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Mixed Respiratory And Metabolic Acidosis

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Acid-base Disorders - Deranged Physiology

A 56 year old gentleman with chronic obstructive pulmonary disease returns to the intensive care unit following a left pneumonectomy for a squamous cell carcinoma. There is no other past medical history. Examination reveals that he is fully alert, comfortable, with a thoracic epidural catheter in situ, respiratory rate 16 bpm, HR 60 bpm, BP 100/80 mmHg and warm peripheries. Auscultation reveals reduced breath sounds over the left lung field. There is no bubbling and minimal drainage from the left intercostal catheter. His arterial blood gas on return from theatre reveals: 1. What explanations would you give for the abnormalities in this arterial blood gas report? Data sets provided for interpretation included a) a combined resp acidosis and a metabolic alkalosis in a post operative patient, b) an acute respiratory acidosis in a pregnant lady c) a combination of hyponatremia and hyperkalemia and d) a patient presenting to the ED whose plasma biochemistry revealed a raised anion and osmolar gaps. A 45 year old previously healthy man was transferred to your ICU 5 days ago after a motor vehicle accident with chest and abdominal injuries. He has been difficult to ventilate on 100% oxyg Continue reading >>

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  1. Mangobananna

    I have tried to do the search, but cannot figure out what the difference is between Keto, and Akins, it seems like the same thing. Can you enlighten me?

  2. bidnow

    These are all pretty good answers. Keto is Atkins plus forty years of scientific research. The induction phase of Atkins is 20g of carbs, and Dr. Atkins did allow some dieters to add back carbs in 5g per week increments IF THEY WANTED TO. If you had a lot of weight to lose, Dr. Atkins suggested that you remain at 20g carbs. Most people do not need to stay at 20g carbs to remain in ketosis, and I'd say that most people on /r/keto, and especially /r/ketogains do not maintain an under 20g carb average weekly diet.
    Dr. Atkins did have very limited food choices at first, and even suggested no cheese or nuts in order to check for any food allergies/intolerance. You will see many posts here from people who are quite confused about nutrition, and instead just ask for a very short and simple list of foods that they can eat, and I think that is what Dr. Atkins discovered as well.
    Keto is an "adequate protein" diet. Atkins was criticized as being a "high protein" diet because Dr. Atkins' books basically said "eat all the meat that you want." However, Dr. Atkins knew that people naturally grow tired of eating just meat, and this becomes a self-limiting behavior. He also stated several times, that dieters sometimes need to learn the difference between the feeling of "satiety" and being gorged like they may have been doing in the past.

  3. Ohthere530

    I think in terms of Venn diagrams. Keto and Atkins partly overlap, but not entirely.
    Keto is any diet with low enough carbs that your body switches to ketones as it's primary fuel.
    Atkins is a particular multi-phase diet plan. The first phase, called induction, is an example of a keto diet. And then in later phases, you add back enough carbs that you drop out of ketosis.

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Acid-base

1. A 30 year old woman with a history of alcoholism and intermittent acetaminophen use presents with mental obtundation, rapidly rising hepatic enzymes (rising from normal to >15,000 IU/L in 16 hrs) and the following laboratory data: Urea 8mmol/l ; serum creatinine 130 umol/L; blood glucose 3.8 umol/L; plasma sodium 135 mEq/L; potassium 4.9 mEq/L; bicarbonate 15 mEq/L and chloride 100 mEq/L. The arterial pH is 7.32 and the PaCo2 4.0 kPa. In the next 6 hours, the plasma bicarbonate concentration falls to 10 mEq/L. Blood ketones and blood alcohol were negative.The diagnosis is: a) Mixed metabolic acidosis and metabolic alkalosis b) Mixed respiratory alkalosis and metabolic acidosis 2. A 42 year old alcoholic farmer is admitted to hospital with increasing lethargy (but no other neurologic abnormalities). His girlfriend is concerned that he drank windshield washer fluid containing methanol. Which one of the following statements regarding methanol poisoning is NOT true? a) Ethanol administration will not be clinically helpful b) Untreated, the patient likely will develop metabolic acidosis with an elevated anion gap c) Untreated, the patient likely will develop optic nerve toxicity d) Continue reading >>

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  1. SecureHandle

    I've skimmed the internet with nothing to show for it. Can anyone explain the difference? Is there any?

  2. [deleted]

    Keto is a descriptive term for any general low-carb, high-fat diet that should induce nutritional ketosis.
    Atkins is a detailed, specifically regimented weight-loss program that restricts many specific foods throughout its various stages and also restricts overall carbohydrate intake. It often induces nutritional ketosis and could be considered a ketogenic diet.

  3. bidnow

    Keto is the Induction phase of Atkins. Dr. Atkins told his patients that they didn't need to count maros (except carbs) at first for the same reason you see here with overweight people saying that they can't or won't count macros.

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Analyzing Abg's: Identifying Isolated Or Mixed Metabolic Disorder

There's a slight variation in the formula for each, so pay attention, it's quite easy. The formula for calculating EXPECTED PaCO2 for Metabolic Acidosis looks like this... Using the ABG's from the previous example, we would get an expected PaCO2 of N=1.5(16)+8 where n=expected PaCO2. In this case our expected PaCO2 is 23 (plus or minus 2) Well, the answer is you're dealing with a MIXED ACIDOSIS. Something else is driving up the CO2 and contributing to your acidosis. The most likely culprit is the the patients hypoventilating. The formula for calculating EXPECTED PaO2 for Metabolic Alkalosis is just a little different and looks like this... The application of the formula is the same. Do your calculation to determine what you'd expect your PaCO2 to be, then compare it to you measured PaCO2. If their the same, or close, you're probably dealing with an isolated acid-base disorder. If the different then you're dealing with a mixed disorder, and you need to do some more investigation as to why. NOTE: The greater the difference between your measured PaCO2 and your expected PaCO2 the more likely it is you're dealing with a mixed disturbance. Check here to read an article published in the Continue reading >>

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  1. helpful

    eric rea
    Co-founder & CEO of Podium


    Pros: Like the idea of it since I eat a keto diet.
    Cons: I preordered three bottles, and now I'm in a really annoying drip marketing campaign and unsubscribing doesn't opt me out of it.
    Get your act together guys. You are spamming your PH early adopters.

    eric rea has used this product for one month.

  2. helpful

    Pros: Very interested once available in Italy

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