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Vasopressors Acidosis

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A discussion of the physiology, pharmacology, and clinical use of vasopressors and inotropes, including phenylephrine, norepinephrine, epinephrine, dopamine, and dobutamine (among others).

Remember That Cardiac Pressors Do Not Work In A Low-ph Environment

Remember that Cardiac Pressors do not Work in a Low-pH Environment Remember that Cardiac Pressors do not Work in a Low-pH Environment Critically ill patients often require inotropic and/or pressor support to maintain adequate cardiac output and adequate blood pressure to sustain end-organ perfusion. Because end-organ perfusion has already likely been compromised and may continue to be problematic despite use of these agents, anaerobic metabolism rather than aerobic metabolism is likely to be generating a limited amount adenosine triphosphate (ATP) in the hypoperfused tissues. The consequence is lactic acid production and acidosis. Additionally, critically ill patients may have other causes of acidosis contributing to the overall acidotic state including renal failure, hyperchloremia, or ketoacidosis. The acidosis may be severe with pH values well below 7.0. Binding of the inotropic or pressor agents to their receptors is influenced by pH, along with other factors such as temperature and concentration. Presumably, the greater the deviation in either direction from the optimal pH for the drug-ligand interaction, the less binding that will occur and hence, the less the effect of the Continue reading >>

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  1. Joe Joe

    I've heard of people buying them at Wal-Mart, but I was just there and couldn't find any. Maybe I was looking in the wrong section?
    Where do you folks find your ketostix? :)

  2. doreen T

    Any store with a pharmacy will have ketostix (sometimes called lipolysis sticks, or ketone testing strips). Look in the section where they sell diabetic supplies. Some stores have them behind the counter ... apparently they're hot shop-lift items :rolleyes: You don't need a prescription though, so just ask.
    hth,
    Doreen

  3. Joe Joe

    Thanks! I'll have to ask next time.
    Here's a dumb question... how do you pronounce keto? 'kee-to', 'kay-to'??? :o
    Thanks again!

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Illustration of the different types of pressors used in ICU, effects and advantages.

Chapter 23: Use Of Vasopressors

1) Which of the following conditions can result in a lowering of blood pressure in critically ill patients? B.Decreased pulmonary capillary wedge pressure 2) The central venous pressure (CVP) catheter is a device that is used to effectively perform what function in critically ill patients? B.Administer drugs directly into the central circulation 3) Which of the following statements about central venous oxygen saturation is correct? A.It indirectly measures oxygen extraction by tissues. B.It may be low in inadequately volume-resuscitated patients with septic shock. C.It measures adequacy of volume resuscitation more accurately than does blood pressure measurement. D.It should be targeted to a value in excess of 70%. 4) Which of the following parameters is a measurement of regional perfusion? A.Arterial blood lactate concentration 5) Stimulation of the beta adrenergic receptor by agonists results in a physiologic response mediated by which of the following? 7) Which of the following outcomes is a goal that should be achieved within THREE hours of presentation in a patient with septic shock? 8) Which of the following explains the development of lactic acidosis by a catecholamine? A.E Continue reading >>

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  1. walkerwally1

    Interpreting the ReliOn Ketone Test Strips

    I have been low carb, less than 25g/day, for the last week and was sure I was in ketosis but thought I would check with the ReliOn test strips from Walmart. My result was 40mg/dl on their chart which they call moderate. Everything I have read lists ketones as mmol and it is said ketosis is from 0.5 to 5.0 mmol. I thing 40mg/dl converts to about 2.2 mmol but I am not sure. If someone understands this better than me I would like to know if I am doing the conversion right.
    I am currently reading a book about Low Carb Living:
    The Art and Science of Low Carbohydrate Living: An Expert Guide to Making the Life-Saving Benefits of Carbohydrate Restriction Sustainable and Enjoyable: Stephen D. Phinney, Jeff S. Volek: 9780983490708: Amazon.com: Books
    I think this is one of the best books I have found so far, not better than Dr. Bernstein's or Jenny Ruhl's, but a great compliment to the lchf WOE. It goes into great detail about the science of low carb and why it works and is more natural than our high carb diets. It is written to inform professionals and they invite you to give a copy to your Doctor. The link is to Amazon so you can get more info and see some of the reviews it has received. I have no connection to this book or authors other than being impressed.

