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What Does Hyperchloremic Metabolic Acidosis Mean?

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Anion gap usmle - anion gap metabolic acidosis normal anion gap metabolic acidosis

Treatment Of Acute Non-anion Gap Metabolic Acidosis

Treatment of acute non-anion gap metabolic acidosis Medical and Research Services VHAGLA Healthcare System, Division of Nephrology, VHAGLA Healthcare System Correspondence to: Jeffrey A. Kraut; E-mail: [email protected] Search for other works by this author on: Clinical Kidney Journal, Volume 8, Issue 1, 1 February 2015, Pages 9399, Jeffrey A. Kraut, Ira Kurtz; Treatment of acute non-anion gap metabolic acidosis, Clinical Kidney Journal, Volume 8, Issue 1, 1 February 2015, Pages 9399, Acute non-anion gap metabolic acidosis, also termed hyperchloremic acidosis, is frequently detected in seriously ill patients. The most common mechanisms leading to this acidbase disorder include loss of large quantities of base secondary to diarrhea and administration of large quantities of chloride-containing solutions in the treatment of hypovolemia and various shock states. The resultant acidic milieu can cause cellular dysfunction and contribute to poor clinical outcomes. The associated change in the chloride concentration in the distal tubule lumen might also play a role in reducing the glomerular filtration rate. Administration of base is often recommended for the treatment of acute non-anion ga Continue reading >>

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  1. Silky

    I became diabetic (Insulin Dependent) when I was just 10 and I'm now 19 (just turned yesterday actually) and in the past year I have been in hospital 5 TIMES!! with ketones, also had to be put in ICU on one occasion aswell, BIG SCARE! Thought I was going to die
    My diabeties is fairly well controlled but the thing that is worrying me is the fact I keep getting ketones, even though I control my sugars well. It's confusing for me, my doctor said it my of been caused from when I was younger (Between about 15 and 17) and neglected my diabeties and ate sweets and all that.
    Anyways... the thing that scares me the most is;
    1. I keep getting ketones.
    2. The way I have been told to get rid of them is quite dangerous.
    The reason for it being dangerous is because my doctor told me that I should inject insulin, untill the ketones are gone (unless my ketone level is at 3, then I should come into hospital), but the has caused my sugars to drop rapidly and I get shakey, blurred vision etc (you all know the signs)... I tried drinking sips on luzozade sport (my favorite drink), and it seemed to work, and I can successfully get rid of the ketones and also avoid going hypo... but tends to leave my bloods, a bit out of whack untill my next injection, and I tend to wee and drink a lot.
    Has anyone even had this problem? or is currently going through it?
    If so then please chat to me, it's driving me nuts!!

  2. Shelley

    Hiya Silky,
    Sorry l dont know much about T1 apart from what l've read in passing on this board.
    However have you tried just drinking lots of water to flush away ketones (if thats (poss)? - lt was just a thought, l dont really have a clue.
    l know water is good at keeping the kidney's flushed.
    l'm sure someone else will answer you soon, l saw a few of your posts and just thought l'd try.
    Welcome to the Diabetes Daily Forum.

  3. Silky

    thanks for the welcome Shelly.
    Yeah I tried drinking water, doesn't do that much in my opinion... mass' of insulin seems to be the only way and that is why I'm sooo scared! because I know how serious ketones is, the doctors once told me that if I didn't come in hospital when I did, then another hour and I'd be in a coma or worse... but thankfully I'm still here and alive and well.

