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Respiratory Acidosis Compensation

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Acid-base Disorders In Patients With Chronic Obstructive Pulmonary Disease: A Pathophysiological Review

Acid-Base Disorders in Patients with Chronic Obstructive Pulmonary Disease: A Pathophysiological Review Department of Internal Medicine and Systemic Diseases, University of Catania, 95100 Catania, Italy Received 2011 Sep 29; Accepted 2011 Oct 26. Copyright 2012 C. M. Bruno and M. Valenti. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. This article has been cited by other articles in PMC. The authors describe the pathophysiological mechanisms leading to development of acidosis in patients with chronic obstructive pulmonary disease and its deleterious effects on outcome and mortality rate. Renal compensatory adjustments consequent to acidosis are also described in detail with emphasis on differences between acute and chronic respiratory acidosis. Mixed acid-base disturbances due to comorbidity and side effects of some drugs in these patients are also examined, and practical considerations for a correct diagnosis are provided. Chronic obstructive pulmonary disease (COPD) is a major public health problem. Its prevalence Continue reading >>

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  1. kween1996

    Hello all,
    I’m a 5’4, 145 pound, 20 year old female, 27% body fat who works out (kickboxing) for about 1 to 1.5 hours a day. I’ve been on Dairy free Keto and doing 16:8 IF for about 3 weeks now and have gained 3 pounds. I was 142 when I started Keto. The macros I follow are 1207 calories, 90 g of Protein, 20 g of carbs and then usually around 80ish g of fat until I feel full. I meal prep ahead of time on Sundays so all my meals are planned and I don’t cheat. With lots of water, exercise, taking a multivitamin/B Complex/Green Tea Extract, dairy free (so no cheese or anything), or artificial sweeteners, I don’t know why I’m not losing any weight on Keto. I’ve seen this work for so many people and have been doing extensive research as to why it won’t work for me. I’ve tried recalculating my macros and gotten these 2 results:
    upping my calories to 1324 calories and 80 g of protein with 20 net carbs, 103 g of fat
    lowering my calories to 1177 and doing 103 g of protein, 20 net carbs and 73 g of fat.
    These two seem completely different macros and I don’t know which one to follow since what I do right now is in the middle of both.
    An example of lunch and dinner I have during IF are like 8 oz of ground turkey, 2 eggs and 1/2 an avocado for lunch and a tuna salad with spinach, flax seed, MCT oil and 1 egg for dinner. With TONS of water- I fill up my hydroflask (32 oz) around 5 times a day.
    I’m just saddened that I haven’t lost ANY weight on Keto when it seems to work for everyone else. I’ve gotten blood tests done as well and my hormones are fine. My goal weight is 120 so I do have a significant amount of pounds to go and would appreciate any advice from you! I have even stopped all nuts and nut butters because I read that those could be an impediment to weight loss. I’m considering doing an egg fast in a few days for 3 days to see if that brings about any change.
    If it helps, I never got the keto flu (maybe because I was around 40-50 g of carbs to begin with), I’ve been tested and found 0 hormonal or thyroid issues, I TRACK EVERYTHING, my ketostix say that I am in ketosis and don’t know what else to do at this point.
    Thank you so much for your time- your journey is SO incredibly inspiring and I would hope to some success on Keto. Open to ANY advice at all! Please help!

    My instagram ketokween1996 has a lot of my meals and their macros, calories and such! I made this to be more accountable of myself!

  2. Brad

    Mom’s Before And After Pics Prove The Scale Means Nothing
    She’s living proof that we need to worry less about the number on the scale and worry more about how our bodies move and function.

  3. Ijjunne

    I have some things that come to mind after reading your post.
    First, being in ketosis doesn’t mean being fat adapted. It takes time, 3 weeks is a short time. Your body needs to adapt to your new lifestyle. And I really mean lifestyle, you shouldn’t consider ketosis as a diet but a new way of life.
    Second, I think your protein intake is too high. You should eat 1 to 1,5 g of protein per kg of lean bodyweight. I don’t think that your lean mass is 90 kg . Decreasing your protein intake means increasing your fat intake.
    Third, you seem to be in the diet mentality like a lot of us women. You shouldn’t count calories. During your keto adaptation, your only concern should be to eat under 20g of carbs, moderate protein and fat to satiety.
    Finally, you should take your body measurements (chest, waist, hips, thighs and arms) to track your progress.

    I hope it helps. And keep calm and keto on.

