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Metabolic Acidosis: Pathophysiology, Diagnosis And Management. Pdf

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Pathophysiology And Management Of Rhabdomyolysis : Oxford Textbook Of Critical Care

Rhabdomyolysis is a potentially life-threatening syndrome characterized by the breakdown of skeletal muscle. It is associated with myalgia, muscle tenderness, swelling, and/or stiffness, accompanied by weakness and raised levels of creatine kinase (CK), myoglobin, phosphate and potassium, sometimes with acute kidney injury (AKI). There are multiple causes of this syndrome, traumatisms and myotoxic effect of drugs being the most frequent in developed countries. The pathophysiology involves direct trauma, as well as energy (ATP) depletion with disruption of sarcolemma integrity and muscle destruction. The sequestration of plasma water leads to hypovolaemic shock, while the release of muscle content, mainly myoglobin and potassium lead to the most severe complications of this syndrome, acute kidney injury/hyperkalaemia. The kidney injury is driven both by renal ischaemia due to vasoconstriction and to the toxic effects of myoglobin. The local oedema produced by the release of muscle content remains trapped within the fascia and can lead to compartment syndrome. Volume repletion with saline is essential to avoid hypovolaemic shock and acute kidney injury (AKI). With respect to compart Continue reading >>

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  1. Judy Mayer

    The frequent urination can be caused by many factors, such as urinary track infection(UTI), cystitis, interstitial cystitis, prostatitis, enlarged prostate, diabetes, etc. You need to get a diagnosis and take a timely treatment. If it’s casued by urinary and reproductive system diseases, you can take herbal remedy called Diuretic and Anti-inflammatory Pill to cure this disease.

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Phenformin-associated Lactic Acidosis: Pathogenesis And Treatment

Phenformin-Associated Lactic Acidosis: Pathogenesis and Treatment Article, Author, and Disclosure Information Author, Article, and Disclosure Information Requests for reprints should be addressed to Robert I. Misbin, M.D.; Division of Endocrinology and Metabolism, Box J-226, JHM Health Center, University of Florida; Gainesville, FL 32610. Since phenformin's introduction into clinical medicine, a total of 552 cases of lactic acidosis have been reported in patients taking this hypoglycemic agent. In 306 cases, sufficient documentation was available to establish the diagnosis with reasonable certainty (blood lactate, 6 meq/litre or greater, and blood pH, 7.33 or less). The mortality rate among insulin-treated patients (15%) was considerably less than the mortality rate in the group as a whole (42%). Taken together with results from animal studies, these data suggest that insulin is the treatment of choice for phenformin-associated lactic acidosis. Sodium bicarbonate should be administered to patients with severe acidosis, but should be withheld from patients with mild acidosis. Overly aggressive administration of sodium bicarbonate can be deleterious and should be avoided. Although d Continue reading >>

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  1. TheCommuter

    You can post this question on this site's Nursing Student Assistance Forums and perhaps get an answer. One of our frequent users, Daytonite, loves to give detailed answers to these types of questions.
    http://allnurses.com/forums/f205/

  2. ICRN2008

    Here is the formula for anion gap:
    Agap = Na + K - Cl -CO2
    I would think that the doctor would be monitoring the glucose level (not the agap) to determine when to stop the insulin drip. Anyone else have an idea?

  3. P_RN

    One of our wonderful members Mark Hammerschmidt has a great FREE MICU site:
    http://www.icufaqs.org/
    Check section 4.2
    It's all acidosis/alkalosis

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Metabolic Acidosis: Pathophysiology, Diagnosis And Management

Recommendations for the treatment of acute metabolic acidosis Gunnerson, K. J., Saul, M., He, S. & Kellum, J. Lactate versus non-lactate metabolic acidosis: a retrospective outcome evaluation of critically ill patients. Crit. Care Med. 10, R22-R32 (2006). Eustace, J. A., Astor, B., Muntner, P M., Ikizler, T. A. & Coresh, J. Prevalence of acidosis and inflammation and their association with low serum albumin in chronic kidney disease. Kidney Int. 65, 1031-1040 (2004). Kraut, J. A. & Kurtz, I. Metabolic acidosis of CKD: diagnosis, clinical characteristics, and treatment. Am. J. Kidney Dis. 45, 978-993 (2005). Kalantar-Zadeh, K., Mehrotra, R., Fouque, D. & Kopple, J. D. Metabolic acidosis and malnutrition-inflammation complex syndrome in chronic renal failure. Semin. Dial. 17, 455-465 (2004). Kraut, J. A. & Kurtz, I. Controversies in the treatment of acute metabolic acidosis. NephSAP 5, 1-9 (2006). Cohen, R. M., Feldman, G. M. & Fernandez, P C. The balance of acid base and charge in health and disease. Kidney Int. 52, 287-293 (1997). Rodriguez-Soriano, J. & Vallo, A. Renal tubular acidosis. Pediatr. Nephrol. 4, 268-275 (1990). Wagner, C. A., Devuyst, O., Bourgeois, S. & Mohebbi, N. R Continue reading >>

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  1. dramalean

    Hey guys, I'm on a pretty strict ketosis diet and I feel great. But lately I have so much energy that I just can't seem to fall asleep anymore. Has anyone else experienced this? Should I up my carbs a bit? Any feedback is appreciated.

  2. rickkan

    My need for sleep went from 9 or 11 hours daily to 4 or 6... I had to get a second job to handle the extra free time and energy I had.

  3. TheGreatK

    This has happened to me too! I thought it was because I quit smoking cigarettes, but this makes more sense. I'm sleeping almost exactly five hours a night, and I feel great. Do you think there is any chance this is a bad thing, though? E.g. our sleep cycle is incomplete because of some deficiency? Or is the traditional recommendation of seven hours a night now outdated?

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