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Paradoxical Intracellular Acidosis Definition

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Sodium Bicarbonate

Indications Metabolic Acidosis Diabetic Ketoacidosis (DKA) (see Diabetic Ketoacidosis and Hyperosmolar Hyperglycemic State) Indications: pH <6.9-7.0 (however, evidence for this recommendation is lacking) Patients with Hemodynamic Compromise (Due to Impaired Myocardial Contractility and Vasodilation) or Life-Threatening Hyperkalemia May Particularly Benefit from Bicarbonate Administration to Correct the pH Lactic Acidosis (see Lactic Acidosis) Adverse Effects of Acidemia: these (selected adverse effects) provide a rationale for administering bicarbonate with pH <7.1 Arrhythmias Arterial Vasodilation and Venoconstriction Decreased Left Ventricular Contractility Impaired Responsiveness to Catecholamine Vasopressors (Nat Rev Nephrol, 2012) [MEDLINE] Indications: pH <7.1 (however, evidence for this recommendation is lacking) This is due to the fact that at pH <7.1, small changes in pCO2 and serum bicarbonate result in large changes in the serum pH Clinical Efficacy: neither of these trials demonstrated clinical benefit with bicarbonate administration in patients with pH >7.1 Trial of Sodium Bicarbonate in Critically Ill Patients with Lactic Acidosis (Ann Intern Med, 1990) [MEDLINE] Sodi Continue reading >>

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  1. nurseprnRN

    The hypokalemia comes when the patient gets treated with insulin, driving the glucose and K+ into the cells. The kidneys can't (and won't) move so much out through urine with the excess glucose to make for hypokalemia.

  2. Esme12

    There can be a brief period of hypoglycemia in the early stages of an elevated blood sugar (polyuria)....but by the time "ketoacidosis" sets in the Serum potassium is elevated but the cellular potassium is depleted (all that shifting that goes on)
    Diabetic ketoacidosis

  3. April2152

    So pretty much what we would observe clinically is hyperkalemia because the osmotic duiresis does not move serum potassium significantly?

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What is DIABETIC KETOACIDOSIS? What does DIABETIC KETOACIDOSIS mean? DIABETIC KETOACIDOSIS meaning - DIABETIC KETOACIDOSIS definition - DIABETIC KETOACIDOSIS explanation. Source: Wikipedia.org article, adapted under https://creativecommons.org/licenses/... license. SUBSCRIBE to our Google Earth flights channel - https://www.youtube.com/channel/UC6Uu... Diabetic ketoacidosis (DKA) is a potentially life-threatening complication of diabetes mellitus. Signs and symptoms may include vomiting, abdominal pain, deep gasping breathing, increased urination, weakness, confusion, and occasionally loss of consciousness. A person's breath may develop a specific smell. Onset of symptoms is usually rapid. In some cases people may not realize they previously had diabetes. DKA happens most often in those with type 1 diabetes, but can also occur in those with other types of diabetes under certain circumstances. Triggers may include infection, not taking insulin correctly, stroke, and certain medications such as steroids. DKA results from a shortage of insulin; in response the body switches to burning fatty acids which produces acidic ketone bodies. DKA is typically diagnosed when testing finds high blood sugar, low blood pH, and ketoacids in either the blood or urine. The primary treatment of DKA is with intravenous fluids and insulin. Depending on the severity, insulin may be given intravenously or by injection under the skin. Usually potassium is also needed to prevent the development of low blood potassium. Throughout treatment blood sugar and potassium levels should be regularly checked. Antibiotics may be required in those with an underlying infection. In those with severely low blood pH, sodium bicarbonate may be given; however, its use is of unclear benefit and typically not recommended. Rates of DKA vary around the world. About 4% of people with type 1 diabetes in United Kingdom develop DKA a year, while in Malaysia the condition affects about 25% a year. DKA was first described in 1886 and, until the introduction of insulin therapy in the 1920s, it was almost universally fatal. The risk of death with adequate and timely treatment is currently around 1–4%. Up to 1% of children with DKA develop a complication known as cerebral edema. The symptoms of an episode of diabetic ketoacidosis usually evolve over a period of about 24 hours. Predominant symptoms are nausea and vomiting, pronounced thirst, excessive urine production and abdominal pain that may be severe. Those who measure their glucose levels themselves may notice hyperglycemia (high blood sugar levels). In severe DKA, breathing becomes labored and of a deep, gasping character (a state referred to as "Kussmaul respiration"). The abdomen may be tender to the point that an acute abdomen may be suspected, such as acute pancreatitis, appendicitis or gastrointestinal perforation. Coffee ground vomiting (vomiting of altered blood) occurs in a minority of people; this tends to originate from erosion of the esophagus. In severe DKA, there may be confusion, lethargy, stupor or even coma (a marked decrease in the level of consciousness). On physical examination there is usually clinical evidence of dehydration, such as a dry mouth and decreased skin turgor. If the dehydration is profound enough to cause a decrease in the circulating blood volume, tachycardia (a fast heart rate) and low blood pressure may be observed. Often, a "ketotic" odor is present, which is often described as "fruity", often compared to the smell of pear drops whose scent is a ketone. If Kussmaul respiration is present, this is reflected in an increased respiratory rate.....

