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Vasopressors For Lactic Acidosis

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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.

Understanding Lactate In Sepsis & Using It To Our Advantage

You are here: Home / PULMCrit / Understanding lactate in sepsis & Using it to our advantage Understanding lactate in sepsis & Using it to our advantage Once upon a time a 60-year-old man was transferred from the oncology ward to the ICU for treatment of neutropenic septic shock. Over the course of the morning he started rigoring and dropped his blood pressure from 140/70 to 70/40 within a few hours, refractory to four liters of crystalloid. In the ICU his blood pressure didn't improve with vasopressin and norepinephrine titrated to 40 mcg/min. His MAP remained in the high 40s, he was mottled up to the knees, and he wasn't making any urine. Echocardiography suggested a moderately reduced left ventricle ejection fraction, not terrible but perhaps inadequate for his current condition. Dobutamine has usually been our choice of inotrope in septic shock. However, this patient was so unstable that we chose epinephrine instead. On an epinephrine infusion titrated to 10 mcg/min his blood pressure improved immediately, his mottling disappeared, and he started having excellent urine output. However, his lactate level began to rise. He was improving clinically, so we suspected that the lactat Continue reading >>

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Popular Questions

  1. tincatinca

    Hello
    I'm type 2 and been on a low-carb diet for about 8 weeks which eventually led to going on a LCHF diet for about 1 week (<30g carb/day). This definitely helped my BS going from 10 to 6.9 (last Hba1c). However, I have an active job and whilst on the LCHF have missed things like porridge, odd piece of toast (which i used to be able to tolerate) to get me going in the morning and have since tried to re-introduce such things over the last couple of weeks and its been absolute turmoil to put it mildly . Around 1.5-2 hrs after eating even a piece of toast I feel totally weary and get symptoms including mild sore throat, headaches, feeling detached which in turn makes me really anxious. It feels like a total intolerance and I'm really at my wits end with what to eat and if this period will ever pass. I was wondering if anyone knew how much carb I should be re-introducing and when - I seem to be able to tolerate it better in my evening meal but breakfast and lunch are a nightmare. Any help would be HUGELY appreciated

  2. Brunneria

    Do you find this happens with wheat? Or all grains? Or all carbs?
    When i went very low carb i found that it revealed a couple of food intolerances. In my case it was grains and whey. Turns out my body had been 'coping' with them for years, but all that time i had felt 'not right'. Giving them up meant i felt better all the time.
    The other option is that the sleepiness is due to high spikes from the carbs. Are you testing to see how high and when you spike?
    Have a google on 'Last Meal Effect' to see if that rings any bells.
    If it is, you get choose whether to push through or stick with a way of eating that doesn't spike you.

  3. tincatinca

    Hi there, thanks for your reply. I seems to be all carbs but it definitely seems to be feel worse with bread and all bran for example rather than porridge although the testing I have done, porridge seems to spike more (more carb in it prob). With egg and toast it went from 7.5 to 9.5 (although I had been a walk inbetween) and porridge went from 7.9 to 11.8. Ill have a look at the last meal effect, thanks

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This is another in my how to series of making things. In this video I show you how to make a water ionization alkalization water unit using simple parts found around the house for around $20 to $30. I did this unit for my health, and to help me clean up 48 years of too many burgers and pizza, also to help me clean the fluoride and chlorine that many cities are putting into the public drinking water systems. I have been drinking the water I made in this unit for over a few weeks, with no harmful effects what so ever, I have however felt better, have more energy, and just a few days. After I started drinking my water I was able to cut my grass and still felt fine, where before I was dead, heck at one point I had to lay in my driveway to rest before I could get cleaned up. This video is intended for educational purposes only. So if you do decide to build one please do so at your own risk. The water made in this unit will result in a high PH ionized alkalized water which is said to balance the high acidic levels of your body. Note to date I do not own a digital ORP or PH level meter so I did the best I could with a chemical test unit I own. I advise anybody building one to purchase these items to get an accurate result of your water levels. Ok Ed, but what does PH and ORP mean? In simple terms PH = acid/alkaline balance = ionizing = O.R.P. (oxidation reduction potential) This is saying that when there are more H+ ions in water than OH- ions, it will read as acidic. When there are more OH- than H+, it's alkaline water. So acid or alkaline liquid is measured as pH, and pH is a measure of hydrogen ions (atoms).The more H+ in a liquid, the more 'acidic'. The more OH-, the more alkaline. What is a good level then? The fact is, most water ionizers will have an ORP reading of -300 to -600 at the 9.5 pH level most often used for drinking, but I have read that the body is not able to process anything over -350, and as the ORP goes to a stronger negative reading than -350 the body isn't able to process the excess. Drinking ionized water throughout the day, at any negative ORP level, gives the body a steady supply of antioxidants -- and minerals -- and hydration, so do not freak out if your water is at a -500 ORP. What is the reason then for drinking alkaline water? Some are reverse aging, more energy, there are too many to list, but the answer is out there on the internet please do the research. Lets just say our body is overloaded with acid type foods like burgers, beer, and soda, it needs help or it starts to rob bones and teeth, and yes, we actually erode our own skeleton to feed our acid habit. It can lead to gout which is painful I'll tell you what. Alkaline water helps to reduce the acid and help the body to balance, but reducing the burgers and beer should be the first step. Remember blood is 7.35 to 7.45 PH.

