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Respiratory Acidosis Pathophysiology

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Respiratory Acidosis

Acid-base balance disturbance from alveolar hypoventilation Rapid production of carbon dioxide Failure of ventilation increases partial pressure of arterial carbon dioxide (PaCO2) Respiratory acidosis can be acute or chronic In acute respiratory acidosis: PaCO2 is > 45 mm Hg with accompanying acidemia (pH < 7.35) In chronic respiratory acidosis: PaCO2 is > 45 mm HG with normal/near-normal pH (renal compensation) and serum bicarbonate levels > 30 mEq/L Treatment directed at underlying disorder/pathophysiologic process Caution: too-rapid correction of hypercapnia can result in metabolic alkalemia CSF alkalization can result in seizures Due to alveolar hypoventilation from any cause CNS depression causing impaired ventilation most common cause Lung diseases causing abnormal alveolar gas exchange usually don't cause hypoventilation Stimulate ventilation and hypocapnia 2 degrees to hypoxia Hypercapnia only occurs if severe disease, respiratory muscle fatigue Accompanying acidemia (can be severe) Only acute compensatory response is intracellular buffering CNS: CVA, infection, trauma, tumor Pulmonary: PNA, COPD, PTX, PE. Pulmonary edema, Smoke inhalation Neuromuscular disease (myasthenia Continue reading >>

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  1. Equinox

    Hello, I am on day 17 of the Whole30, which I started in an attempt to get my rosacea under control. I am also interested in weight loss. Anyway, I can say that my pants are fitting a little looser since I started and my rosacea is better than it has been in a long time. So far I have tried to be as compliant as possible and my only two slips were accidental. I ate a sausage that had red wine on the ingredient list (I forgot that wine isn't allowed as I don't drink alcohol at all so I didn't register that part of the book as applying to me and just skimmed over it!). I also accidentally grabbed my daughter's glass instead of mine and got a small sip of lime-ade before I could spit it out. Those were in the first week though. I didn't bother starting again on Day 1 with these as I plan to be on the Whole30 for more than 30 days and counting things annoys me.
    On the other hand, my menstrual cycle (which arrived about 10 days in) was both heavier and longer than normal and I had terrible insomnia for a week beforehand. After my cycle began this eased off somewhat but I still have trouble falling asleep, staying a sleep and also with waking up too early. I feel like a zombie and I'm averaging about 5 hours of poor quality sleep a night. I've had to stop my regular exercise routine as I'm just too tired. I should mention that I'm usually a good sleeper, except when my daughter wakes me up in the night, which unfortunately happens a couple of times a week these days. And that happened more than the usual number of times in the past two weeks so my sudden insomnia has been all the worse. This is seriously the worst quality sleep I have ever gotten in my life that was not caused by some external factor (like having a newborn). I just toss and turn and feel really anxious over nothing at all.
    It seems that some other people have experienced this with the Whole30 as well. I'm wondering if I've entered into ketosis, which I read was associated with insomnia in some people, especially women. I just weighed myself to see if I had any sort of profound weight loss that might explain it and it seems I've lost 4 lbs, which is more than usual for me but certainly not beyond the pale. So, assuming that I have not been eating enough starch (I've been trying to eat a starchy vegetable once a day and eating a banana once a day also), how long will it take to get out of ketosis if I start adding a starchy vegetable to each of my three meals? I should add that even though I maybe haven't been getting enough starch, I haven't been hungry at all and I didn't experience any cravings at all until the sleep deprivation started to kick in. Also, has anyone had success with melatonin?
    I just really want to get a good night's sleep.

  2. missmary

    I would not recommend melatonin as a long-term solution because it interferes with your bodies ability to produce melatonin on it's own. Magnesium is a great supplement that can help with sleep.
    If you already have included starchy veggies and bananas every day, ketosis is very unlikely. Regardless, starchy veggies can certainly help with sleep and anxiety issues, especially when consumed at meal #3. How is your fat intake? Make sure you keep that at least to the minimum recommended 1-2 thumbs per meal (don't rely on cooking fat alone, since much of that stays in the pan).
    Eating within an hour of waking and also getting sunlight right away in the morning (go outdoors for 15 minutes) can really help with getting cortisol in the right rhythm which will help with sleep. In the same vein, avoiding bright light and screens at night will also help keep circadian rhythms in proper order. Some people use amber glasses or software like f.lux to reduce blue light at night for a similar effect.
    Good luck. I hope you get some better sleep soon!

