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Paradoxical Acidosis

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Dry eyes and dry mouth are frequently reported by patients with systemic sclerosis. There are many medications and a number of other disease entities that can occur in life that can account for some of the dryness. Less than one-quarter of the SSc patients with dryness of the eyes and/or mouth will be found to have Sjogrens Syndrome. Evaluation and treatments for dryness will be discussed. Video Production: Magnus Media Group http://www.magnusmediagroup.com (206) 973-0844

A Case Of Renal Tubular Acidosis With Sjogrens Syndrome Showing Paradoxical Block Of Pth Due To Severe Hypomagnesemia

, Volume 32, Issue4 , pp 496499 | Cite as A Case of Renal Tubular Acidosis with Sjogrens Syndrome Showing Paradoxical Block of PTH Due to Severe Hypomagnesemia Distal renal tubular acidosis (RTA) manifests either as Complete/Classical form or Incomplete/Latent Form. Distal RTA causes normal anion gap metabolic acidosis and hypokalemia. Interstitial Nephritis is the most frequent renal manifestation of Sjogrens, which presents as Distal RTA in 2540% of patients with Sjogrens syndrome. Magnesium deficiency is frequently associated with hypokalemia. Although serum calcium is the main physiological control for the secretion of parathyroid hormone (PTH) by the parathyroid, serum magnesium can also exert similar effects. While low levels of magnesium stimulate the secretion of PTH, very low serum concentrations tend to induce a paradoxical block of PTH release by activation of the alpha-subunits of heterotrimeric G-proteins. This mimicks the activation of calcium sensing receptor leading to inhibition of PTH secretion. Here we describe the case history of a 35-year-old lady who presented to our hospital with severe hypokalemia due to distal RTA and perhaps had a paradoxical block of PTH Continue reading >>

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  1. kaazoom

    I recently had my Hba1c tests and it was over 9 . The doctor increased my metformin from 1 tablet twice a day to 2 tablets twice a day. I was told to start by increasing the morning dose and after 2 weeks increase my evening dose. I have had a lot of stomach discomfort, and terrible indigestion since increasing the does. I work up the other morning in extreme pain like I was having a heart attack. The pain went after taking antacids. Indigestion is something I get every now and then, but it is usually due to eating something I should avoid. This day I don't think I had eaten anything that would cause it. But I had increased my evening dose of metformin, so I was and am on 4 tablets a day. I have had more general discomfort than usual, muscle pains and more breathlessness.The difficult is I have other health problems so knowing which one is caused by which is a nightmare.
    I also tend to let myself get dehydrated at night as I have bladder problems which I having investigations for at the moment. If I don't stop drinking about at about 7pm I end up waking numerous times to go to the loo. The only drink I have after 7pm is a few sips of water to help swallow my medications.
    Sorry for being so long winded. My main question is does lactic acidosis come on suddenly, or does it build up over days or weeks?
    Paul

  2. destiny0321

    Hi. If you find your metformin could be causing problems which it did with me runs,breathing problems and generally really poorly go back to your gp I did and I was put on me form in slow release which is much gentler on the stomach hope this helps you destiny
    Sent from the Diabetes Forum App

  3. kaazoom

    Thanks.
    I've got to see my GP next week about something else so I will talk to him about it. I don't think I have lactic acidosis, I was curious about whether it was sudden or gradual onset. I saw something on the TV yesterday that said patients are risking their health because they don't read the information sheets that come with their medication. So I had a look at mine. It gave a number of symptoms to watch out for including severe indigestion,muscle spasms etc it said if you have any of these symptoms when taking Metformin to go immediately to the nearest hospital A&E because these symptoms can be signs of lactic acidosis. I don't think what I'm experiencing is severe enough for A&E.
    I had muscle spasms, pains and a number of the other symptoms list prior to my diabetes diagnose due to other illnesses, and they can vary in severity. They seem to have got somewhat worse since my metformin was increased, but it could just be coincidence. The indigestion and stomach problems are particularly bad. My feeling is my body is taking time to adapt to them. i will ask my doctor if I can change to a slow release version.
    Paul

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Anion gap usmle - anion gap metabolic acidosis normal anion gap metabolic acidosis