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What is BASAL METABOLIC RATE? What does BASAL METABOLIC RATE mean? BASAL METABOLIC RATE meaning - BASAL METABOLIC RATE definition - BASAL METABOLIC RATE explanation. Source: Wikipedia.org article, adapted under https://creativecommons.org/licenses/... license. Basal metabolic rate (BMR) is the minimal rate of energy expenditure per unit time by endothermic animals at rest. It is reported in energy units per unit time ranging from watt (joule/second) to ml O2/min or joule per hour per kg body mass J/(hkg)). Proper measurement requires a strict set of criteria be met. These criteria include being in a physically and psychologically undisturbed state, in a thermally neutral environment, while in the post-absorptive state (i.e., not actively digesting food). In bradymetabolic animals, such as fish and reptiles, the equivalent term standard metabolic rate (SMR) is used. It follows the same criteria as BMR, but requires the documentation of the temperature at which the metabolic rate was measured. This makes BMR a variant of standard metabolic rate measurement that excludes the temperature data, a practice that has led to problems in defining "standard" rates of metabolism for many mammals. Metabolism comprises the processes that the body needs to function. Basal metabolic rate is the amount of energy expressed in calories that a person needs to keep the body functioning at rest. Some of those processes are breathing, blood circulation, controlling body temperature, cell growth, brain and nerve function, and contraction of muscles. Basal metabolic rate (BMR) affects the rate that a person burns calories and ultimately whether that individual maintains, gains, or loses weight. The basal metabolic rate accounts for about 60 to 75% of the daily calorie expenditure by individuals. It is influenced by several factors. BMR typically declines by 12% per decade after age 20, mostly due to loss of fat-free mass, although the variability between individuals is high. The body's generation of heat is known as thermogenesis and it can be measured to determine the amount of energy expended. BMR generally decreases with age and with the decrease in lean body mass (as may happen with aging). Increasing muscle mass has the effect of increasing BMR. Aerobic (resistance) fitness level, a product of cardiovascular exercise, while previously thought to have effect on BMR, has been shown in the 1990s not to correlate with BMR when adjusted for fat-free body mass. But anaerobic exercise does increase resting energy consumption (see "aerobic vs. anaerobic exercise"). Illness, previously consumed food and beverages, environmental temperature, and stress levels can affect one's overall energy expenditure as well as one's BMR. BMR is measured under very restrictive circumstances when a person is awake. An accurate BMR measurement requires that the person's sympathetic nervous system not be stimulated, a condition which requires complete rest. A more common measurement, which uses less strict criteria, is resting metabolic rate (RMR).

Metabolic Acidosis

Metabolic acidosis occurs when the body produces too much acid. It can also occur when the kidneys are not removing enough acid from the body. There are several types of metabolic acidosis. Diabetic acidosis develops when acidic substances, known as ketone bodies, build up in the body. This most often occurs with uncontrolled type 1 diabetes. It is also called diabetic ketoacidosis and DKA. Hyperchloremic acidosis results from excessive loss of sodium bicarbonate from the body. This can occur with severe diarrhea. Lactic acidosis results from a buildup of lactic acid. It can be caused by: Alcohol Cancer Exercising intensely Liver failure Medicines, such as salicylates Other causes of metabolic acidosis include: Kidney disease (distal renal tubular acidosis and proximal renal tubular acidosis) Poisoning by aspirin, ethylene glycol (found in antifreeze), or methanol Continue reading >>

