Saline Induced Hyperchloremic Metabolic Acidosis Mechanism

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Urinary Strong Ion Difference Is A Major Determinant Of Plasma Chloride Concentration Changes In Postoperative Patients

To show that alterations in the plasma chloride concentration ([Cl-]plasma) during the postoperative period are largely dependent on the urinary strong ion difference ([SID]urine=[Na+]urine+[K+]urine-[Cl-]urine) and not on differences in fluid therapy. Measurements were performed at intensive care unit admission and 24 hours later in a total of 148 postoperative patients. Patients were assigned into one of three groups according to the change in [Cl-]plasma at the 24 hours time point: increased [Cl-]plasma (n=39), decreased [Cl-]plasma (n=56) or unchanged [Cl-]plasma (n=53). On admission, the increased [Cl-]plasma group had a lower [Cl-]plasma (1055 versus 1094 and 1063mmol/L, p<0.05), a higher plasma anion gap concentration ([AG]plasma) and a higher strong ion gap concentration ([SIG]). After 24 hours, the increased [Cl-]plasma group showed a higher [Cl-]plasma (1114 versus 1044 and 1073mmol/L, p<0.05) and lower [AG]plasma and [SIG]. The volume and [SID] of administered fluids were similar between groups except that the [SID]urine was higher (3837 versus 1822 and 2318mmol/L, p<0.05) in the increased [Cl-]plasma group at the 24 hours time point. A multiple linear regression analys Continue reading >>

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Popular Questions

  1. deborahbarnes904

    I started January, 34 days ago, down almost 16 lbs. I lose on average 2 to 4 ounces a day. Of course some days no loss, others a gain. I have experienced two "whoosh" and each time lost over 1 lb. My loss is trending pleasantly down. Much different than my first attempt at LCHF.
    Making mistakes with Keto can cause serious stalls and even hinder weight loss. I'll talk about Keto first. Learn from my blunders. If you're doing keto and not happy with your loss answer these questions. Am I drinking diet soda? Am I consuming artificial sweeteners? Am I consuming any "diet" food (example: Atkins products). Am I consuming more than 30% of protein daily? Have I used a keto calculator to determine my total daily energy expenditure? Am I consuming OVER 75% fat? Do I daily eat at a deficit? (Some keto folks don't believe in eating at a deficit. I learned to, i personally had to. You may be different. Discover your own truth about deficits by experimenting).
    I used to consume upwards of 80% fat or more, (fat bombs) (you want to utilize your OWN body fat so you do not want to consume over 75% fat on average. I currently consume between 70 to 75%, most often is 70%. Protein is essential. I used to not calculate at all how much protein I consumed. Too much and it converts to glucose. You should keep protein between 15 to 30%. I average around 25 to 30%. (Once you know your daily energy expenditure say it's 1700. Then you use the keto calculator to determine how many fat, protein grams you should consume. Then log daily what you'll eat, and from there you will see as you log your food what percent you're at. I use fatsecret and cronometer.com.). You can google ketogenic diet for appropriate food to consume.
    OMAD. What can I say about one meal a day? I would suggest intermittent fasting regularly and increase your time to learn how to manage hunger with distraction and water. Fasting takes much practice. The more often you do it the better you get at managing the little voice in your head that says" feed me!" I love OMAD.
    I was surprised that my stomach volume shrunk by fasting everyday for 23 hours. At first I could hardly eat 1000 calories, then I was able to eat normal amounts then I found I was miserable because I felt so stuffed. It's taken some time but now I eat till I'm almost full. I consume between 1350 and 1850 calories. Averaging 1500.
    When I started OMAD for some reason I didn't lose any weight. A week later I decided to go back to LCHF or Keto. I wanted to do them together. There was an immediate response. I started losing right away.
    Not like many people, I believe in climbing the scale everyday. I'm learning patterns in my weight loss and gains. I simultaneously take body measurements of my neck, arm, waist, hips, and thighs. As well as photos. When the scale goes up I grab my measuring tape. So far each time I check I've LOST more inches from the last record made. So far I've lost 8.5 inches, five on my waist!
    Finding a weight loss plan is very personal. What works for me may not work for you. Don't give up. Keep tweaking and trying. I gave up and regained 30 lbs.
    This is the first time in my life when a weight loss strategy/lifestyle worked so well for me. I'm here if you have any questions!!