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Assessment Of Compensation In Acute Respiratory Acidosis - Deranged Physiology

Assessment of Compensation in Acute Respiratory Acidosis Mechanisms and classification of metabolic acidosis This chapter is concerned with the changes in pH and serum bicarbonate which result from acute fluctuations in dissolved CO2, as a consequence of acute changes in ventilation. It is a more detailed look at the wayCO2interacts with the human body fluid, and the resulting changes which develop in theserum bicarbonate concentration and pH. The discussion which follows builds upon and benefits from someof thebackground knowledgeoffered in otherchapters: Let us consider the favoured model of acute respiratory acidosis, the patient who has stopped breathing. Conventional wisdom dictates that so long as the oxygen supply continues to mass-transfer its way into the patient, then the patient will continue to produce CO2, and as a result of this metabolic activity the PaCO2will rise at a rate of around 3mmHg every minute. This technique of "apnoeic anaesthesia" is well known to anaesthetists, and has enjoyed a fluctuating level of interest since the sixties. With a high PEEP and a sufficient attention to detail one may go through the entire hour-long case without any breaths being ta Continue reading >>

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  1. Azrael

    Hi All,
    Firstly thanks so much for everyone who posts on this forum. I have been a lurker for around 5 weeks which is the length of time I have been doing lazy keto.
    I don't feel hungry anymore - this has been a revelation and a blessing that I am very grateful for since starting keto.
    From the 2 keto dudes podcast I remeber the frequenbt refrain "if you aren't hungry, don't eat"
    I have been eating at the normal times I usually eat but I'm not sure that I'm always hungry and have just eaten because I feel I should do to ensure I get my macros. It has occured to me that this is the perfect time for me to keep a copy of the hunger scale and actually workout what hungry is for me because I have spent so long emotionally eating.
    However, I have ingested alot of information on keto and I have smatterings of half digested ideas floating around in my head. If I didn't eat in the next 2 days would my BMR drop? Is low calorie ok as long as I don't spike my insulin with carbs? I am not sure how to proceed.
    Apologies if this has been covered ad nauseum but when I have searched some posts say there is no such thing as starvation mode and others refer to it.

    Thanks
    Azra

  2. BillJay

    Azrael:


    If I didn't eat in the next 2 days would my BMR drop?
    This would be considered a fast and metabolism can actually increase during a fast, but will not likely decrease.
    Azrael:


    Is low calorie ok as long as I don't spike my insulin with carbs?
    Chronic low calorie is the problem because at that point the body begins to predict that calories will continue to be limited and will down-regulate the metabolism to be conserving through what it thinks is an impending famine.
    Azrael:


    actually workout what hungry is for me because I have spent so long emotionally eating
    Yeah, this is part of my problem too and why I track everything in MFP so I can at least review the information to detect patterns and associate them with how I feel.
    Using MFP, I noticed that my IF was actually being combined with calorie restriction and although keto does seem to naturally reduce calories, I was just too low considering how I felt.
    I find it best for me to restrict carbs to under 20 grams, protein between 70 and 100 grams and eat fat until I feel full and some days that means eating very little and some days I eat a lot (and I really mean a lot) and I've been hovering around the same bodyweight for a couple of years. I have problems when I try to increase calories using carbs or protein.
    I would recommend against eating just to get your macros unless that is based on empirical evidence that eating too little of something consistently results in feeling cold or hungry, etc.. This is taken from personal experience because I noticed that feeling cold correlated with eating too little in general and specifically too little fat as well as eating too little protein was associated with more soreness and slower recovery from activity and exercise.
    In other words, spend some time eating what you want and evaluate the results. In your case and mine this can be scary knowing that we have a history of eating for emotional reasons so it's constantly second-guessing whether or not the hunger is real.
    I've used the information I log to find out what works for me and review it weekly to see if I'm drifting too high or too low and I will occasionally correct with an extra fast or skipping a fast and eating more in the next couple of meals.

    That's probably not very helpful, although you're not alone when it comes to really understanding hunger and eating to satiety, and I will say that I have gotten much, much better at understanding real hunger and eating appropriately because there are now many more times when I've eaten to satiety and spontaneously fast which is something that never happened before keto.

