Tham Lactic Acidosis

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The Use Of Tris-hydroxymethyl Aminomethane In The Emergency Department

The use of tris-hydroxymethyl aminomethane in the emergency department Lu, Leibner, and Wright: The use of tris-hydroxymethyl aminomethane in the emergency department Christina Lu , Evan Leibner , Brian Wright Department of Emergency Medicine, Stony Brook University, Stony Brook, NY, USA Correspondence to: Brian Wright Department of Emergency Medicine, Stony Brook University, Hsc, Level 4, Room 080, Stony Brook, NY 11794, USA Received: July 20, 2016 Revised: August 22, 2016 Accepted: August 22, 2016 Copyright 2016 The Korean Society of Emergency Medicine This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( ). Bicarbonate therapy is often not effective for alkalinizing the blood pH in critically ill patients because it requires patients to augment their already maxed respiratory drive. Tris-hydroxymethyl aminomethane is a little known amine buffer that works in a closed system independent of pulmonary function and may be an effective alternative to sodium bicarbonate. Treatment of critically ill patients is a multi-faceted problem. Often the physician is faced with multiple complex tasks that range from correctly di Continue reading >>

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Popular Questions

  1. ToriG

    Bought some strips this afternoon and I'm not in ketosis. What are the most common causes?
    I really don't think I'm going over 20 carbs--can't see how I can be. At 2-3 cups of those veggies each day plus some salad dressing...otherwise, I am eating MEAT. (And getting tired of it--will have to browse the recipes!)

  2. juddinminime

    How many days have you been inducting in lc? Usually takes me 3-4days to get there. And check and make sure that there is no sugar in anything you consume.

  3. pcaltman

    Takes me 4 days too. Make sure your eating butters and fats. When I add more of the fats I go into Ketosis faster.

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You can directly support Crash Course at http://www.subbable.com/crashcourse Subscribe for as little as $0 to keep up with everything we're doing. Also, if you can afford to pay a little every month, it really helps us to continue producing great content. In this episode, Hank talks about how nutty our world is via Buffers! He defines buffers and their compositions, talks about carbonate buffering systems in nature, acid rain, pH of buffers, and titration. Plus, a really cool experiment using indicators to showcase just how awesome buffers are. ***** AND NOW, A SUBBABLE MESSAGE! ***** "Olena, you Spanish-speaking Ukrainian, will you marry me?" -Emannuel Martinez -- Table of Contents Nature is Nutty 0:00 Carbonate Buffering and Acid Rain 0:35 Definition of Buffers 1:47 Composition of Buffers 2:26 pH of Buffers 3:33 Titration 7:43 Carbonate Buffering in Nature 7:12 -- Want to find Crash Course elsewhere on the internet? Facebook - http://www.facebook.com/YouTubeCrashC... Twitter - http://www.twitter.com/TheCrashCourse Tumblr - http://thecrashcourse.tumblr.com Support CrashCourse on Subbable: http://subbable.com/crashcourse


(Version 1.0 3/1/2001 - 7/30/2007) Acidosis is a frequent problem in critically-ill neonates. Buffers may be used as part of the treatment strategy of a metabolic acidosis. The etiology of a low pH must be understood to treat infants appropriately. Respiratory acidosis (increased CO2 on a blood gas) can only be treated by improving ventilation. Buffers will not help in this case, and may make the situation worse. The etiology of a metabolic acidosis (highly negative base deficit on a blood gas) must also be taken into account to determine the need to treat and appropriate measures to take. In all cases, giving buffer will only partially and transiently remedy the situation; the underlying problem generating the acidosis must be addressed. Although many different illnesses can cause a metabolic acidosis, the two most common etiologies seen in the NICU are lactic acidosis from impaired perfusion and non-anion gap hyperchloremic acidosis due to renal bicarbonate wastage. Lactic acidosis heralds a significant underlying problem; possibilities include hypovolemic shock, inadequate cardiac output, and sepsis. Hyperchloremic non-anion gap acidosis is a much less critical problem but is e Continue reading >>

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Popular Questions

  1. kensid23

    Hello all,
    I've been trying to educate myself and read as much as possible about this diet but I have an obvious concern about the relationship between ketosis and the adverse effects on the kidneys.
    In discussions I've had, I've been told that your kidneys have to work harder when you are doing diets like Atkins, Paleo (Upgraded Bulletproof), which result in problems with filtering waste, high blood pressure, kidney stones and risk of kidney failure. Albeit pretty extreme, I'd like to know if any of you have seen anything that would support either stance?
    Here's one of the articles I've read from Livestrong.com:
    I like when they say at the end of the article, "ketosis is simply an evolution-driven response to the need to survive on stored fat. And that ketones are a more preferred fuel source than carbohydrates"

