Nejm Lactic Acidosis

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Dr. G explains how to calculate an anion gap and then interpret how that relates to changes in bicarb via the delta-delta.

Delta Gap And Delta Ratio - Deranged Physiology

The delta gap and delta ratio, advantages and disadvantages . Once one has calculated the anion gap and finds it raised, one is almost obliged to figure out whether those anions have been solely responsible for the acidosis, or whether another (non-anion-gap) cause is lurking in the background. A brief review of this can be found in the "Required Reading" section hidden among the CICM Fellowship Exam preparation material.For actual education, the exam candidates are directed to the LITFL delta ratio page , and to the excellent online works of Kerry Brandis. The delta gap is a straight-out difference between the change in anion gap and the change in bicarbonate. Delta gap = (change in anion gap) - (change in bicarbonate) (The normal anion gap is assumed to be 12, and the normal HCO3is assumed to be 24.) A simplified equation which does not require a bicarbonate value is also available: -6 = Mixed high and normal anion gap acidosis -6 to 6 = Only ahigh anion gap acidosis exists over 6 = Mixed high anion gap acidosis and metabolic alkalosis Delta gap is essentially a tool to determine whether or not there is also a normal anion gap metabolic acidosis present.The normal value for delt Continue reading >>

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  1. Berengal

    First a bit of background, feel free to skip it: I’ve been doing keto since the end of May, and doing very well. This is actually the second time I’m doing keto, the first time I started 6 years ago and went on for almost two years before I got depression and stopped caring about everything. That time I lived by myself, and while my family was glad to see how much my physical fitness had improved they didn’t really pick up on the difference keto had on my daily life, and they thought low-carb was just a fad diet no matter how I tried to convince them otherwise. Fast forward to today; I moved back in with my parents a few years ago because of my depression, and started keto again at the end of May, so I’ve been going for about two months now. This time both my parents and my sister (who’s also back home for the summer) really did notice the (rather profound) effects keto has on me beyond just my weight dropping, so they’re a lot less vigorous in their opposition, but they still remain somewhat unconvinced.
    So, what I’m thinking is that beyond just showing my family the effect keto has had on me, I wonder if it’s possible to give them a taste of the mental effects of being in ketosis with exogenous ketones, even if it’s just for a short time. I don’t expect this to be some all-powerful argument to win them over, I just want to share some of my experiences with them that goes beyond just telling them about how I feel and relaying the knowledge I have.

    I might just get some exogenous ketones anyway, just to satisfy my own curiosity (I have no plans on incorporating them in my life beyond that), but I’m wondering if anyone has any experience with using them, if you notice a difference in mental focus, and in particular feeding them to people on a high-carb diet and how they experience it.

  2. stacy

    I don’t know but I am very skeptical that anyone can “fake” the benefits of natural ketosis this way. It may not even be safe.
    If you want to persuade someone of the benefits I think the best way is to demonstrate it. You will find many posts here about attempts to convert unhealthy friends and family to keto, many of which fail because people don’t change until they are truly ready to. I tried that with some family members a few years ago, and I won’t do it again. They are still fat and diabetic because everyone knows that eating fat is unhealthy.


  3. Peter

    All you can be is an example.
    If you tried to convince them with something like that, they would stub their toe and say “see? It’s no good.”