  2. Steve3129

    Quote:

    Originally Posted by walkerwally1
    I have been low carb, less than 25g/day, for the last week and was sure I was in ketosis but thought I would check with the ReliOn test strips from Walmart. My result was 40mg/dl on their chart which they call moderate. Everything I have read lists ketones as mmol and it is said ketosis is from 0.5 to 5.0 mmol. I thing 40mg/dl converts to about 2.2 mmol but I am not sure. I use these strips as well, but the only thing they tell you is if you are spilling Ketones in the urine, excess Ketones at that. The color code really doesn't tell you more other than the darker the color, the more your kidneys are taking out of the blood.
    You have to get a special meter and strips to accurately measure blood Ketones, which is rather expensive and I'm not willing to buy. I'm satisfied to know that I'm producing Ketones by the excess production as indicated by the strip.

  3. MCS

    If your showing any color on the urine test strip your in ketosis.

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In this video we discuss the progression of a systemic infection including systemic inflammatory response syndrome, sepsis, severe sepsis, septic shock and multi organ dysfunction syndrome.

Lactate Clearance And Vasopressor Seem To Be Predictors For Mortality In Severe Sepsis Patients With Lactic Acidosis Supplementing Sodium Bicarbonate: A Retrospective Analysis

Lactate Clearance and Vasopressor Seem to Be Predictors for Mortality in Severe Sepsis Patients with Lactic Acidosis Supplementing Sodium Bicarbonate: A Retrospective Analysis Contributed equally to this work with: Su Mi Lee, Seong Eun Kim Affiliation: Department of Internal Medicine, Dong-A University, Busan, Korea Contributed equally to this work with: Su Mi Lee, Seong Eun Kim Affiliation: Department of Internal Medicine, Dong-A University, Busan, Korea Affiliation: Department of Internal Medicine, Dong-A University, Busan, Korea Affiliation: Department of Internal Medicine, Dong-A University, Busan, Korea Affiliation: Department of Internal Medicine, Dong-A University, Busan, Korea Affiliations: Department of Internal Medicine, Dong-A University, Busan, Korea, Institute of Medical Science, Dong-A University College of Medicine, Busan, Korea Initial lactate level, lactate clearance, C-reactive protein, and procalcitonin in critically ill patients with sepsis are associated with hospital mortality. However, no study has yet discovered which factor is most important for mortality in severe sepsis patients with lactic acidosis. We sought to clarify this issue in patients with lacti Continue reading >>

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  1. Shruti Padmanabhan

    Ketosis

    Insulin

    Diabetes

    Medicine and Healthcare



    How does ketosis occur due to low insulin rate?




    1 Answer







    Type 2 diabetes is a condition where the glucose metabolism has gone all awry due to either the body not being able to produce enough insulin or the cells not responding sufficiently to insulin. This condition can result in a host of health complications which can range from mild to life threatening. One such complication is called diabetic ketoacidosis (DKA) and if untreated can lead to coma and death.
    When your body produces little or no insulin, it starts burning fats for fuel. This is because insulin is necessary for pushing glucose (the preferred energy source) inside muscle cells. In the absence of glucose, fats are broken down by cells to derive energy. During this process, acidic substances called ketones are formed which start piling up inside the blood stream. This accumulation leads to ketoacidosis.

    Find out why complications occur in type 2 diabetes in this excellent article.

    124 Views · 1 Upvote








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    Related Questions



    What is insulin's role in ketosis?


    Is it true that insulin makes you age faster or is it just more dieting mumbo jumbo?


    When does protein sparing occur during ketosis?


    What problems can occur during insulin treatment?


    Is ketosis safe?


    What deficiencies can occur due to low stomach acid?


    What are the differences between ketosis and deep ketosis?


    Does low serum insulin cause high BSR?


    Does low serum insulin cause a low blood sugar level?


    Is longterm ketosis healthy?
    Ask New Question

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