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Metabolic Acidosis Mnemonic

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

High Anion Gap Metabolic Acidosis - Hagma

High Anion Gap Metabolic Acidosis - HAGMA Simply put, High Anion Gap Metabolic Acidosis (HAGMA) is a type of metabolic acidosis caused by a high anion gap usually situated above 12 mEq/L. Metabolic acidosis can be categorized as either high or normal anion gap based on the presence or absence of unmeasured anions in serum. In general, it is caused by an accumulation of acid components within serum. Usually due to; Increased acid production or acid indigestion With the help of this formula, we can better understand the relationship between the anions and the cations which are responsible for the calculation of the gap itself In general, the balance between the anions (negativeions)and the cations(positive ions) is kept neutral. In other words, the electrical charge between theanions and cations are in equilibrium. In daily practice, potassium (K+) is often left out during the calculation due to the very low concentrations of it. Therefore the most used equation is; Keep in mind that the gap is calculated according to how many ions arenotaccounted for by the lab measurements (seen in the above equation). A normal serum anion gap is usually kept anywhere between 6 - 12mEq/L however d Continue reading >>

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  1. Nathaniel66

    I've been on keto for over 1.5 year. About once every month i'm hosting / visiting our customers/ suppliers and then there's usually plenty of food (whole day, or 1 looong lasting feast. Lots of carbs!
    Every morning after day like this i have keto breath + this specific urine smell. The next day all is gone.
    What's going on? Morning after carbs up ketones are not used, therefore body is getting rid of them (breath + urine smell), and the nex day when carbs are burned up i use my ketones again and so no more dragon breath/ urine smell- i'm back on keto?

  2. superdogfarm

    You could be right. Also could be from burning your fat stores.

  3. JonBanaitis

    since you are eating carbs your body is getting rid of the ketones through urin and breath because its burning sugar , this is why your getting the smell you no longer need ketons with sugar in the blood stream so I will release the remaining ketones to use sugar up

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High anion gap metabolic acidosis

High Anion Gap Metabolic Acidosis

When acidosis is present on blood tests, the first step in determining the cause is determining the anion gap. If the anion gap is high (>12 mEq/L), there are several potential causes. High anion gap metabolic acidosis is a form of metabolic acidosis characterized by a high anion gap (a medical value based on the concentrations of ions in a patient's serum). An anion gap is usually considered to be high if it is over 12 mEq/L. High anion gap metabolic acidosis is caused generally by acid produced by the body,. More rarely, high anion gap metabolic acidosis may be caused by ingesting methanol or overdosing on aspirin.[1][2] The Delta Ratio is a formula that can be used to assess elevated anion gap metabolic acidosis and to evaluate whether mixed acid base disorder (metabolic acidosis) is present. The list of agents that cause high anion gap metabolic acidosis is similar to but broader than the list of agents that cause a serum osmolal gap. Causes[edit] Causes include: The newest mnemonic was proposed in The Lancet reflecting current causes of anion gap metabolic acidosis:[3] G — glycols (ethylene glycol & propylene glycol) O — oxoproline, a metabolite of paracetamol L — L-lact Continue reading >>

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  1. Dm 2 with ketoacidosis

    I had a case to code a couple of days ago; patient had "diabetic ketoacidosis." There was no description as to the type of diabetes, so I went with type 2. At this point, I noticed there are combination codes for DM 1, DM due to drug or chemical, due to underlying condition and specified type NEC, but there is no combination code for DM 2 with ketoacidosis. I coded it as DM 2 with complication NEC E11.69 and Ketoacidosis E87.2. The doctor gave an additional diagnosis of lactic acidosis, which is also coded as E87.2. Does anyone have any insights on a better way to code this, or the rationale of not having a combination code for DM type 2 with ketoacidosis? (Incidentally, the patient also had urogenital warts, severe sepsis present on admission, and there was no mention of any kind kidney malfunction.)

  2. I found an answer on another thread that indicated to go with "DM specified type NEC with ketoacidosis (without coma) E13.10" instead of DM 2 with complication NEC E11.69 and ketoacidosis E87.2 (even though the type of diabetes is not specified); seems strange, but I guess that's what I'll do if it ever comes up again.