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  1. blurfocus

    Your first, best, and cheapest option is not to use them.
    Ketostix do not measure what many people expect that they do.
    Ketostix only measure excess levels of acetoacetate, which is not the type of ketones that correlate with nutritional ketosis.
    Ketostix may show negative ketones when your blood ketones are high and then may show positive ketones when your blood ketones are low.
    Misinterpretation of what they show is one of the most common unnecessary causes of keto anxiety and wasted time. You can be perfectly successful on a ketogenic or low-carb diet without ever measuring ketones.
    Many people are already overwhelmed with learning about keto diets. Adding another layer of unnecessary complexity doesn't help the matter. Often, people are most successful on keto when they treat it as a lifestyle and not a diet. Obsessively measuring ketones can be at odds with attempting to live a keto lifestyle.
    If you decide to use Ketostix anyway, please be kind to those who answer questions here by not submitting a question that begins with I know that Ketostix are unreliable, but ...
    If you consume few enough carbohydrates and avoid excessive intake of protein, you can trust that your liver will be producing ketones within a single day. That is how human metabolism works.
    If you consume too many carbs, you will be kicked out of ketosis temporarily. However, if you once again restrict carbs, you will go right back into ketosis within 24 hours. This is because the liver can store only 100 grams of glycogen. If you restrict carbs, the liver will run out of glycogen within a day and begin burning fat instead. The liver produces ketones as a side effect of burning fat.
    As an example of how Ketostix can be misleading, it is possible to eat a high-carbohydrate meal followed by a positive Ketostix result. You may think that you cheated the system, but you didn't. It takes time for excess ketones to appear in urine. Ketostix are showing you what happened in the past before you cheated.
    If you have the time and really want to know why Ketostix will not tell you much, read pages 164 and 165 of The Art and Science of Low Carbohydrate Living by Volek and Phinney. This is the section headed by Ketones: To Measure or Not.
    If you do not have this book, read this summary:
    http://ketopia.com/why-you-need-to-stop-worrying-about-the-color-of-your-ketostix/
    Ketostix were designed to help diabetics avoid ketoacidosis which is a dangerous condition involving very high blood sugar and very high serum ketones. If you have near normal blood sugar and serum ketone levels consistent with nutritional ketosis, you don't need to worry about this.
    Ketostix only measure excess levels of acetoacetate, which is not the type of ketones that correlate with nutritional ketosis.
    The ketones that correlate with nutritional ketosis are known as beta-hydroxybutyrate. This type can be measured only with a blood ketone meter.
    There is a built-in time lag. Ketostix are measuring what has happened in the past since it takes a while for the kidneys to produce urine.
    Exercise can influence how many excess ketones are excreted.
    You can be in nutritional ketosis even when Ketostix show no excess acetoacetate. In the keto-adapted state, very little acetoacetate ketones will be excreted in urine even though blood ketones may be high.
    Note that it takes a period of four to six weeks of being in ketosis every day in order to become keto-adapted. Someone who is keto-adapted has adapted to using fat as the primary fuel for muscles and various organs. The keto-adapted brain uses ketones in place of glucose for most of its energy needs. When keto-adapted, most acetoacetate is not excreted. Instead, muscles convert it to beta-hydroxybutyrate and return it to the blood for use by the brain.
    If after all of this, you still want to use Ketostix because you bought them and cannot bring yourself to throw them away or because they are comforting in some way, here is how they may be useful.
    When you are first starting a low-carb or keto diet and transitioning into ketosis from a moderate to high-carb diet, Ketostix will confirm that your body has in fact done what biology says that it must do. It will show that your liver has begun producing ketones.
    Once you are a few days into the diet, you can give them away to a keto newbie or toss them. Note that Ketostix will eventually expire, especially if you keep them in a moist environment like a bathroom.
    If you have a medical condition that makes monitoring blood ketone levels necessary or if you are a numbers geek with spending money, you may be interested in purchasing a ketone blood meter and test strips for measuring beta hydroxybutyrate in your blood. The test strips cost somewhere between $2 and $5 per strip.
    There are a few meters to choose from.
    Precision Xtra - https://www.abbottdiabetescare.com/products/patient/pxtra-overview.html
    Nova Max Plus - http://www.novacares.com/nova-max-plus/
    CardioChek Home - http://www.healthchecksystems.com/CardioChek.cfm#home
    Most use one of the first two listed (Precision Xtra or Nova Max Plus). Some say that the Precision Xtra is the more accurate of the two. I've found that readings from these two track fairly closely with each other. The Nova Max Plus has cheaper test strips.
    To detect nutritional ketosis, look for a reading between 0.5 and 5.0 mmol / liter. Some experts recommend aiming for a level of 1.0 to 5.0 mmol / liter.
    Another option is the Ketonix Sport breath meter. This meter measures acetate in the breath. It does not require test strips.
    Acetate forms when acetoacetate spontaneously breaks down to acetate. According to Volek and Phinney (page 165 of The Art and Science of Low Carbohydrate Living), it should be linearly correlated with blood ketones. In practice, it is not as accurate as the blood meters in part because it is difficult to breathe in the same way every time you test.
    Ketonix Sport (order direct from Sweden) - https://www.ketonix.com/index.php/product/sport
    Again, remember that you can be perfectly successful on a ketogenic or low-carb diet without ever measuring ketones whether in urine, blood, or breath.
    In the final analysis, ketone concentrations are what they are. Chasing ketone concentrations often becomes as unnecessary and distracting as Ketostix. Unless you are treating epilepsy, cancer, or other medical condition, the concentration of ketones do not matter too much. You can achieve weight loss and a sense of well-being even with lower levels of ketones.
    Focus on how you feel, not on the number. Use ketone meters for interest and experimentation, but don't let the results stress you out.
    tl;dr never, unless you have read and understood this post, yet still want to use them anyway
    [If anyone has any suggestions for improving this post or correcting misinformation, let me know. I'll correct this and re-post it once in a while]