    Just keep calm and keto on

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Part of our series on hyponatraemia - where we tackle the causes of low sodium using a systematic approach. This video series is best watched from the start. Hyponatramia EXPLAINED: https://youtu.be/3QunAw5l0w8 Pseudohyponatraemia: https://www.youtube.com/watch?v=laQRt... True Hyponatraemia: https://www.youtube.com/watch?v=1krkd... Primary Polydipsia: https://www.youtube.com/watch?v=p05lj... Urine Osmolality vs Serum Osmolality: https://www.youtube.com/watch?v=0KUCw... Adrenal Insufficiency: https://www.youtube.com/watch?v=YZBpg... Fluid Assessment: https://www.youtube.com/watch?v=QOjzN... Hypovolaemia: https://www.youtube.com/watch?v=hq8u_... Oedematous Conditions: https://www.youtube.com/watch?v=9Rb3T... SIADH: https://www.youtube.com/watch?v=xS7m1... You only need five pieces of information to make a diagnosis! They are: 1. Serum sodium 2. Serum osmolality 3. Urine osmolality 4. Urine sodium 5. An assessment of the patient's fluid balance Causes include: Pseudohyponatraemia Primary polydipsia Adrenal insufficiency Hypovolaemia Oedematous States SIADH And take it from there! Hope you enjoy these videos - leave us some feedback and tell us what you'd like to see us cover next! REFERENCES: 1. Kearney T, Giritharan S, Kumar M. 2014. Endocrinology. In: Kalra, PA. Essential Revision Notes for MRCP (Fourth Edition). PasTest. pp 121 - 123 2. Longmore M, Wilkinson IB, Davidson EH Foulkes A, Mafi AR. 2010. Clinical chemistry. In: Oxford Handbook of Clinical Medicine (Eight Edition). Oxford Press. pp 676 - 708 3. Ballinger A. 2012. Endocrine disease. In: Essentials of Kumar & Clark's Clinical Medicine (Fifth Edition). Saunders Elsevier. pp 607-667 MUSIC: George Street Shuffle Hep Cats Pamgaea All courtesy of Kevin Mcleod at Incompetech.com

Welcome To Osmolality.com | Presented By Advanced Instruments, Inc.

Bhagat, C.I., Garcia-Webb, P., Fletcher, E., Beilby, J.P. Calculated versus Measured Plasma Osmolalities Revisited. Clinical Chemistry, 30(10):1703 1984 Boyd, D.R., Mansberger, A.R., Serum Water and Osmolal Changes in Hemorrhagic Shock: An Experimental and Clinical Study, Am Surgeon, 34: 744 (1968) Dorwart, W.V., Chalmers, L., Comparison of Methods for Calculating Serum Osmolality from Chemical Concentrations, and the Prognostic Value of Such Computations, Clinical Chemistry, 21: 190 (1975) Eskew, L., Speicher, C.E., Using Anion and Osmolal Gaps to Diagnose the Cause of Intoxication, Diagnostic Medicine, p. 6 February 1985 Evans, J.R., Osmolal Gaps in Urine, Clinical Chemistry, 32(7): 1415 (1986) Evans, J.R., Yet More on Osmolal Gaps in Urine, Clinical Chemistry, 33(5): 736 (1987) Garg, A.K., Nanji, A.A., Osmolar Gap, Diagnostic Medicine, p. 38 Mar/Apr 1982 Neary, R.H., More on Osmolal Gaps in Urine, Clinical Chemistry, 32(12): 2225 (1986) Osterloh, J.D., Discrepancies in osmolal gaps and calculated alcohol concentrations -see comments-. Archives of Pathology Laboratory Medicine 1996; 120: 637-41. Soloway, H.B., What is an osmotic gap, and how is it used in diagnosis?, Diagnostic Continue reading >>

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Popular Questions

  1. Cydonia

    I'm 32 weeks, had a check up with MW on Friday where everything was fine. Sat and Sun I had a little bit of brownish discharge, but only a little and there was normal discharge too. Being a worrier (!) I decided to test my pee while I was at work- I work in a vets and we use the same dipsticks as they do in the doctors.I was looking for blood, but It came up positive for ketones, but not glucose which I thought was a bit strange? I thought you'd see ketones in a more long term, undiagnosed diabetes and therefore there would always be glucose too? Does anyone know any other causes of ketonuria? Could acidic urine affect the test as pH was 6.5? Couldnt really find anything useful online, don't know if I should be worried and ring MW tomorrow.

  2. atalantis

    I had traces of ketones in my urine at one of my early-ish MW appointments (am 38 wks now and can't remember which appt it was; maybe at 16 wks?). The MW suggested it was probably just because I was hungry and my body was starting to use up its own resources. The appointment was just before lunchtime and I'd been running around all morning. Apparently, ketones (without glucose) are often found in the urine of women who are suffering from severe morning sickness, though this wasn't the case with me. My subsequent appointments were all fine. If you're worried, though, there's no harm in getting this checked out.

