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What Causes Normal Anion Gap Acidosis?

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Metabolic Acidosis - Endocrine And Metabolic Disorders - Merck Manuals Professional Edition

(Video) Overview of Acid-Base Maps and Compensatory Mechanisms By James L. Lewis, III, MD, Attending Physician, Brookwood Baptist Health and Saint Vincent’s Ascension Health, Birmingham Metabolic acidosis is primary reduction in bicarbonate (HCO3−), typically with compensatory reduction in carbon dioxide partial pressure (Pco2); pH may be markedly low or slightly subnormal. Metabolic acidoses are categorized as high or normal anion gap based on the presence or absence of unmeasured anions in serum. Causes include accumulation of ketones and lactic acid, renal failure, and drug or toxin ingestion (high anion gap) and GI or renal HCO3− loss (normal anion gap). Symptoms and signs in severe cases include nausea and vomiting, lethargy, and hyperpnea. Diagnosis is clinical and with ABG and serum electrolyte measurement. The cause is treated; IV sodium bicarbonate may be indicated when pH is very low. Metabolic acidosis is acid accumulation due to Increased acid production or acid ingestion Acidemia (arterial pH < 7.35) results when acid load overwhelms respiratory compensation. Causes are classified by their effect on the anion gap (see The Anion Gap and see Table: Causes of Metab Continue reading >>

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  1. Peter Flom

    I wet the bed until the summer I turned 13. My parents tried all sorts of things (although much less was available back then) nothing worked. Then it stopped.
    Given what you've said, I do not think stopping fluids earlier is the answer. I have known other teens who wet the bed and stopping them earlier didn't work. If your daughter is sometimes wetting the bed twice a night, then it is not a matter of too much fluid in her bladder.
    I think there are two ways to go:
    1) Diapers. These come in all sizes, including for adults. The main problems here would be cost and potential embarrassment.
    2) Medicine. I haven't been following this closely, but I have heard of medicines to deal with this problem. There may be problems with these, but it's worth investigating.

  2. Amanda S. Glover

    How are her verbal skills?
    If she is capable of telling you, what does she say about it?
    How is her access to the bathroom at night? Can she reach it independently? Is there a nightlight?
    Does she have problems going without being directed to? (You didn't say, but it took a long time for two of my guys to start going without being prompted to.)
    Some ideas:
    If you are certain she isn't drinking in the hour before bed, I think perhaps, she just isn't fully emptying her bladder, and is perhaps not certain on how to judge the need to go/what an empty bladder feels like
    Some suggestions:
    stop liquids earlier than you have been and having her go twice before laying down for bed, consider getting rid of obvious diuretics (tea/other caffeinated drinks) or limiting to much earlier in the day.
    Set a timer and get up to wake her up to go to the bathroom, I know this could mess up the sleep cycle for everyone, but I knew a mom who did this to avoid the mess and it worked out.
    Have your doctor prescribe an adult sized incontinence product (this will help keep the cost down if you have insurance) you can order them from medical supply, or as another suggested, try depends.
    Make sure the bathroom is accessible, move her toward more independent toileting if this is a problem.
    Create a social story about getting up to go by herself (yes even if she isn't verbal, read it to her anyway) use pictures of your home or make a video about it.
    If she needs assistance in the bathroom, get a baby monitor so you can hear when she needs you, consider waking earlier than you do to take her to the bathroom.

    Consider getting covers for the mattress or get a bed pad if you haven't as yet (comment about doubling up is a great idea).
    Get her looked over by the doctor to be sure it isn't a problem. Some people do have an overactive bladder; I do believe there is medicine for that.

    Don't shame her (not saying you do) but encourage.
    Good luck.
    (Mom with pdd-nos diagnosis three sons on the autism spectrum)

  3. Jerry Crespi

    Go to this site and check out several different ways to stop it. http://bedwettingstore.com/?gcli...
    The most common treatment when there is no medical problem is a retraining using an alarm which teaches you to wake up at the first few drops and go to the bathroom. Soon when you bladder is full, your mind will have you awake and go to the bathroom. There are some other sites and great tips on what you should or shouldn't do before bedtime to stop the problem.
    Usually it can be solved in a short period of time.

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this will be a series of lectures to illustrate in simple and precise way how you can manage acid-base imbalance in practical step by step approach.

Approach To The Adult With Metabolic Acidosis

INTRODUCTION On a typical Western diet, approximately 15,000 mmol of carbon dioxide (which can generate carbonic acid as it combines with water) and 50 to 100 mEq of nonvolatile acid (mostly sulfuric acid derived from the metabolism of sulfur-containing amino acids) are produced each day. Acid-base balance is maintained by pulmonary and renal excretion of carbon dioxide and nonvolatile acid, respectively. Renal excretion of acid involves the combination of hydrogen ions with urinary titratable acids, particularly phosphate (HPO42- + H+ —> H2PO4-), and ammonia to form ammonium (NH3 + H+ —> NH4+) [1]. The latter is the primary adaptive response since ammonia production from the metabolism of glutamine can be appropriately increased in response to an acid load [2]. Acid-base balance is usually assessed in terms of the bicarbonate-carbon dioxide buffer system: Dissolved CO2 + H2O <—> H2CO3 <—> HCO3- + H+ The ratio between these reactants can be expressed by the Henderson-Hasselbalch equation. By convention, the pKa of 6.10 is used when the dominator is the concentration of dissolved CO2, and this is proportional to the pCO2 (the actual concentration of the acid H2CO3 is very lo Continue reading >>

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  1. doug684

    Ketosis can cause damage to kidneys and liver

    So I'm about to fire up a keto regiment (again, I always fall off the wagon after about 2 months). Just searching around as it seems the other two times I started it I tend to have diarrhea a lot. Anyway, came across this. Any truth to this?

