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Saline Infusion Metabolic Acidosis Usmle

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Acid-base Differential Diagnosis

This patient's elevated blood pH and decrease in PaCO2 is consistent with acute respiratory alkalosis. Respiratory acid-base disorders are caused by primary changes in PaCO2, whereas metabolic acid-base disorders are due to primary changes in the concentration of HCO3-. A primary rise in PaCO2 or a fall in plasma HCO3- reduces the pH (acidemia), whereas the opposite increase the pH (alkalemia). Patients suffering from pneumonia can have tachypnea due to hypoxia. Increased minute ventilation reduces arterial CO2, an acid, resulting in alkalosis. A slight decrease in bicarbonate level may be seen due to early renal compensation. Answer 1: Normal pH range is 7.35-7.45. This patient's pH is outside this range, which indicates an acid-base disturbance. Answer 2: A decreased pH and an decrease in HCO3- would be consistent with metabolic acidosis. Answer 3: An elevated pH and an increase in HCO3- would be consistent with metabolic alkalosis. Answer 4: Respiratory acidosis results from decreased alveolar ventilation, which causes increased arterial CO2 levels. Continue reading >>

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  1. Ketosis breath

    I'm starting a diet that will have me in ketosis. Exactly how bad am I going to smell, and is there anything I can do about it besides chew gum?

  2. —Anonymous

    Gross. Stay in the fucking house.

  3. —Anonymous

    What made you decide to destroy your muscle tissue instead of eating sensibly?

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Hyperglycemic crises: Hyperglycemic hyperosmolar nonketotic coma (HHNK) versus DKA. See DKA video here: https://youtu.be/r2tXTjb7EqU This video and similar images/videos are available for instant download licensing here https://www.alilamedicalmedia.com/-/g... Voice by: Penelope Hammet Alila Medical Media. All rights reserved. All images/videos by Alila Medical Media are for information purposes ONLY and are NOT intended to replace professional medical advice, diagnosis or treatment. Always seek the advice of a qualified healthcare provider with any questions you may have regarding a medical condition. Support us on Patreon and get FREE downloads and other great rewards: patreon.com/AlilaMedicalMedia Hyperosmolar hyperglycemic state, or HHS, is another ACUTE and life-threatening complication of diabetes mellitus. It develops slower than DKA, typically in the course of several days, but has a much higher mortality rate. Like DKA, HHS is triggered when diabetic patients suffer from ADDITIONAL physiologic stress such as infections, other illness, INadequate diabetic treatment or certain drugs. Similar to DKA, the RISE in COUNTER-regulatory hormones is the major culprit. These hormones stimulate FURTHER production and release of glucose into the blood, causing it to overflow into urine, resulting in excessive LOSS of water and electrolytes. The major DIFFERENCE between HHS and DKA is the ABSENCE of acidosis in HHS. This is because, unlike DKA, the level of insulin in HHS patients is HIGH enough to SUPPRESS lipolysis and hence ketogenesis. This explains why HHS occurs more often in type 2 diabetics, who have more or less normal level of circulating insulin. Reminder: type 2 diabetics DO produce insulin but their cells do NOT respond to insulin and therefore cannot use glucose. Because symptoms of acidosis are NOT present, development of HHS may go UNnoticed until blood glucose levels become EXTREMELY high. Severe dehydration results in INcreased concentrations of solutes in the blood, raising its osmolarity. HyPERosmotic blood plasma drives water OUT of bodys tissues causing cellular dysfunction. Primary symptom of HHS is ALTERED consciousness due to excessive dehydration of brain tissues. This can range from confusion to coma. Emergency treatment consists of intravenous fluid, insulin and potassium similar to those used in DKA.