  3. Azrael

    Thanks so much @billjay that is so helpful.
    I have never felt satiated before or had so much stable energy and it isn't something I wish to lose see through my ignorance.
    I know it's silly but I think I'm worried that if I don't eat consistently I will get caught short and end up eating carbage and fall back into the carb cycle.
    I've decided to keep some mini cheeses, avocado and preserved meat with me and listen to my body. From your story and other people's I have faith I will even out.
    Thanks again Azra

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Acute Renal Response To Rapid Onset Respiratory Acidosis

Acute Renal Response to Rapid Onset Respiratory Acidosis Jayanth Ramadoss , Randolph H. Stewart , and Timothy A. Cudd Department of Veterinary Physiology and Pharmacology and Michael E. DeBakey Institute, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, Texas, 77843, USA Send correspondence to: Timothy A. Cudd, DVM, PhD, Department of Veterinary Physiology and Pharmacology, Hwy 60, Building VMA, Rm 332, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, TX 77843-4466 Fax: 979-845-6544 [email protected] The publisher's final edited version of this article is available at Can J Physiol Pharmacol See other articles in PMC that cite the published article. Renal strong ion compensation to chronic respiratory acidosis has been established but the nature of the response to acute respiratory acidosis is not well defined. We hypothesized that the response to acute respiratory acidosis in sheep is a rapid increase in the difference in renal fractional excretions of chloride and sodium (FeCl-FeNa). Inspired CO2 concentrations were increased for one hour to alter significantly PaCO2 and pHa from 32 1 mm Continue reading >>

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  1. Ash Simmonds

    This topic is actually much simpler than it's made out to be, that being it is merely a question of quantity of ketone production, and is only an issue in an individual who is unable to produce insulin.
    Unfortunately this is often glossed over even in medical texts, so it's not uncommon for even doctors and nurses to misunderstand the simple yet crucial difference, not to mention nutritionists.
    In the end it's all a matter of volume. Kind of like the difference between a sip, a gulp, and drowning.
    A moderate carbohydrate diet will often result in occasional trace amounts of ketone levels in the blood, typically after a fast (first thing in the morning) or after a decent exercise session. A very low carbohydrate diet is ketogenic by nature due to both low levels of carbohydrates in circulation/storage and ingestion of high levels of fat, and will result in moderate levels of ketone bodies circulating, usually around quarter-to-half the concentration of blood glucose, but occasionally reaching or even exceeding parity.
    Proper starvation - as in complete caloric avoidance for a week or two - can result in ketone bodies up to double or even triple circulating glucose levels, but even then the body has plenty of feedback loops to maintain ketone levels that are still well within safe parameters, you'll do organ damage from other stressors before ketones become a problem. There is of course something called alcoholic ketoacidosis, but this requires extensive periods of time where near 100% of your calories are derived from ethanol.
    Point being, this has nothing to do with nutritional ketosis. If you are capable of producing insulin then there is no danger of acidosis, which is actually ridiculously elevated ketones AND glucose levels.
    Serum ketone body levels typically look like this:
    Normal diet: 0-0.1 mmol/L
    Normal diet overnight fasted: 0.1-0.5 mmol/L
    Ketogenic Diet: 0.6-3.0 mmol/L
    1-4 weeks starvation: 6-10 mmol/L
    Diabetic insulin deficiency: >20 mmol/L

  2. Ketoacidosis

    http://caloriesproper.com/?p=4192
    Quote
    Ketoacidosis
    Nutritional ketosis is a normal, physiological response to carbohydrate and energy restriction. A ketogenic diet is an effective weight loss strategy for many. Ketoacidosis, on the other hand, is a pathological condition caused by insulin deficiency. The common theme is low insulin; however, in ketoacidosis, blood glucose levels are very high. Ketone levels are elevated in both states, although are 10-20x higher in ketoacidosis (~0.5-2 vs. > 20 mM). Nutritional ketosis and ketoacidosis should not be confused with one another, and a ketogenic diet doesn't cause ketoacidosis.
    ...
    In people on a ketogenic diet, blood glucose levels are not increased. This is an important aspect differentiating nutritional ketosis from ketoacidosis.
    ...
    Ketogenic dieting is safe, and can be beneficial. Ketoacidosis is pathological, and can be fatal.

  3. Ash Simmonds

    http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2129159/
    Quote
    Metabolic Effects of the Very-Low-Carbohydrate Diets: Misunderstood "Villains" of Human Metabolism
    ...
    Diabetic Ketoacidosis vs. Dietary Ketosis
    Diabetic patients know that the detection in their urine of the ketone bodies is a danger signal that their diabetes is poorly controlled. Indeed, in severely uncontrolled diabetes, if the ketone bodies are produced in massive supranormal quantities, they are associated with ketoacidosis.
    ...
    However, during very low carbohydrate intake, the regulated and controlled production of ketone bodies causes a harmless physiological state known as dietary ketosis.

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