Diabetic Ketoacidosis

I. Review of normal lipid metabolism Triglycerides in adipose ==lipolysis==> Long-chain FAs Long-chain FAs==hepatic beta-oxidation==>Acetyl CoA Acetyl CoA==hepatic ketogenesis==>ketone bodies Ketone bodies are Beta-hydroxybutyrate and Acetoacetate Beta-OHB is oxidized to AcAc-; their relative concentrations depend on redox state of cell; Beta-OHB predominates in situation favoring reductive metabolism (e.g. decreased tissue perfusion, met. acidosis, catabolic states--like DKA!) Typical ratio Beta-OHB:AcAc- is 3:1; us. increases in DKA II. Hormonal influences on glucose and lipid metabolism Insulin In liver, increases glu uptake from portal blood; stimulates glycogenesis, inhibits glycogenolysis and gluconeogenesis In skeletal muscle, increases glu uptake from blood, stimulates protein synth, inhibits proteolysis In adipose tissue, required for glu and lipoprotein uptake from blood; stimulates lipogenesis, inhibits lipolysis Tissues which don't require insulin to transport glucose into cells: brain, renal medulla, formed blood elements Counterregulatory hormones: glucagon (major player in DKA), epi/norepi, cortisol, growth hormone (no acute effects, only over days-weeks) Glucagon: i Continue reading >>

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  1. NewdestinyX

    Is moderate Ketosis too much?

    Hey gang,
    For dieting reasons I've recently started an Atkins styled approach. It's modified in that I sorta blend Phase 1 and 2(which adds nuts and more dairy) with a little bit of 'potatoes' (from Phase 3). No grains at all no fruit juices at all. I stay under 30g of carbs a day without fail. In the first 5 days I'm down 6.5 lbs -- after having been on an extended plateau for 6 months caused by taking too much basal insulin AND by still allowing myself some grains in the form of Sugar Free treats from different companies.
    So this modified Atkins is working. Cool!. BUT I picked up Ketosis sticks the other day to verify whether or not I'm in full Ketosis (not to be confused with Ketoacidosis which is VERY bad for diabetics). I had heard on several forums that it's good to get yourself so the read out is between 'trace' to 'low' and that means you're where Atkins wants you for fat burning. But I was surprised to not that I'm in the MODERATE zone for sure -- with the color coding and at the 15 second mark after passing thru urine stream. Even on a very 'liberal' Atkins program that is not following it to a tee... I've achieved and agressive ketosis. That explains the nearly 1 pound of weight loss a day so far..
    My question is -- is 'moderate' on the read too TOO MUCH ketosis. Should I add back some carbs to slow that down? Am I endangering myself at all for the dreaded 'ketoacidosis' by being at this level of ketosis?
    Thanks for your input!

  2. jwags

    I think you are confusing ketoacidosis which is caused by very high bgs and dehydration, usually in Type 1's but can happen in Type 2's ( rarely). Usually bgs are quite high . When you are on a ketogenic diet you start to use fat for fuel ( energy). That is why you lose weight. Bein on a ketogenic diet does not lead to ketoacidosis. Go to Jenny's Low Carb Blog, she discusses all aspects of very low carb diet and what to expect
    www.phlaunt.com/lowcarb/

  3. furball64801

    When I was Atkins I never was concerned with it, felt the best in my life if only I have the determination again, you never know I might wake up and say this is the day.

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Demonstration of short duration of action of Sodium Bicarbonate Bolus

Md51 - Anaesthesia_mcq

MD51 [Jul01] An intravenous infusion of 8.4% sodium bicarbonate to a healthy adult maycause:A. HypotonicityB. Intracellular AcidosisC. Ionized HypercalcaemiaD.?Respiratory AlkalosisE. Rebound Metabolic AcidosisMD51b [Feb04] BicarbonateA. Complications include intracellular acidosisB. 100ml of 8.4% NaCO3 has 200 milliosmolesC.? Aug15 108. Side effect 8.4% NaHCO3 administration A. Intracellular acidosisB. Rebound metabolic acidosisC. ... Other options were easy to rule out =============================================================================================================== Brandis p38 - almost word for word (is that allowed?) 8.4% NaHCO3 is a one molar solution because the molecular weight of NaHCO3 is 84 = 84g/L = 8.4g/100mls.But each molecule of NaHCO3 dissociates into 2 particles in solution so the osmolality is double the molality. ie 2 osmoles/kg = 2000mOsm/kg = about 7 times the plasma osmolality. 100mls of the solution would then have 200 mOsm. The ECF HCO3 will cause decrease in H+ concentration. I think this then causes H+ to move out of the cells and K+ to move in. If this is true, B would also be incorrect. Don't know about C,D,E can some smart person help me? R Continue reading >>

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  1. jcs

    Thanks pats found it. Could I check if those Philly stir in sauces are ok to use? And what's the best way to make tasty cauliflower mash? Thanks

  2. Jeanne76

    Thanks pat, checked the carb content and your right, Highlights hot chocolate is way over the 5-8g limit. Thanks for your help. X

  3. jenijen

    Philly sauces can be used, I'm hoping to use one in a fish pie- my way of making cauli mash I cook frozen/fresh cauli in microwave untill soft- put in a mini chopper and whizz, that's it done , sometimes I add a small bit of Philly or cayenne, cumin whatever I fancy really. If you don't have a mini chopper you should be able to mash with a masher or fork, generally you don't need to add anything as it comes out quite soft.

    Lost 3st in 3 months, not done well since, but restarting!!!!

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