  2. lizh9

    what time do you eat your meal?

  3. deborahbarnes904

    Lizh9 because of my odd sleep schedule on average I eat at 9:30pm. But I'm not married to it if my schedule changes.

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

Differential Diagnosis Of Nongap Metabolic Acidosis: Value Of A Systematic Approach

Differential Diagnosis of Nongap Metabolic Acidosis: Value of a Systematic Approach Division of Nephrology, Veterans Administration Greater Los Angeles Healthcare System (VHAGLA), Los Angeles, California; David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California; Department of Medicine, Division of Nephrology, St. Elizabeth's Medical Center, Boston, Massachusetts; and Department of Medicine, Tufts University School of Medicine, Boston, Massachusetts Dr. Jeffrey A. Kraut, Division of Nephrology, VHAGLA Healthcare System, 11301 Wilshire Boulevard, Los Angeles, CA 90073. Email: jkraut{at}ucla.edu Nongap metabolic acidosis is a common form of both acute and chronic metabolic acidosis. Because derangements in renal acid-base regulation are a common cause of nongap metabolic acidosis, studies to evaluate renal acidification often serve as the mainstay of differential diagnosis. However, in many cases, information obtained from the history and physical examination, evaluation of the electrolyte pattern (to determine if a nongap acidosis alone or a combined nongap and high anion gap metabolic acidosis is present), and examination of the serum potass 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

  2. rockyromero

    ” 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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Hyperchloremia Why And How - Sciencedirect

Volume 36, Issue 4 , JulyAugust 2016, Pages 347-353 Hyperchloremia Why and howHipercloremia: por qu y cmo Author links open overlay panel Glenn T.Nagami Open Access funded by Sociedad Espaola de Nefrologa Hyperchloremia is a common electrolyte disorder that is associated with a diverse group of clinical conditions. The kidney plays an important role in the regulation of chloride concentration through a variety of transporters that are present along the nephron. Nevertheless, hyperchloremia can occur when water losses exceed sodium and chloride losses, when the capacity to handle excessive chloride is overwhelmed, or when the serum bicarbonate is low with a concomitant rise in chloride as occurs with a normal anion gap metabolic acidosis or respiratory alkalosis. The varied nature of the underlying causes of the hyperchloremia will, to a large extent, determine how to treat this electrolyte disturbance. La hipercloremia es una alteracin electroltica frecuente que se asocia a una serie de distintos trastornos clnicos. El rin desempea una funcin importante en la regulacin de la concentracin de cloruro a travs de diversos transportadores que se encuentran a lo largo de la nefrona. Sin Continue reading >>

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Popular Questions

  1. JudoMuscle

    Induction Stage

    How long did it take YOU to enter ketosis on your first keto diet?
    I'm at day 2, dieting strictly, and feeling the gloom of induction pretty hard. Just curious how long it took you guys before you knew you were in ketosis. I've read that it could be anywhere from 3- 30 days...

  2. dcd5269

    Originally Posted by JudoMuscle
    How long did it take YOU to enter ketosis on your first keto diet?
    I'm at day 2, dieting strictly, and feeling the gloom of induction pretty hard. Just curious how long it took you guys before you knew you were in ketosis. I've read that it could be anywhere from 3- 30 days...

    This is my second day on it. Though, I was in ketosis the first time I used a ketostix, which was yesterday. I've never eaten many carbs, just never gotten enough fat either. So, I was always in ketosis. Though, tonight I had 2 shots of vodka and as i was dumping my milk down the drain I had a swallow or two :/ Then I had a piss later and had 'trace amounts' of ketons. No biggie.
    I'm worried about calories. I lift hard for an hour and do 20 minutes of cardio 6 days a week and eat roughly 2600 calories a day. Im totally within the 60 35 5 ratio though. Hoping this 15 lbs fall off....
    Good luck to you!

  3. Bubbarossa

    First time it was about 3-4 days. After that, I believe it only took a couple days.

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