  3. MissTapestry

    Ketones can be found when someone has a very high fat, low carb/sugar diet (think extreme Atkins)

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ABGs Tic Tac Toe Method for Nurses with QUIZ: This video tutorial is on how to set-up arterial blood gas problems using the tic tac toe method. This TIC TACE TOE method is so super easy when solving respiratory alkalosis, acidosis, metabolic alkalosis, or acidosis. Nursing students will be tested on this material in nursing school, and this is one of the easiest ways to solve these arterial blood gas problems. This is an "ABGs made easy for nurses and nursing students" tutorial. Arterial Blood Gas Quizzes: http://www.registerednursern.com/abg-... Video: How to use the Tic Tac Toe Method for PARTIALLY vs FULLY Compensated ABGs: https://www.youtube.com/watch?v=t_V8E... Respiratory Acidosis: https://www.youtube.com/watch?v=X0Vjn... Subscribe: http://www.youtube.com/subscription_c... Nursing School Supplies: http://www.registerednursern.com/the-... Nursing Job Search: http://www.registerednursern.com/nurs... Visit our website RegisteredNurseRN.com for free quizzes, nursing care plans, salary information, job search, and much more: http://www.registerednursern.com Check out other Videos: https://www.youtube.com/user/Register... Popular Playlists: "NCLEX Study Strategies": https://www.youtube.com/playlist?list... "Fluid & Electrolytes Made So Easy": https://www.youtube.com/playlist?list... "Nursing Skills Videos": https://www.youtube.com/playlist?list... "Nursing School Study Tips": https://www.youtube.com/playlist?list... "Nursing School Tips & Questions": https://www.youtube.com/playlist?list... "Teaching Tutorials": https://www.youtube.com/playlist?list... "Types of Nursing Specialties": https://www.youtube.com/playlist?list... "Healthcare Salary Information": https://www.youtube.com/playlist?list... "New Nurse Tips": https://www.youtube.com/playlist?list... "Nursing Career Help": https://www.youtube.com/playlist?list... "EKG Teaching Tutorials": https://www.youtube.com/playlist?list... "Personality Types": https://www.youtube.com/playlist?list... "Dosage & Calculations for Nurses": https://www.youtube.com/playlist?list... "Diabetes Health Managment": https://www.youtube.com/playlist?list...

American Thoracic Society - Interpretation Of Arterial Blood Gases (abgs)

Interpretation of Arterial Blood Gases (ABGs) Chief, Section of Pulmonary, Critical Care & Sleep Medicine Bridgeport Hospital-Yale New Haven Health Assistant Clinical Professor, Yale University School of Medicine (Section of Pulmonary & Critical Care Medicine) Interpreting an arterial blood gas (ABG) is a crucial skill for physicians, nurses, respiratory therapists, and other health care personnel. ABG interpretation is especially important in critically ill patients. The following six-step process helps ensure a complete interpretation of every ABG. In addition, you will find tables that list commonly encountered acid-base disorders. Many methods exist to guide the interpretation of the ABG. This discussion does not include some methods, such as analysis of base excess or Stewarts strong ion difference. A summary of these techniques can be found in some of the suggested articles. It is unclear whether these alternate methods offer clinically important advantages over the presented approach, which is based on the anion gap. Step 1: Assess the internal consistency of the values using the Henderseon-Hasselbach equation: If the pH and the [H+] are inconsistent, the ABG is probably no Continue reading >>

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  1. connie7

    I used to use the ketostix every morning -- was in moderate zone most days. After a while I stopped checking. That was about 2 months ago. Last week, I took my daughter to college orientation session, and had some chicken nuggets at Chik-Fil-A (my only cheat in about 6 months), so when I got home I decided to check. The result was negative ketones, so I tried to go back to induction levels for a few days. It's been a week, and they still register negative every morning. Could the sticks have "gone bad"? The scale is not changing too much -- the normal fluctuations, but nothing dramatic. Should I go out and get some more ketostix, or just stick with it and not worry so much?

  2. hayes

    The sticks have a 6month shelf life after opening. The least little moisture inside the bottle can effect the reading also as can other conditions.
    If your very curious, get a new bottle.
    Remember that some people never make the sticks change color.

  3. omgtwins

    Because Ketosis stix don't really do much when it comes to encouragment - I don't use them. There are way too many variables - you could be in ketosis and it may not show, you are'nt in ketosis but loosing weight...IMNSHO I stick to the scale once a week and the measurements every month - the clothes in the back of the closet that are slowly moving up are also better indicators. You know what you're eating - good or bad, so save some money and get rid of those sticks!

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