  2. anbeav

    Hallelujah!!
    tl;dr never
    If you want to do it for experimentation, go for it but please spare the rest of us the unnecessary ketosis anxiety
    edits: In addition to false negatives, ketostix commonly show false positives as in when people eat a high carb meal and think they cheated biology. Also I might remove the bit about using ketostix to monitor keto-adaptation, just asking for more posts about the issue. Also I might emphasize that people seem to already be overwhelmed with keto when starting and adding another layer of unnecessary complexity doesn't help the matter. People always talk about lifestyle, live a lifestyle and IMO living a lifestyle certainly shouldn't have to include measuring. Lastly, ketone concentrations are what they are. If you want to measure with a blood or breath meter, they are what they are and chasing ketone concentrations often becomes as unnecessary as ketostix. Unless someone has a medical condition for which a particular concentration is required for management, focus on how you feel not the number. Use the meter for interest and experimentation, but don't let it stress you out.

  3. blurfocus

    Thanks. I have incorporated your feedback.

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Whether due to bicarbonate loss or volume repletion with normal saline, the primary problems is in hyperchloremic metabolic acidosis hcl ammonium chloride loading, reabsorption proximal tubule reduced, part, because of hyperchloraemic acidosis, anion gap (in most cases). Administration of ns will decrease the plasma sid causing an acidosis this patient also had a normal anion gap hyperchloremic metabolic (hcma). Googleusercontent search. Normal anion gap (hyperchloremic) acidosis semantic scholar. Hyperchloremic metabolic acidosis is it clinically relevant? (pdf hyperchloremic in diabetes mellitus. Hyperchloremic acidosis wikipedia. Treatment of acute non anion gap metabolic acidosis ncbi nih. Aug 4, 2016 a normal ag acidosis is characterized by lowered bicarbonate concentration, which counterbalanced an equivalent increase in plasma chloride concentration. Acid base physiology 8. Hyperchloraemic metabolic acidosisdepartment of medicine. Mechanism of hyperchloremic metabolic acidosis. Hyperchloremic acidosis background, etiology, patient education emedicine. Respiratory acidosis alkalosis as with the hyperchloremic may result from chloride replacing lost bicarbonate. Although it can occur with disease of either the small or nov 5, 1984 normal anion gap (hyperchloremic) acidosiswalmsley and ghyperchloremic metabolic acidosis in which is jun 30, 2017 approach to adult causes hyperchloremic (normal gap) acidosis; Combined elevated official full text paper (pdf) existence has been recognized many areas for some was examined persistent. [1 ] quantify two phenomena that are important to anesthesiologists and other clinicians caring for hyperchloremic metabolic acidosis with a low serum k level is most commonly caused by diarrhea. Approach to the adult with metabolic acidosis uptodate. The most common nov 23, 2014 hyperchloremic metabolic acidosis is different. Extreme acidemia (ph 7. For this reason, it is also known as hyperchloremic metabolic acidosis a form of associated with normal anion gap, decrease in plasma bicarbonate concentration, and an increase chloride concentration (see gap for fuller explanation) common acid base disturbance critical illness, often mild (standard excess 10 meq l). Albumin corrected anion gap normal (5 15 meq l). Is correcting hyperchloremic acidosis beneficial? Emcrit. Hyperchloremic metabolic acidosis due to cholestyramine a case sid hyperchloremic openanesthesia. Anesthesiology hyperchloremic metabolic acidosis is a predictable consequence of pathophysiology, diagnosis and management. Hyperchloremia why and how science direct. There was no evidence of ingestion hydrochloric acid or its equivalentHyperchloremic acidosis wikipedia. The effect of acidemia on the serum potassium concentration depends we do not believe that transient perioperative hyperchloremic metabolic acidosis in this patient required presence ileal bladder augmentation issue anesthesiology, scheingraber et al. Hyperchloremic acidosis background, etiol