  3. Tom Denham

    I am one of those people who needs starchy veggies every day to keep me sleeping good. I've also had a great experience with taking magnesium. I used to take Natural Calm, but it provoked diarrhea for me. I switched to magnesium aspartate supplements - 200 to 300 mgs per night. It is working very well. Actually, when I first saw a functional medicine doctor, she gave me an injection of magnesium and I enjoyed great sleep that night and for the next several nights.

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Respiratory Acidosis Pathophysiology

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Vamsikrishna Gunnam M.B.B.S [2] Respiratory acidosis is an result of imbalance between acid-base due to alveolar hypoventilation .The normal range is 35-45 mm Hg for PaCO2.Increase in the production of carbon dioxide due to failure of ventilation results in sudden increase of the partial pressure of arterial carbon dioxide (PaCO2) above the normal range. Alveolar hypoventilation is one of the cause to increased PaCO2which is is called hypercapnia . Hypercapnia and respiration acidosis occur while impairment in air flow happens and the elimination of carbon dioxide by the respiratory system is much less than the production of carbon dioxide in the tissues .Respiratory acidosis encountered in the emergency department and inpatient patients, as well as in intensive care unit s and postoperative patients. Metabolism in the body tissues rapidly generates a big quantity of volatile acids which are like eg carbon dioxid e and nonvolatile acid. [1] The metabolism of fats and carbohydrates ends up in the formation of a huge quantity of carbon dioxide . The carbon dioxide combines with water to form carbonic ac Continue reading >>

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  1. lucullus

    low carb causing my fasting blood sugar to rise?

    A few months ago I had a fasting blood sugar test which showed signs of pre diabetes. I went on a strick diet for 4 weeks and lost 22lbs. I had another checkup and they told me there was no signs of diabetes. HBA1C was 5.4 and fasting blood was 99. I assumed all was well and went back to normal diet. Three weeks later I noticed my fasting level where 110-125 over a few days. I went straight on to a low carb restricted calorie diet, that's about 12 days ago.
    I have been consuming about 1400-1600 calories with around 130g carbs. Nearly All foods being low glycemic index. I thought I would add fasting days to my diet also. So I had one day on 650 calories. I have been doing about 1.5 to 2 hours of walking per day, plus either 1 hr bike or 1 hour gym. Since the fasting day (5 days ago) my fasting blood sugars have risen quite dramatically. My fasting blood sugar is averaging 145 and before bed I have scores as high as 175. I have lost around 12 lbs in the last 12 days. My BMI is currently 26.7 down from 30.2. My waist measurement is less than half my height 191cm versus 94 cm
    It appears that by loosing approx 34 lbs in total. I have managed to go from pre diabetic to full diabetes. I am very concerned can anyone give we a reason why my blood sugars are rising when I am eating such a low calorie low carb diet. It like my pancreas just decided to stop producing insulin. When a few weeks into the start of first part of my diet it was producing normal amounts. 72.3 pmol/l. My wife has said my breath has started to smell a bit worse last few days?

  2. Nan OH

    Hello and welcome
    For many people 130 grams of carbohydrates is not a low carb diet. Your extra fasting may be causing your liver to release stored glucose and that is raising your numbers. For me, if my Blood Glucose Level is 150 or higher I can not do heavy work outs. Well I could not, my health has changed due to other conditions and I can no longer work out at all.
    It is debated whether there is actually a pre-diabetes. When you notice that carbohydrates are giving you problems, they will almost always give you problems. We can control but we can not stop our inability to use our bodies' insulin.
    How often are you testing? I know test strips are expensive but since you are trying to figure this out you may want to test when you get up, one hour and two hours after each meal and then at bed time.
    Has your doctor run any test to rule out the possibility that you could be a Type One diabetic?

