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Non Anion Gap Metabolic Acidosis Treatment

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Therapy 3 Acid Base Disorders

O2 sat and PO2 does NOT affect acid-base balance Anion gap: measure that expresses the balance between circulating anions and cations [AG = Na - (HCO3 + Cl)] Recognize common causes, including medications, of primary acid-base disturbances 1. Anion gap (non volatile organic aicds) : albumin, Na, lipids, lithium 2. non-anion gap (only HCO3 and Cl involved) a. Drug - induced hyperkalemia: K-sparring diuretics, TMP, Heparin, ACE, ARB Recognize the presence and degree of physiologic compensation of acid base disorders Acute buffering of respiratory acidosis is accomplished by tissue buffers (protein, hemoglobin) Lungs adjust minute ventilation (rate and tidal volume) to change [CO2] to compensate for metabolic disorders Kidneys retain or excrete bicarbonate to compensate for changes in [CO2] Identify appropriate patient cases where treatment of acid-base disorders is indicated a. Treatment of reversible cause (ex. opioid discontinuation) b. Mechanical ventilation to aid in CO2 exchange c. NOT give sodium bicarbonate- Shift in equilibrium will result in more CO2 production d. Last line: May give THAM if unresponsive to ventilation 2. Chronic, compensated respiratory acidosis does not r Continue reading >>

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  1. digitaldoc2002

    A Cool MNEMONIC for Rx/ Mgt in COPD

  2. toothhornet88

    Pretty Cool links for mnemonics

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Is Correcting Hyperchloremic Acidosis Beneficial?

You are here: Home / PULMCrit / Is correcting hyperchloremic acidosis beneficial? Is correcting hyperchloremic acidosis beneficial? An elderly woman presents with renal failure due to severe dehydration from diarrhea. She has a hyperchloremic acidosis from diarrhea with a chloride of 115 mEq/L, bicarbonate of 15 mEq/L, and a normal anion gap. During her volume resuscitation, should isotonic bicarbonate be used to correct her hyperchloremic acidosis? Does correcting her hyperchloremic acidosis actually help her, or does this just make her numbers better? The use of bicarbonate for treatment of metabolic acidosis is controversial. However, this controversy centers primarily around use of bicarbonate for management of lactic acidosis or ketoacidosis.Treatment of these disorders requires reversing the underlying disease process, with bicarbonate offering little if any benefit.Hyperchloremic metabolic acidosis is different.Whether due to bicarbonate loss or volume repletion with normal saline, the primary problems is a bicarbonate deficiency.Treating this with bicarbonate is a logical and accepted approach: Giving bicarbonate to a patient with a true bicarbonate deficit is not controve Continue reading >>

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  1. Kellye P

    My little poodle has been diabetic for 4 years. His glucose levels are good. I have had every imaginable test run on him to find out why he can’t gain weight. Everything checks out perfectly except one time his electrolytes were off. I now put an electrolyte powder in his water. He was 10 lbs when diagnosed and is now 6 pounds. Every bone in his body sticks out. I take him to a Traditional Chinese Medicine vet, an acupunture specialist, and his regular vet. He is on Vetsulin and thyroid. I give him Caniotic probiotics, coconut oil and digestive enzymes. I have gone raw, dehydrated, bought recipes at Balance It, bought recipes from a California company that makes food based on their vet’s advice, tried Sojo’s and other “add meat” foods, dry food, canned food, etc. I have tried everything. High fat foods make him throw up. It is breaking my heart that we are heading back into winter and he’s skin and bones. Yes, he stays inside and wears shirts or sweaters all year, but he is way too skinny.

  2. USA

    Hi Kellye P,
    I am so sorry to hear about your little guy.
    When you say his glucose levels are good can you tell me how often he is tested and what his numbers are please? Has he had a Hemoglobin A1c Test or a Fructosamine test, both of which will show your dog’s average blood sugar over a couple of weeks or months? High blood sugars could interfere with glucose metabolism and cause weight loss.
    He is also on thyroid meds and a high thyroid level could also cause weight loss. Does he take thyroid medicine once or twice a day? He should be taking his meds twice a day not once. His thyroxine (T4) levels should be tested about 4 hours after giving him his thyroid medicine and should be high normal to about 25% over normal.
    Does he just stop eating after he eats a certain amount of food? Would it be possible for you to feed him 25% more than you are feeding him now?
    Please let me know these things so we can all try to figure out how to help your little guy gain some weight.