Efficient Extra- And Intracellular Alkalinization Improves Cardiovascular Functions In Severe Lactic Acidosis Induced By Hemorrhagic Shock | Anesthesiology | Asa Publications

Efficient Extra- and Intracellular Alkalinization Improves Cardiovascular Functions in Severe Lactic Acidosis Induced by Hemorrhagic Shock From the CHU Nancy, Service de Ranimation Mdicale Brabois, Pole Cardiovasculaire et Ranimation Mdicale, Hpital Brabois, Vandoeuvre les Nancy, France; Institut National de la Sant Et de la Recherche Mdicale (INSERM) U1116, Equipe 2, Facult de Mdecine, Vandoeuvre les Nancy, France; Universit de Lorraine, Nancy, France (A.K., N.D., and B.L.); INSERM U1116, Equipe 2, Facult de Mdecine, Vandoeuvre les Nancy, France; Universit de Lorraine, Nancy, France (N.S., K.I., and C.S.); and Critallographie, Rsonnance Magntique et Modlisation (CRM2), Unit Mdicale de Recherche (UMR), Centre National de la Recherche Scientifique (CNRS), Institut Jean Barriol, Facult des Sciences et Technologies, Vandoeuvre les Nancy, France; Universit de Lorraine, Nancy, France (J.-M.E. and S.L.). From the CHU Nancy, Service de Ranimation Mdicale Brabois, Pole Cardiovasculaire et Ranimation Mdicale, Hpital Brabois, Vandoeuvre les Nancy, France; Institut National de la Sant Et de la Recherche Mdicale (INSERM) U1116, Equipe 2, Facult de Mdecine, Vandoeuvre les Nancy, France; Univer Continue reading >>

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Popular Questions

  1. Rcroix

    Hello everyone.
    I have been on the 2:5 for about 6 months and lost about 10kg (over 20lbs) So thank you Dr Mosley!
    A lot of the reviews of the fasting lifesyle seem to suggest that it is just a way to reduce average weekly calories, but I’m sure most of you think there is more going on than simple calorie reduction.
    During the last 10 days I didn’t fast as I was on holiday traveling and found it difficult. Amazingly I did not gain any weight. This has happend on two occasions during the last 6 months.
    I think the fasting days are forcing the body to relearn how to burn fat. I’m a bit confused about the correct scientific terms for this ‘lypolysis’ is I believe the breackdown of fats (into amino acids) and ketosis the burning of
    fat as fuel.
    What ever the terminology it seems like the fasting days teach the body a long forgotten trick of switching from available glucose derived from what we just ate, to reserves stored as fat.
    I suggest that this trait applies to non fast days too, hence the lack of weigh gain during holidays.
    I used to do a bit of distance running and am quite familiar with the concept of ‘hitting the wall’. This is when a runner runs out of glucose and has to switch to fat burning (around the 18mile mark). Often that process is difficult, I have had to sit on the ground for about 3 minutes until my legs felt like they would work again.
    I’m not running now so I can’t try a quick marathon to see if the diet has helped with the switch.
    I welcome your thoughts.
    Good luck
    Martin.
    Perhaps Dr Mosely could weigh in on this with some scientific evidence.

  2. zec4peach

    I love science and this is why I love the 5.2 as it makes so much sense.
    Your body will go into ketosis when fasting for a short time, this is probably why some people get headaches. It will also make you very thirsty and wee a lot as your body tries to flush out the by products from fat metabolism. This is a common symptom of type 1 diabetes but obviously they go into a severe more ketoacidosis due to prolonged lack of insulin and metabolism of glucose and start burning muscle for fuel.
    It’s quite complicated stuff but if you google fasting ketosis there’s loads of interesting info online. Michaels book was lacking in any science stuff which is a shame as I think people are interested.
    I know that athletes or very fit people are more efficient at burning fat as they are used to it so yes I think the 5.2 does reset the metabolism in a similar way.
    I have managed to this this after years of cycling and find I can ride for a few hours on an empty stomach. Always need coffee though !!!
    Z

