN/2.8) + (ethanol/4.6)from General Formulas of emedicine.medscape.com In addition to d-lactate, the D in GOLDMARK can stand for drugs and an article that discussesdrugs causing metabolic acidosis isDrug-Induced Metabolic Acidosis [ PubMed Abstract ] [ Full Text HTML ] [ Full Text PDF ].F1000Res. 2015 Dec 16;4. pii: F1000 Faculty Rev-1460. doi: 10.12688/f1000research.700 Continue reading >>

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  1. MathWiz

    I wasn’t sure which section I should post this in, my strategy is what I call the 4–2–1 plan, I fast 2 day non consecutive days a week, eat a low carb but not calorie restricted diet 4 days a week to keep the fat burning benefits of ketosis going and then I give myself 1 day a week to indulge and eat whatever I want, usually a Saturday pasta dinner and wonderful dessert. I also walk 4 to 6 miles a day during the week and 10 to 12 miles on Saturday.
    Low Carb plans such as Atkins can be very effective for some people including me, many people who start a low carb diet experience get what’s called the “ketosis flu” or the “induction flu” in the first few days while the body is adapting to burning ketones instead of glucose.
    The basic symptoms are:
    – Headaches
    – Nausea
    – Upset stomach
    – Lack of mental clarity (brain fog)
    – Sleepiness
    – Fatigue
    It’s called the “ketosis flu” for a reason: you feel sick. I’ve gone through it and it wasn’t a pleasant experience. Fortunately it only lasted 2 days but then suddenly I woke up feeling much better, less hungry and my energy level was really high and consistent throughout the day!
    The first time I thought to myself: “What the heck am I doing? I feel like I’m going to die!” but I persevered and when it was over I didn’t regret a thing because what I had gained mentally and physically was 100% worth it.
    For those of you that are going through the ketosis flu, don’t give up! I know you feel like it’s never going to get better but stick with it and you´ll be so happy you did! I’m telling you, waking up refreshed for the first time in years, not getting the afternoon “blah” feeling and stuffing my face with carbs to try to boost my energy is the best side effect of the low carb diet I’ve experienced. Okay, losing weight while eating good food, feeling full and satisfied is great too.
    First you have to understand why your body is reacting this way. Your body’s been burning glucose for energy so it’s basically full of enzymes that are waiting to deal with the carbs you eat, but now the body needs to make new enzymes that burn fat for fuel instead of carbs, and the transition period causes the flu-like symptoms.
    There are some things you can do to lessen the symptoms of the ketosis flu and to make it go away sooner (to force the body to transition sooner) Ok, let’s get to the good part – what to do:
    First of all – you’re probably dehydrated. Drink PLENTY of water while you’re on a low carb diet, and then drink some more.
    Watch your electrolytes. When the body is getting rid of excess insulin from your former carb-crazy diet you´ll lose lots of fluids that have been retained in your body. This causes the rapid weight loss most people see in their first few days of ketosis, it’s mostly water, sorry. When you lose all the retained water you also lose electrolytes like sodium, magnesium and potassium. When you’re lacking them you´ll feel like crap so when you’re feeling really ill on the ketosis flu try things like chicken/beef broth and look for foods rich in these minerals. Take a multi-vitamin and a multi-mineral.
    Ok, here is where people throw the red flag – Eat more fat – Yup, I said MORE fat. Have some butter, just not on a roll, eat some bacon and eggs for breakfast, just skip the potatoes and toast. This will force your body to hurry up the transition. You´ll think this is crazy and think you´ll never get lose weight eating this way, but you will.
    Don’t eat too much protein – The body can transform protein into glucose so if you eat too much of it in the first days it will slow down the transition. Go for fatty meat and cheese if you can, add fat to protein shakes etc.
    Drink water, replenish electrolytes (sodium, magnesium, potassium) with food and supplements, drink broth, eat fat and not too much protein.
    I hope this helps, and have a great day
    Charles

  2. rockyromero

    @mathwiz
    ” Take a multi-vitamin and a multi-mineral.”
    I have been forgetting to take a multi-vitamin on fast days. Thanks for the reminder.
    “Eat more fat – Yup, I said MORE fat. ”
    I will have avocado more often.

  3. AussieJess

    Thanks for that info, very interesting

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