Hyperosmolar Hyperglycemic State (hhs)

By Erika F. Brutsaert, MD, Assistant Professor, Albert Einstein College of Medicine; Attending Physician, Montefiore Medical Center Hyperosmolar hyperglycemic state is a metabolic complication of diabetes mellitus (DM) characterized by severe hyperglycemia, extreme dehydration, hyperosmolar plasma, and altered consciousness. It most often occurs in type 2 DM, often in the setting of physiologic stress. HHS is diagnosed by severe hyperglycemia and plasma hyperosmolality and absence of significant ketosis. Treatment is IV saline solution and insulin. Complications include coma, seizures, and death. Hyperosmolar hyperglycemic state (HHSpreviously referred to as hyperglycemic hyperosmolar nonketotic coma [HHNK] and nonketotic hyperosmolar syndrome) is a complication of type 2 diabetes mellitus and has an estimated mortality rate of up to20%, which is significantly higher than the mortality for diabetic ketoacidosis (currently < 1%). It usually develops after a period of symptomatic hyperglycemia in which fluid intake is inadequate to prevent extreme dehydration due to the hyperglycemia-induced osmotic diuresis. Acute infections and other medical conditions Drugs that impair glucose to Continue reading >>

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  1. martin

    To maximize fat burn, is it better to eat before a cardio session (e.g. spin class), or after?

  2. Brenda

    Neither. I'll be back with more.

  3. Brenda

    As far as "maximizing" fat burning? If there is a scientific formula, I don't know it.

    What I DO know is this: I never eat before a lift session. Matter of fact, I normally lift at around 9 or 10 am, when I am 14 to 15 hours fasted. I have much more energy fasted.

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From: http://qbank.org http://qbank.org/thread-25008.html For correct answer and thousands of free high quality MCQs and videos join our members for free

Usmle Step 2: Electrolytes Part 2 Qbank (6 -> 27) Flashcards - Cram.com

How to treat lithium-induced nephrogenic DI? salt restriction and discontinuation of lithium severe polyuria, mild hypernatremia, urine osmolality may be lower than the elevated serum osmolality chronic compensated respiratory alkalois due to stimulatory effect of progesterone on the medullary respiratory center used to calculated the expected PCO2 during respiratory compensation for a primary metabolic acidosis mixed metabolic and respiratory acidosis lab values -decreased HCO3 to indicate primary metabolic acidosis -inappropriately nl PaCO2 indicates a primary respiratory acidosis (can be proven using Winter's formula -> PaCO2 should be lower than actual PaCO2) primary polydipsia -> nothing wrong with ADH anion gap metabolic acidosis + osmolar gap acidosis calcium oxalate crystals viewed on U/A -> rectangular envelope-shaped crystals serum osmolality (calculated) = 2Na + glucose/18 + BUN/2.8 primary metabolic acidosis with respiratory compensation type A: poor oxygen delivery to tissues 2/2 CO poisoning and circulatory failure (shock) quickest way to correct hyperkalemia + other ways calcium gluconate: cardiac membrane stabilization bicarb/beta 2 agonist: drive K into cells In c Continue reading >>

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  1. Leelluu

    I've done keto successfully before, but I got off the bandwagon and gained a ton of weight. I got back on keto at the beginning of February and have lost 20 pounds since then.
    The bad news is, my cholesterol has gone up - WAY up. It was around 210 last time I was tested (October 2016), and I just got my results today. It's 270!
    I thought keto was supposed to help with high cholesterol, not create it?
    My doctor says I need to severely reduce my fat intake. Does that mean I should quit keto, or should I go low carb, low fat?
    Why is my experience so different than what I've read about here?

  2. Mr_Truttle

    A few notes, as this is not uncommon on keto:
    It has been documented that rapid weight loss will spike cholesterol. You won't get a truly accurate read until your weight stabilizes (which may not be a while depending on what your goal is).
    Total cholesterol is a meaningless bio marker for health in and of itself. LDL ("bad") cholesterol is only slightly less meaningless. I would wager your HDL went up proportionate to your total, and that your triglycerides are down, which are both more important markers of cardio health according to modern research.
    Unless your LDL-P (particle count) has been directly measured, it's likely you're not getting a complete picture of the composition of your LDL cholesterol anyway. Standard lipid panels only estimate LDL through a formula that has been shown not to be reliable given low triglycerides. Google "Iranian formula."
    Not directly mentioned in original post, but remember that dietary cholesterol has been shown to not be all that relevant to serum cholesterol. Egg away.

  3. Leelluu

    Thanks, that's super helpful! I've been freaking out because my cholesterol has never been this high and my doctor is very worried.

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