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Saline Induced Hyperchloremic Metabolic Acidosis Mechanism

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Bala Venkatesh (University of Queensland, Australia) busting lactate myths at #SGANZICS on 22 April 2017. Mark your calendar for SGANZICS 17-21 May 2018!

Saline-induced Hyperchloremic Metabolic Acidosis And Clinical Outcomes In Critically Ill Patients

Saline-induced Hyperchloremic Metabolic Acidosis and Clinical Outcomes in Critically ill Patients Co-Investigators: Gilles Clermont, MD , Raghavan Murugan, MD , Lan Kong, PhD Hyperchloremic metabolic acidosis (HCA) is a common complication arising secondary to large-volume (saline) resuscitation (LVR) in patients. Several large clinical studies have documented the development of HCA during critical illness but none could adequately evaluate the impact of HCA on patient clinical outcomes. At present, 0.9% saline is the standard of care for volume resuscitation of critically ill patients throughout the world. However, data from animal experiments indicate that HCA is associated with hemodynamic instability, development of renal dysfunction, inflammatory response induction and decreased survival. Our preliminary clinical data also suggest that HCA is associated with prolonged hospitalization, greater number of days in the intensive care unit (ICU) and increased mortality compared to standardized intensive care unit mortality rates. Using a large dataset of critically ill patients from the intensive care units (ICUs) at the University of Pittsburgh Medical Center we will assess the in Continue reading >>

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  1. MathWiz

    I wasn’t sure which section I should post this in, my strategy is what I call the 4–2–1 plan, I fast 2 day non consecutive days a week, eat a low carb but not calorie restricted diet 4 days a week to keep the fat burning benefits of ketosis going and then I give myself 1 day a week to indulge and eat whatever I want, usually a Saturday pasta dinner and wonderful dessert. I also walk 4 to 6 miles a day during the week and 10 to 12 miles on Saturday.
    Low Carb plans such as Atkins can be very effective for some people including me, many people who start a low carb diet experience get what’s called the “ketosis flu” or the “induction flu” in the first few days while the body is adapting to burning ketones instead of glucose.
    The basic symptoms are:
    – Headaches
    – Nausea
    – Upset stomach
    – Lack of mental clarity (brain fog)
    – Sleepiness
    – Fatigue
    It’s called the “ketosis flu” for a reason: you feel sick. I’ve gone through it and it wasn’t a pleasant experience. Fortunately it only lasted 2 days but then suddenly I woke up feeling much better, less hungry and my energy level was really high and consistent throughout the day!
    The first time I thought to myself: “What the heck am I doing? I feel like I’m going to die!” but I persevered and when it was over I didn’t regret a thing because what I had gained mentally and physically was 100% worth it.
    For those of you that are going through the ketosis flu, don’t give up! I know you feel like it’s never going to get better but stick with it and you´ll be so happy you did! I’m telling you, waking up refreshed for the first time in years, not getting the afternoon “blah” feeling and stuffing my face with carbs to try to boost my energy is the best side effect of the low carb diet I’ve experienced. Okay, losing weight while eating good food, feeling full and satisfied is great too.
    First you have to understand why your body is reacting this way. Your body’s been burning glucose for energy so it’s basically full of enzymes that are waiting to deal with the carbs you eat, but now the body needs to make new enzymes that burn fat for fuel instead of carbs, and the transition period causes the flu-like symptoms.
    There are some things you can do to lessen the symptoms of the ketosis flu and to make it go away sooner (to force the body to transition sooner) Ok, let’s get to the good part – what to do:
    First of all – you’re probably dehydrated. Drink PLENTY of water while you’re on a low carb diet, and then drink some more.
    Watch your electrolytes. When the body is getting rid of excess insulin from your former carb-crazy diet you´ll lose lots of fluids that have been retained in your body. This causes the rapid weight loss most people see in their first few days of ketosis, it’s mostly water, sorry. When you lose all the retained water you also lose electrolytes like sodium, magnesium and potassium. When you’re lacking them you´ll feel like crap so when you’re feeling really ill on the ketosis flu try things like chicken/beef broth and look for foods rich in these minerals. Take a multi-vitamin and a multi-mineral.
    Ok, here is where people throw the red flag – Eat more fat – Yup, I said MORE fat. Have some butter, just not on a roll, eat some bacon and eggs for breakfast, just skip the potatoes and toast. This will force your body to hurry up the transition. You´ll think this is crazy and think you´ll never get lose weight eating this way, but you will.
    Don’t eat too much protein – The body can transform protein into glucose so if you eat too much of it in the first days it will slow down the transition. Go for fatty meat and cheese if you can, add fat to protein shakes etc.
    Drink water, replenish electrolytes (sodium, magnesium, potassium) with food and supplements, drink broth, eat fat and not too much protein.
    I hope this helps, and have a great day
    Charles

  2. rockyromero

    @mathwiz
    ” Take a multi-vitamin and a multi-mineral.”
    I have been forgetting to take a multi-vitamin on fast days. Thanks for the reminder.
    “Eat more fat – Yup, I said MORE fat. ”
    I will have avocado more often.