  3. Nika

    Hey Martin!
    I’m also very interested in ketosis. I tried it out a few weeks ago and didn’t eat any carbs for 1,5 week. I lost quite some weight, but felt like I couldn’t sustain it – I started feeling really weak, dizzy, couldn’t walk straight some days and all in all didn’t get the energy boosts some people boast about.
    So now I just cut carbs on my fast days and allow myself fruit and yoghurt on normal days – still prefer not to eat rice, noodles, bread and potatoes though. Sometimes a baked good or chocolate pudding as a treat, but not regularly. I do think this really contributes to my quicker than average weightloss (7kg in 3 weeks, of which most during that first 1,5 week).
    I’ve also started working out fasted. I do this after work before my only meal of the day, so after fasting for over 20 hours. I do HIIT (Insanity), which combines cardio and strength through bodyweight exercises. So far my results have been worse than when I did the program before when eating regularly, but I’m waiting to see how it goes in two weeks when I do my second fit test. My body is most likely also learning how to switch to burning fat efficiently.
    What you said about going on a holiday, this reminded me of the “carb loaders” I know. They basically cut carbs during the week, then they “carbload” on Saturday – eating everything from pizza to ribs to whatever they want. They say that it doesn’t cause them to gain weight, because the body is still in fat burning mode and the glucose from the carbs goes straight to the muscles, giving the muscles the strength to keep working out through the next week. Hence carb ‘loading’. These people are basically in ketosis 3 days a week (it usually takes the body about 3 days to go into full ketosis).
    These are all bodybuilder types though, who do mostly strength training so it doesn’t really sound like a great idea for me. I wanna be lean, not buff.
    Anyway, long post – gonna head over to the next one
    Annika

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The patient at risk and resuscitation team (PAART) at the Royal Free are celebrating both the success of an app they have developed to help fight the disease and being awarded for a national Nursing Times award. The following film demonstrates the six interventions for patients who are suffering severe sepsis. The steps are patient receives oxygen, intravenous antibiotics and fluid resuscitation, have blood cultures taken and fluid balance and blood lactate measured. The number one aim of our staff is to provide world class care to every patient, every day. However the trust has recognised that sepsis is sometimes hard to diagnose and the six medical interventions need to be delivered quickly, in a high pressure environment -- that is why a tool such as the app is a valuable bedside aid.

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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Popular Questions

  1. celiacgirls

    This past weekend, my 8 year old daughter was complaining that she was always thirsty. Then on Tuesday, my husband noticed she had acetone breath. She has had it before, last January, and they did the blood sugar test in the pediatrician's office and it was fine. They said her bad breath could be from not brushing her teeth properly. I don't really buy that but it did go away until now. She had just brushed her teeth when my husband noticed it. Because of the increased thirst and the acetone breath, I have her scheduled for the blood test again on Monday, when her doctor gets back from vacation.
    Are there any other causes of acetone breath that aren't related to diabetes? Even if her blood sugar is ok, could this be a sign she is at risk of diabetes?
    I'm already expecting the doctor to think I'm just an overzealous mom. I did tell her the girls are on a gluten-free/CF diet due to Enterolab and she didn't seem overly interested one way or the other, so maybe there is hope she will be ok with this.

  2. CarlaB

    I don't know about acetone breath, but I notice my kids get very bad breath even right after they've brushed if they have loose teeth, even slightly loose, it's like you can smell the root rotting away.
    I'd still have her checked out to be sure, but it's not unusual for a kid to have bad breath.

  3. 2kids4me

    This is an excellent link that discusses why a non-diabetic child may have acetone breath.
    http://www.childrenwithdiabetes.com/dteam/...10/d_0d_bc8.htm
    a bit from that link:
    Quote

    My six year old adopted son has had acetone breath consistently for several weeks. I've tested his urine with the strips for glucose and ketones twice, and they are both negative. He has had this previously only when he was slightly dehydrated from bouts of nausea and vomiting. He is otherwise perfectly healthy and active and has no symptoms of diabetes. We have a dog with diabetes which is why I am familiar with the signs and the breath odor and have the urine strips. Are there other causes of acetone breath in an otherwise normal six year old? In view of the negative strips should I still have his blood glucose tested?
    Answer:
    Not everyone can smell acetone, but if you can, the most sensitive vehicle is the breath which may explain why urine testing has been negative. Ketosis in children can occur when the body is unable to get sufficient basal energy needs from the metabolism of carbohydrate and resorts to the breakdown of fat stores with the production of ketones. This can occur because of diabetes, but, as you have noticed, this is most likely to occur when appetite is diminished by intercurrent illness. The same can happen if energy consumption is increased and a child is too busy to eat sufficiently.

    I think it very unlikely that what you describe has anything to do with diabetes, but if you have a diabetic dog and the means of measuring blood sugars you might test your son after a period of energetic activity to see if it is low because the phenomenon I have described is called ketotic hypoglycemia.

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