  3. AnnC

    You've made a lot of changes to your diet in the past 12 days, without waiting for each change to take effect. If eating the first 'strict diet' brought your HbA1c back into non-diabetic ranges while maintaining normal insulin production, is there any reason why you can't go back to eating that diet?

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Pathophysiology And Therapeutic Strategy Of Respiratory Acidosis - Oxford Medicine

PRINTED FROM OXFORD MEDICINE ONLINE (www.oxfordmedicine.com).Oxford University Press, 2015. All Rights Reserved. Under the terms of the licence agreement, an individual user may print out a PDF of a single chapter of a title in Oxford Medicine Online for personal use(for details see Privacy Policy ). Out of 1530 103 moles/day of protons derived from the hydration of CO2 only 4060 109 moles/day remain unbounded in the plasma. If the CO2 production exceeds the excretion, the CO2 content in plasma and tissue rises (respiratory acidosis) until a new equilibrium is reached. In fact, doubling the PCO2 may compensate the halving of alveolar ventilation with unchanged excretion of the CO2 metabolically produced. Body reacts to respiratory acidosis increasing the secretion of chloride associated with ammonium. The process leads to an increase of bicarbonate in the plasma with an associated increase of pH. All the steps described may be altered in critically-ill patients due to hyper-metabolism, decreased excretion, decreased content of buffering proteins and impaired kidney response. Several options are available for therapy, from mechanical ventilation to artificial lung, up to lung trans Continue reading >>

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  1. Hankpiggy

    Throwaway account for obvious reasons.
    Husband (55) was just diagnosed with adult-onset diabetes (misdiagnosed for 5 years as panic attacks) but refuses to do anything about it. He had a fasting glucose test (360mg/dL) and a follow-up a1c blood test (11.4%). That's literally the only testing he's had done for it.
    As soon as the initial diagnosis came back, he "fired" his primary care physician for misdiagnosing his condition. But he refuses to talk to his new PCM about it (the PCM has threatened to drop him as a patient because of it). He insists that he'll be fine, "or if not at least I know what's going to kill me."
    Won't change his diet, which has always been high in sugar. He can drink a 2liter bottle of soda a day, jokes that the suggested serving size for cinnamon buns is "all of them," etc. I've made some sneaky changes around the house. There's no snacks in easy reach. I'm cutting down on portion sizes and cooking with fewer carbs. But I have no control over what he does when he leaves for work, and I'm sure there are daily Dunkin Donut runs and fast food lunches.
    He gets blurred vision and what we used to call panic attacks but now we're calling "blood sugar events" about once a week. They're debilitating. He's unable to function for close to an hour and then shaky for another three or four. I did notice that he had a tiny cut on his foot that took forever to heal last year. In retrospect, I should have forced him to get tested then. No cardio or other issues. We regularly go on hikes with steep grades and 1,000' changes in altitude.
    I'm scared (and super pissed off) about his attitude. How long do I have to dig this grave?

  2. Ceanot

    Unfortunately, he can live for many years with horrible complications. You need to figure out what kind of life/partner you want. Are you happy to be sneaky and watch your partner slowly kill himself; or do you want a partner who will take care of himself so he can be around to do fun things? Are you partners or are you his caregiver?

  3. cdn_SW

    I'm so sorry your going through this, you must be incredibly frustrated. In my opinion it's not about how long it will take to kill him, it's about what it will do to his quality of life. Two of the more common and horrible complications of diabetes are problems with the eyes and neuropathy. He could go blind or end up losing a limb. You mentioned a cut that took forever to heal, uncontrolled blood sugar makes you prone to infections that can be difficult to heal, he could end up losing a toe, foot, or part of his leg. Neuropathy can also be horribly painful.
    Your husband needs to get a grip on dealing with this, it's really not that difficult once you make a decision to make some changes and get the proper treatment. You may also need to let him know whether or not you feel you would be able to be his caregiver if his health goes to shit due to his own negligence. It's a harsh reality, but better to come to grips with it now than when it's too late. It's hard to give a timeline, like in many things some people seem to fair reasonably well even with horrible control, and others may do all the right things and still end up with complications. Hopefully you can talk some sense into your husband, maybe have him google some images of diabetic neuropathy or diabetic foot ulcers, and see if that is enough to scare him into doing something.

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