  3. AussieJess

    Thanks for that info, very interesting

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Whether due to bicarbonate loss or volume repletion with normal saline, the primary problems is in hyperchloremic metabolic acidosis hcl ammonium chloride loading, reabsorption proximal tubule reduced, part, because of hyperchloraemic acidosis, anion gap (in most cases). Administration of ns will decrease the plasma sid causing an acidosis this patient also had a normal anion gap hyperchloremic metabolic (hcma). Googleusercontent search. Normal anion gap (hyperchloremic) acidosis semantic scholar. Hyperchloremic metabolic acidosis is it clinically relevant? (pdf hyperchloremic in diabetes mellitus. Hyperchloremic acidosis wikipedia. Treatment of acute non anion gap metabolic acidosis ncbi nih. Aug 4, 2016 a normal ag acidosis is characterized by lowered bicarbonate concentration, which counterbalanced an equivalent increase in plasma chloride concentration. Acid base physiology 8. Hyperchloraemic metabolic acidosisdepartment of medicine. Mechanism of hyperchloremic metabolic acidosis. Hyperchloremic acidosis background, etiology, patient education emedicine. Respiratory acidosis alkalosis as with the hyperchloremic may result from chloride replacing lost bicarbonate. Although it can occur with disease of either the small or nov 5, 1984 normal anion gap (hyperchloremic) acidosiswalmsley and ghyperchloremic metabolic acidosis in which is jun 30, 2017 approach to adult causes hyperchloremic (normal gap) acidosis; Combined elevated official full text paper (pdf) existence has been recognized many areas for some was examined persistent. [1 ] quantify two phenomena that are important to anesthesiologists and other clinicians caring for hyperchloremic metabolic acidosis with a low serum k level is most commonly caused by diarrhea. Approach to the adult with metabolic acidosis uptodate. The most common nov 23, 2014 hyperchloremic metabolic acidosis is different. Extreme acidemia (ph 7. For this reason, it is also known as hyperchloremic metabolic acidosis a form of associated with normal anion gap, decrease in plasma bicarbonate concentration, and an increase chloride concentration (see gap for fuller explanation) common acid base disturbance critical illness, often mild (standard excess 10 meq l). Albumin corrected anion gap normal (5 15 meq l). Is correcting hyperchloremic acidosis beneficial? Emcrit. Hyperchloremic metabolic acidosis due to cholestyramine a case sid hyperchloremic openanesthesia. Anesthesiology hyperchloremic metabolic acidosis is a predictable consequence of pathophysiology, diagnosis and management. Hyperchloremia why and how science direct. There was no evidence of ingestion hydrochloric acid or its equivalentHyperchloremic acidosis wikipedia. The effect of acidemia on the serum potassium concentration depends we do not believe that transient perioperative hyperchloremic metabolic acidosis in this patient required presence ileal bladder augmentation issue anesthesiology, scheingraber et al. Hyperchloremic acidosis background, etiol

Mechanism Of Hyperchloremic Metabolic Acidosis | Anesthesiology | Asa Publications

Mechanism of Hyperchloremic Metabolic Acidosis Lawrence R. Miller, MD ; Jonathan H. Waters, MD ; Charlton Provost Department of Anesthesiology FHP, Inc., Fountain Valley, California, Department of Anesthesiology, University of California, Irvine Medical Center, 101 City Drive South, Route 81A, Orange, California 92668. Mechanism of Hyperchloremic Metabolic Acidosis Anesthesiology 2 1996, Vol.84, 482-483.. doi: Anesthesiology 2 1996, Vol.84, 482-483.. doi: Lawrence R. Miller, Jonathan H. Waters, Charlton Provost; Mechanism of Hyperchloremic Metabolic Acidosis. Anesthesiology 1996;84(2):482-483.. 2018 American Society of Anesthesiologists Mechanism of Hyperchloremic Metabolic Acidosis You will receive an email whenever this article is corrected, updated, or cited in the literature. You can manage this and all other alerts in My Account To the Editor:--Several points in the case report "Transient Perioperative Metabolic Acidosis in a Patient with Ileal Bladder Augmentation" [1] merit further discussion. We do not believe that the transient perioperative hyperchloremic metabolic acidosis in this patient required the presence of the ileal bladder augmentation. We accept that prolonged Continue reading >>

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  1. treehorn+bunny

    You don't need to be in DKA to get ketosis. It's probably because he hasn't been eating enough/is sick. It is not uncommon for people who have stomach viruses to burn ketones.
    In nondiabetic persons, ketonuria may occur during acute illness or severe stress.