    When protein is deflected in this manner, it releases nitrogen into the blood stream, placing a burden on the kidneys as they try to excrete excessive urinary water due to sodium loss. When fat is likewise deflected, the breakup releases fatty acids, or ketones, into the bloodstream, further burdening the kidneys. If ketosis continues for long periods of time, serious damage to the liver and kidneys can occur, which is why most low-carbohydrate, or ketogenic diets recommend only short-term use, typically 14 days.
    http://www.holisticonline.com/remedi...nd-ketosis.htm

  2. Eileen

    I don't know where to start.
    Okay, I'll start with the assumption that keto is high protein. No, it's not, it's moderate protein compared with standard BB diets. The dangers of protein to the kidneys would apply far more to a 40/40/20 diet than to a keto one. If they applied. But they don't. People with damaged kidneys can not tolerate high levels of protein. So some "experts" have extrapolated this to mean that high levels of protein can damage healthy kidneys. Except there has not been one single case of this ever, in the history of recorded medicine.
    Most keto diets do not recommend 14 days or less, that's the classic way to do it wrong. Most low carb diets recommend making it a lifestyle.
    And again, where is the evidence that ketones do any damage to liver or kidneys or any other organ? Not a single case. The closest to damage from a low carb diet comes from the odd nutcase who tries to combine keto with no liquid, which does put stress on the kidney (just like any other diet which does not include liquid) but because keto is slightly diuretic, you'll see the effects a little quicker.

  3. doug684

    Originally Posted by Eileen
    The closest to damage from a low carb diet comes from the odd nutcase who tries to combine keto with no liquid, which does put stress on the kidney (just like any other diet which does not include liquid) but because keto is slightly diuretic, you'll see the effects a little quicker.

    There are people who try that? I don't see how. Keto makes me thirsty and will often drink constantly as long as my glass of water is full.

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A lecture on the differential diagnosis of a normal anion gap metabolic acidosis, focusing on renal tubular acidosis, but also covering diarrhea, saline infusion, hyperkalemia, kidney failure, and ureteral diversion

Normal Anion Gap Metabolic Acidosis

Home | Critical Care Compendium | Normal Anion Gap Metabolic Acidosis Normal Anion Gap Metabolic Acidosis (NAGMA) HCO3 loss and replaced with Cl- -> anion gap normal if hyponatraemia is present the plasma [Cl-] may be normal despite the presence of a normal anion gap acidosis -> this could be considered a ‘relative hyperchloraemia’. Extras – RTA, ingestion of oral acidifying salts, recovery phase of DKA loss of bicarbonate with chloride replacement -> hyperchloraemic acidosis secretions into the large and small bowel are mostly alkaline with a bicarbonate level higher than that in plasma. some typical at risk clinical situations are: external drainage of pancreatic or biliary secretions (eg fistulas) this should be easily established by history normally 85% of filtered bicarbonate is reabsorbed in the proximal tubule and the remaining 15% is reabsorbed in the rest of the tubule in patients receiving acetazolamide (or other carbonic anhydrase inhibitors), proximal reabsorption of bicarbonate is decreased resulting in increased distal delivery and HCO3- appears in urine this results in a hyperchloraemic metabolic acidosis and is essentially a form of proximal renal tubular aci Continue reading >>

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  1. Justin Mulesa

    Depends on your definition of Damage to the brain. It does, by definition, alter the brain chemistry, whether this alteration is beneficial or harmful depends on the baseline state, and effect of the medication. If all brain chemistry alteration was considered damaging, then all psych meds could be considered to cause brain damage (an interesting consideration). However, if the baseline state is itself abnormal, for example in schizophrenia, then dopamine antagonists, such as anti-psychotics, could be and are considered therapeutic. However, with these, and any drugs that alter brain chemistry (and indeed any drug at all) have undesired effects, known as side effects, due to the crudeness and non-specificity medications have. In the brain, even minor fluctuations can have massive consequences. A consequence of dopamine antagonism, at least for the older, less specific, 1st generation anti-psychotics, such as haloperidol, had a cumulative dose side effect which was like Parkinson's disease, known as tardive dyskinesia. Parkinson’s, and a great deal of all motor skills, are very closely linked to dopamine and their receptors, and too much or too little can lead to a decline in motor function. As a dopamine agnoist, as due to the widespread almost ubiquitous negative feedback loop found in physiology, one could conjecture that long term over stimulation of the dopamine tracts could result in a Parkinson’s like disease or other forms of dementia later on down the road, although long term and geriatric studies on adhd medications can be somewhat difficult to come across, here is a link to a simple google search:

  2. Mike Repik

    However that doesn't mean it will. There are a lot of factors. But the big question is, can you solve the problem by any other means than taking a pill which can possibly cause damage?

  3. Brendan Hardy

    There is some evidence to suggest that releasers like Adderall (a proprietary formulation of amphetamine salts) can cause damage to dopamine receptors over long term high dosage use. It appears that Dopamine reuptake inhibitors like Ritalin or Concerta (methylphenidate) have much less risk of brain damage. Now when I say brain damage, I don't mean it'll put you in a coma. It's more likely to kill off some dopamine receptors via overstimulation. As far as I know, the brain is very plasticine and can heal much of the damage over time.

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