  2. Rod

    Depending on your lifestyle, it's recommend (Dave) to come in and out of ketosis every 3-5 days. I assume this would be for someone who went on a very long ketosis cycle.
    Edit: After reading the link:
    Ketosis Effects on the Kidneys
    Very high levels of ketones make your blood more acidic and overburden your kidneys. "Medical News Today" reports that one of the side effects of a ketogenic diet is the formation of kidney stones. In processing higher amounts of protein, your kidneys work hard and are forced to excrete more sodium, calcium and potassium, as well as filter more of the byproducts of protein metabolism. This extra fluid and electrolyte loss can cause low blood pressure, another function mediated by your kidneys. Ketosis in the presence of diabetes can lead to ketoacidosis and coma, and can be life threatening.
    [font=Arial, Helvetica]Read more: http://www.livestrong.com/article/463341-ketosis-kidney-failure/#ixzz2Df9fHaWB [/font]
    [font=Arial, Helvetica] [/font]
    [font=Arial, Helvetica]I'm eating about just a little over the normal amount of protein I would, instead of beef I would have lots of chicken. It seemed to focus more about protein hurting your kidneys and 20% of your calories should be from protein. Doesn't sounds crazy to me....[/font]
    Everything I learned about "biohacking" has been baby steps to "circadian biology", that's where the real biohacking comes in. You can buy a bunch of cool shit to "hack" but if you don't have context, you're not winning. Paleo is just a brand now and too many have opinions, it's on you to read and reread the material to not only find truth but to connect the dots. Much love to everyone who has helped me on my journey for restoring my health, please keep in touch. Feel free to message me with health questions [email protected]

  3. 16bit

    just remember the ketosis and ketoacidosis are two different things.

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Your Patient In Extremis: Tham To The Rescue?

Your Patient In Extremis: THAM To The Rescue? By: Prathap Sooriyakumaran, MD and Curtis Geier, PharmD One of the final common denominators dictating the success or failure of any resuscitative effort, be it a trauma or medical code, is the patients acid-base status. In the presence of acidosis, many of the tools at your disposal, including vasopressors, become impotent and the patients ability to strike a balance between bleeding and clotting or mounting an appropriate inflammatory response become deranged.16 So what are the options to tilt the acid-base status in our favor? One thing is clear, sodium bicarbonate is not the hero we have been searching for. Unfortunately, the buffer we all know and want to love is ineffective in producing any significant change that will alter outcomes in the setting of the acutely acidemic patient.7,8 Why? Well to understand this, well have to do a brief dive (a wade) into the relevant human biochemistry. So if you give sodium bicarbonate in an attempt to scavenge your troublemaking protons, youll get carbonic acid which dissociates into carbon dioxide and water, which can freely diffuse across the cell membrane creating an intracellular acidosis. Continue reading >>

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Popular Questions

  1. NewdestinyX

    Is moderate Ketosis too much?

    Hey gang,
    For dieting reasons I've recently started an Atkins styled approach. It's modified in that I sorta blend Phase 1 and 2(which adds nuts and more dairy) with a little bit of 'potatoes' (from Phase 3). No grains at all no fruit juices at all. I stay under 30g of carbs a day without fail. In the first 5 days I'm down 6.5 lbs -- after having been on an extended plateau for 6 months caused by taking too much basal insulin AND by still allowing myself some grains in the form of Sugar Free treats from different companies.
    So this modified Atkins is working. Cool!. BUT I picked up Ketosis sticks the other day to verify whether or not I'm in full Ketosis (not to be confused with Ketoacidosis which is VERY bad for diabetics). I had heard on several forums that it's good to get yourself so the read out is between 'trace' to 'low' and that means you're where Atkins wants you for fat burning. But I was surprised to not that I'm in the MODERATE zone for sure -- with the color coding and at the 15 second mark after passing thru urine stream. Even on a very 'liberal' Atkins program that is not following it to a tee... I've achieved and agressive ketosis. That explains the nearly 1 pound of weight loss a day so far..
    My question is -- is 'moderate' on the read too TOO MUCH ketosis. Should I add back some carbs to slow that down? Am I endangering myself at all for the dreaded 'ketoacidosis' by being at this level of ketosis?
    Thanks for your input!

  2. jwags

    I think you are confusing ketoacidosis which is caused by very high bgs and dehydration, usually in Type 1's but can happen in Type 2's ( rarely). Usually bgs are quite high . When you are on a ketogenic diet you start to use fat for fuel ( energy). That is why you lose weight. Bein on a ketogenic diet does not lead to ketoacidosis. Go to Jenny's Low Carb Blog, she discusses all aspects of very low carb diet and what to expect

  3. furball64801

    When I was Atkins I never was concerned with it, felt the best in my life if only I have the determination again, you never know I might wake up and say this is the day.

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