  3. Kellye P

    Thanks for the response. He gets the Fructosamine test every six months. He is always in the proper range. He is due to get tested again in October so I will have new numbers, but nothing has changed. He does not drink a lot of water or have any other symptoms of high glucose.
    Last year I had the complete thyroid panel done – every single test. I thought maybe he was too high. He takes .1 mg of thyroxine twice a day. I was hoping that was the problem but all the tests came back normal. My vet is very particular with the timing so I’m sure she had me in the office 4 hours after he took his pill.
    He is so tiny and cannot eat much at one time. I feed him exactly twelve hours apart but give him a little bit of food around noon and he gets a small snack at night. If he eats more than his usual amount, he throws up. His tiny stomach can’t hold more than half a cup.
    I exercise him 30 minutes a day. He’s blind but can fetch in the house and will trot behind me on our very long driveway. The TCM vet does chiropractic adjustments and says his muscles are in pretty good shape. We walk uphill and he goes up our stairs.
    A specialist in this area also treats him and consults with my vet. He suggested that we stop insulin for three days to reset him and then start up again. During the days he was not getting insulin, his glucose levels were right around 250. However, his urine test showed ketones. The specialist said that did not make sense. My vet said she probably would have taken him off insulin if he stayed at 250 without it. The ketones messed up that plan, though. Nobody has any explanation as to why he had ketones. I think that is the key to the weight problem but I have no idea what it means.
    I have taken him to a vet school and many other specialists. He is a medical mystery. The good news is that he is quite content and if he knew how much time I spent trying to figure out why he won’t gain weight, he’d probably think I was crazy!

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Internal Medicine Series: Clinical Clerkships Overview and Causes of Non-Anion Gap Metabolic Acidosis [Updated version]: https://www.youtube.com/watch?v=pTooy... Made with help of Blueberry Flashback Recorder

Metabolic Acidosis; Non-gap

Non-gap metabolic acidosis, or hyperchloremic metabolic acidosis, are a group of disorders characterized by a low bicarbonate, hyperchloremia and a normal anion gap (10-12). A non-gapped metabolic acidosis fall into three categories: 1) loss of base (bicarbonate) from the gastrointestinal (GI) tract or 2) loss of base (bicarbonate) from the kidneys, 3) intravenous administration of sodium chloride solution. Bicarbonate can be lost from the GI tract (diarrhea) or from the kidneys (renal tubular acidosis) or displaced by chloride. A. What is the differential diagnosis for this problem? Proximal renal tubular acidosis: (low K+) Distal renal tubular acidosis: (low or high K+) Prostaglandin Inhibitors, (aspirin, nonsteroidal anti-inflammatory drugs, cyclooxygenase 2 inhibitors) Adrenal insufficiency (primary or secondary) (high K+) Pseudoaldosteronism, type 2 (Gordon's syndrome) B. Describe a diagnostic approach/method to the patient with this problem. Metabolic acidosis can be divided into two groups based on anion gap. If an anion gap is elevated (usually greater than 12), see gapped metabolic acidosis. Diagnosis of the cause of non-gapped metabolic acidosis is usually clinically evi Continue reading >>

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  1. Desley

    Help! I'm frustrated, I'm into my 2nd week on Induction & I'm still not into Ketosis. I've been keeping my carbs below 20 carbs a day.
    If fact I've been averaging 18. Testing my Urine every 2sd day for the recommended 15 seconds. Anybody got any ideas?

  2. Desley

    Have been reading some old posts (2011) about bringing on Ketosis by upping your fat intake using Coconut Oil. Has anyone got any info on this. What does Atkins think about this?

  3. Helen

    The ketostix are not always accurate. You may be in ketosis when they say you aren't.
    Are you thirsty all the time? Has your hunger gone away? Those are generally the best two ways to recognise that you are in ketosis.
    Saying that, while most people can achieve ketosis in 3-6 days, for some it can take a few weeks, especially if they are insulin resistant.
    Not sure about the Coconut oil (although it is good for you). I have read that it can help in ketogenic diets, but not sure if it will help in the case of Atkins.
    Helen

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