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Metabolic Acidosis Treatment

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Bicarbonate Therapy In Severe Metabolic Acidosis

Abstract The utility of bicarbonate administration to patients with severe metabolic acidosis remains controversial. Chronic bicarbonate replacement is obviously indicated for patients who continue to lose bicarbonate in the ambulatory setting, particularly patients with renal tubular acidosis syndromes or diarrhea. In patients with acute lactic acidosis and ketoacidosis, lactate and ketone bodies can be converted back to bicarbonate if the clinical situation improves. For these patients, therapy must be individualized. In general, bicarbonate should be given at an arterial blood pH of ≤7.0. The amount given should be what is calculated to bring the pH up to 7.2. The urge to give bicarbonate to a patient with severe acidemia is apt to be all but irresistible. Intervention should be restrained, however, unless the clinical situation clearly suggests benefit. Here we discuss the pros and cons of bicarbonate therapy for patients with severe metabolic acidosis. Metabolic acidosis is an acid-base disorder characterized by a primary consumption of body buffers including a fall in blood bicarbonate concentration. There are many causes (Table 1), and there are multiple mechanisms that mi Continue reading >>

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Popular Questions

  1. Bobhes

    What is the best time of the day to check blood ketone levels? I've heard that upon rising is a bad time because the body produces glucose overnight while you sleep. I've heard others say mid afternoon and still others at night at the end of the day.

    Please unconfuse this confused keto novice. Thanks in advance!

  2. Shortstuff

    I've been testing three times a day, just out of curiosity.
    Can't keep doing it as the test strips are so expensive, but interesting to gauge things properly.

  3. MaryAnn

    Bobhes:


    I've heard that upon rising is a bad time because the body produces glucose overnight while you sleep.
    I've heard this too. But I'm doing an N=1 experiment and my blood ketone readings are higher in the AM (generally).

    Not fasting *approx 5 hrs after eating Ketones: 3.9

    Not fasting (mid afternoon) Ketones: 1.4

    Not Fasting (approx 5 hrs after eating) Ketones 2.0

    Not Fasting (approx 3.5 hrs after eating) Ketones 1.6

    Fasting Ketones 3.3

    Fasting Ketones 2.9

    Fasting but a few hours (3) after ACV Ketones 2.8

    Fasting Ketones 3.6

    Not Fasting 2.2

    Not fasting means in the afternoon and at least after 1 meal. My first reading was the highest and it was in the afternoon. These are all separate day measurements. I haven't done the test in the AM and the PM (only because of cost). Will try that next.

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