Sid Hyperchloremic Acidosis

Strong ions are cations and anions that exist as charged particles dissociated from their partner ions at physiologic pH. The SID (Strong Ion Difference) is the difference between the positively- and negatively-charged strong ions in plasma. This method of evaluating acid-base disorders was developed to help determine the mechanism of the disorder rather than simply categorizing them into metabolic vs. respiratory acidosis/alkalosis as with the Henderson-Hasselbalch equation. Strong cations predominate in the plasma at physiologic pH leading to a net positive plasma charge of approximately +40: SID = [strong cations] [strong anions] = [Na+ + K+ + Ca2+ + Mg2+] [Cl- + lactate- + SO42-] Disturbances that increase the SID increase the blood pH while disorders that decrease the SID lower the plasma pH. According to the law of electroneutrality the sum of positive charges is equal to the sum of negative charges. Therefore the SID must be equal to the sum of weak anions in the body (such as bicarbonate, albumin, and phosphate). Hyperchloremic acidosis may result from chloride replacing lost bicarbonate. Such bicarbonate-wasting conditions may be seen in the kidneys (renal tubular acidosi Continue reading >>

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  1. MikeCrazy

    So I'm getting into ketosis and have come across something that all new should know about...(if they don't already), the keto flu, so to speak. It feels like the flu and/or food poisoning, and can scare the willpower out of you, if you don't know what's going on. Let me explain:
    WARNING THIS COULD BE SLIGHTLY GRAPHIC - THOSE WITH SENSITIVE STOMACHS BE ADVISED
    I'm on day 12 of this diet, and last night I over exerted myself with some exercise. As a result, a mild feeling of nausea that had been subtly bugging me, turned into some quality time with my head hanging over the porcelain throne. I was like WTF is wrong with me? My gut hurt so bad that I almost considered going to the hospital, and my nausea was through the roof. This coming from a guy who was known for the "iron stomach," needless to say, had me very worried. Had I understood what was happening, and what would happen, while transitioning through what's called induction, I would have prepared better, and it wouldn't have been as bad, or maybe almost unnoticeable.
    Things to know:
    1 - Enzymes. Your body makes enzymes for the digestion of fat and starches/sugars, in your stomach. These enzymes are fairly specific, and if they are out of balance you can get a bit upset in there.
    2 - Fungal. Candida cultures (yeast) throughout our bodies, and especially in our gut, thrive on sugars. If you cut the sugar, they die in swaths leaving toxins behind. All those toxins, if not properly flushed, will cause gastronomic distress, a temporary increase in acne, and even cough, stuffiness, and nasty achy flu symptoms. Flushing is the key, leading to the next point:
    3 - Fluids. Not drinking enough water, and not getting the proper balance of electrolytes in your system, will allow a build up of all the toxins release from all sources, including toxins stored in your fat cells. You can have all sorts of issues from it, let alone the dehydration issue – in and of itself.
    4 - Liver. Your liver must deal with all these toxins in your system, and if you are already on the toxic side of the coin, a keto induction can throw your liver into overtime. This causes pain, nausea, and more flu like symptoms. You can feel like death warmed over, when your liver is weak and over-taxed. Again, fluids help, but you may need to reduce fat, and total caloric intake for a few days, to give your liver a chance to catch up. I also hear that turmeric tea helps the liver detox, but I don't know much about it yet.
    So there you have it folks. That’s the scary side of keto induction. It's not so scary and bad, if you know what's going on, and you prepare for it. The biggest key is to drink lots of water with electrolytes.
    Good luck, and stay healthy!

  2. SnowFlinga

    Be careful with the exercise while keto-adapting. You're in a kind of "limbo land" while still in the adaptation phase; you're no longer giving your body the carbs it expects to refuel your glycogen stores and you're not quite efficient yet at burning ketones for energy. So exercise during this period can be a real mixed bag and for some people can sideline them in their attempt to adapt to this WOE.

  3. Leonidas_meets_Spartacus

    It's hard to prepare and depends on individual. I probably had worst 4 weeks of my life when I started eating this way, but it's been very easy for me to maintain with out any cravings for carbs.

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