Acquired Pyloric Stenosis Resulting In Hypokalaemic, Hyperchloraemic Normal Anion Gap Metabolic Acidosis. Persistent Vomiting In An Adult: Cause And Effect

A 24-year-old woman presented with a history of persistent vomiting for at least 3 months. This resulted in severe dehydration with risk of acute kidney injury. In addition to volume depletion, loss of gastric fluid resulted in a specific metabolic derangementhypokalaemic, hypochloraemic normal anion gap metabolic alkalosis with a reduced ionised calcium concentration and paradoxical aciduria. These metabolic changes were reflected in her ECG. Investigation demonstrated acquired gastric outflow tract obstruction secondary to a pyloric peptic ulcer. The patient was resuscitated with intravenous crystalloid and electrolyte supplements. The acquired pyloric stenosis was treated medically with a proton pump inhibitor and Helicobacter pylori eradication therapy with excellent recovery. Contributors PK is the sole author of this manuscript. The full text of all Editor's Choice articles and summaries of every article are free without registration The full text of Images in ... articles are free to registered users Only fellows can access the full text of case reports (apart from Editor's Choice) - become a fellow today, or encourage your institution to, so that together we can grow and d Continue reading >>

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  1. Jeanwf

    Hi. Anyone out there suffer from feeling really, really hot doing Keto Diet. My face is as red as beetroot in the mornings and throughout the day I get several hot flushes. Any ideas?:explode:

  2. rachelrb85

    Could it be menopause?

  3. Jeanwf

    I have finished now with the menopause as I started when I was 46! Grrrrr. Could it be because I am burning fat?

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Testing a "Khan Academy" presentation for USMLE style videos.

Pyloric Stenosis: Fluid Therapy

Home / ABA Keyword Categories / P / Pyloric stenosis: Fluid therapy Pyloric stenosis is a medical emergency, not a surgical emergency. The patient should not be operated on until there has been adequate fluid and electrolyte resuscitation. According to Barash, the infant should have normal skin turgor, and the correction of the electrolyte imbalance should produce a sodium level that is >130 mEq/L, a potassium level that is at least 3 mEq/L, a chloride level that is >85 mEq/L and increasing, and a urine output of at least 1 to 2 mL/kg/hr. These patients need a resuscitation fluid of full-strength, balanced salt solution and, after the infant begins to urinate, the addition of potassium. The cardinal findings in pyloric stenosis are dehydration, metabolic alkalosis, hypochloremia, and hypokalaemia. Loss of gastric fluid leads to volume depletion and loss of sodium, chloride, acid (H+) and potassium. This results in a hypokalemic, hypochloremic metabolic alkalosis. The kidneys attempt to maintain normal pH by excreting excess HCO3.The kidneys attempt to conserve sodium at the expense of hydrogen ions, which can lead to paradoxical aciduria. In more severe dehydration, renal potassiu Continue reading >>

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  1. SunnySmile

    Please explain ketosis in layman's terms

    My mother, who is also type 2 and does not believe in low carb, tells me ketosis is dangerous and eventually your body will start using muscle for energy, including the heart muscle. She's an RN, but hasn't worked in years and years. I'm not sure she knows what she's talking about.
    My research (limited) tells me it's being in the process of your body converting from using sugar to using fat for energy. Is this correct? Is there any danger in this that you know of?
    Also I think ketoacidosis is bad, but I haven't researched that yet. Any thoughts on this would be appreciated.

  2. timothyw

    High blood sugar readings with high ketones can lead to something called ketoacidosis which is very bad. Your mother is probably thinking that all keytones are bad. Low blood sugar readings with the presence of ketones is just the body telling you that you are burning fat for energy. Many people confuse the two or don't know enough about low carb to understand there is a big difference. The body can fuel itself using glucose or keytones - a healthy liver is capable of producing all of the glucose needs of those cells that cannot use the keytones so that the actual need for carbohydrate foods as a fuel source are actually pretty low. If you are low carbing though you need to increase your fat content so that you are producing plenty of keytones for fuel and you need to be sure that you are eating sufficient protein. Even a high carb low fat diet will cannibalize muscle tissues since they are usually portion controlled diets and it's hard to get enough fat and protein.

  3. SunnySmile

    OK, sounds like I was on the right track; but what exactly are keytones?

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