  2. PorcineWithMe

    GERD/reflux/"heartburn" can cause that smell and so can taking Prilosec (or other PPIs). My husband had THE WORST breath from taking Prilosec. Ugh.

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http://bit.ly/1HjUiAOHyperchloremic Metabolic Acidosis, um weitere Informationen ber Hyperchloremic Metabolic Acidosis, klicken Sie bitte aufhttp://bit.ly/1HjUiAO

Hyperchloremic Acidosis

Author: Sai-Ching Jim Yeung, MD, PhD, FACP; Chief Editor: Romesh Khardori, MD, PhD, FACP more... This article covers the pathophysiology and causes of hyperchloremic metabolic acidoses , in particular the renal tubular acidoses (RTAs). [ 1 , 2 ] It also addresses approaches to the diagnosis and management of these disorders. A low plasma bicarbonate (HCO3-) concentration represents, by definition, metabolic acidosis, which may be primary or secondary to a respiratory alkalosis. Loss of bicarbonate stores through diarrhea or renal tubular wasting leads to a metabolic acidosis state characterized by increased plasma chloride concentration and decreased plasma bicarbonate concentration. Primary metabolic acidoses that occur as a result of a marked increase in endogenous acid production (eg, lactic or keto acids) or progressive accumulation of endogenous acids when excretion is impaired by renal insufficiency are characterized by decreased plasma bicarbonate concentration and increased anion gap without hyperchloremia. The initial differentiation of metabolic acidosis should involve a determination of the anion gap (AG). This is usually defined as AG = (Na+) - [(HCO3- + Cl-)], in whic Continue reading >>

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  1. survivn

    Keto while nursing?

    Hey fitnessman, is it a good idea to try a keto diet while nursing?, I have a friend that just had a baby and she would like to try keto to lose the "baby" fat. thanks for your help

  2. fitforlife

    I am not fitnessman, and probably will get jumped on for this, but I would say DEFINETLY NOT!!!!! Keto is a GREAT fat loss program, but it does deny you of some vitamins and minerals, even if you do take multi-vitamins and eat vegis, that your baby MUST have. I would tell her just to eat healthy and reasonable proportions and to exercise. That baby is taking a LOT out of her that she doesnt realize. Shoot, nursing a baby burns about 500 calories extra a day for women. I learned a lot about breast feeding because my wife just had a baby and we went to all these pre-baby classes.

  3. fitnessman

    That I'd jump you on this one
    A quick story. Well over 5 years ago the first I even heard of a high fat diet was from my wife. Being a nutritionist, I thought the diet was just plain silly. Also being a diet researcher at jeart, I set out to prove that the crap she trying was wrong.
    Well guess who was wrong?....ME! 5 years later the rest is hisorty. I have become a ketogenic diet guru to many. Just a story for ya all.
    Now on with the meat. All of my children have been breast fed. So Survivn, kudos to your friend for breasting! That is how babies were designed to eat. There still are 100's of componetes in breast milk that researchers cant even identify.
    My wife loves the Ketogenic lifestlye. While pregnant she does not do the diet due to such really odd cravings(nor would I stand in her way). Our last two children had been fed from her while being on the diet. She has found that the milk production is greater and has less trouble expressing milk than with the older ones, when she was on a carb based diet.
    The big key here while breast feeding(with any diet) is to take into account that more calories are needed for the milk production. How many really depends on metabolism. For my wife it works out to 13 or so per pound of TOTAL bodyweight.
    She will get plently of nutrients from the green veggies and low GI fruits in the diet.
    So yes, it is fine to breast feed on a ketogenic diet. You MUST eat greens and some low GI fruits.
    Also keep in mind that the female body will not release fat very well while breast feeding. HOWEVER the over all health and well being of the mother and baby will be much better. Not to fret the slow fat loss, because after the baby is weened(about 18 months) her metabolism will be already amped and ready to go!
    I have #6 coming in Dec. I can guarantee you my wife will be on a ketogenic diet. She is already looking forward to it!
    Have her pick up Protein Powers Lifesplan by the Eades doctors, this is a perfect diet for a lactating female.

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