  3. rbandaru

    Hello,
    As per coding Clinic Diabetic with ketoacidosis code is E13.10 below is reference from coding Clinic.
    Assign code E13.10, Other specified diabetes mellitus with ketoacidosis without coma, for a patient with type 2 diabetes with ketoacidosis. Given the less than perfect limited choices, it was felt that it would be clinically important to identify the fact that the patient has ketoacidosis. The National Center for Health Statistics (NCHS), who has oversight for volumes I and II of ICD-10-CM, has agreed to consider a future ICD-10-CM Coordination and Maintenance Committee meeting proposal
    Regards
    Dr.Ramnath Bandaru, CCS, CPC
    American Medical Services LLC
    http://amshealth.com/
    Twitter: @HospitalCoders

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Remember increased Anion gap causes in an easier way than MUDPILES! "Ur LADy PISes ME". Try it! Good luck, study well!

File:cat Mudpiles - Causes Of High Anion-gap Metabolic Acidosis.svg

File:Cat mudpiles - causes of high anion-gap metabolic acidosis.svg DescriptionCat mudpiles - causes of high anion-gap metabolic acidosis.svg English: Causes of high anion-gap metabolic acidosis Diabetic ketoacidosis, Alcoholic ketoacidosis, Starvation ketoacidosis Paracetamol/Acetaminophen, Phenformin, Paraldehyde Iron, Isoniazid, Inborn errors of metabolism Ethanol (due to lactic acidosis), Ethylene glycol This SVGdiagram uses embedded textthat can be easily translated using a text editor. Learn more . I, the copyright holder of this work, hereby publish it under the following license: This file is made available under the Creative Commons CC0 1.0 Universal Public Domain Dedication . The person who associated a work with this deed has dedicated the work to the public domain by waiving all of his or her rights to the work worldwide under copyright law, including all related and neighboring rights, to the extent allowed by law. You can copy, modify, distribute and perform the work, even for commercial purposes, all without asking permission. Commons Zero, Public Domain Dedicationfalsefalse Click on a date/time to view the file as it appeared at that time. This file contains additi Continue reading >>

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  1. sk8wh33ler

    I looked around here and in the web, but could not find a clear answer. So the situation is: I am in ketosis around 6 month and started to get higher blood sugar 2 month ago. Before I was around 70 - 90. Now I am around 100 to 120, no matter when I meassure. Blood-Ketone level is always around 0.4 to 1.2. My macros are ok and I felt good most of the time. The last 2 weeks though I started to feel a bit down so I started to worry a bit and read into the high BG thing I found 2 articles which leaves a lot of questions unanswered.
    article1!
    article2!
    They are a bit old, so there might be more information by now? I am really worried that I have to stop keto just because of this.... can anyone help by making a holding argument? Can I just ignore this? Thanks in advance.

  2. DavePD

    Given your BHB of .4 to 1.2, I think it's more likely you still need to limit carbs and/or protein as there's likely too much glucose still in play. Check your postprandial glucose 1, 2, and 3 hours after meals and see if you spike above 120. If so, your meal is still too high in carbs and/or protein when coupled with your existing insulin response.
    When you get your next blood test, be sure to ask for "Fasting Insulin" too. (This should actually be standard in ALL metabolic panels, but isn't.)
    I'm about 17 months into the diet and I've observed my fasting blood glucose bottom out at 70s to start, then slowly increase to 90s (or even low 100s about 15% of the time), yet my blood BHB is typically between 1.8-3.8. I'm confident this is glucose sparing as my fasting insulin tests are now at the bottom of their range (3.3 with reference range 2.6-24.9) AND I check my postprandial glucose which rarely climbs above 120.
    To add to /u/Solol123's point -- protein is tricky because I find if I have too much within a single meal (such as large steak), it will bring up my glucose postprandial and even have a lasting margin into the next morning with higher glucose and lower BHB.

  3. sk8wh33ler

    thanks for the advice. I will try to control protein even more and will stay with mostly 77g a day.

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