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What Is An Anion Gap Metabolic Acidosis?

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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. jkungcho

    Hello and Happy New Year! I've been on Keto since the start of December. I've had some bad moments (involuntary/voluntary cheats) at the very beginning and know that eating carbage isn't helping me and my health improvement goals and I have those desires absolutely under control. I'm not hungry so I don't eat which is something I've never experienced before! I love this WOE!!!
    Here's my current dilemma. I'm so stinking tired!!! All of the time! I can never get enough sleep! I read that if you're energy levels are low to eat fat. This morning I had some chicken bone broth with butter and coconut oil and took the kids to school. I felt so sleepy behind the wheel and I haven't felt like that in years. I came home and made myself some BPC, but I'm still sooooo tired. I added salt to both my broth and coffee. I feel nauseated and don't feel like eating especially since I'm not hungry and I always used to be hungry. It seems that I typically eat once a day and sometimes twice a day.

    What gives? What am I missing? I am taking daily vitamins, my high blood pressure and cholesterol meds. Do I need to also supplement with magnesium and potassium? I've been getting plenty of fluids. I don't feel like I caught some bug. Am I still converting to fat burning? Feeling confused but not giving up. Thank you in advance!

  2. devhammer

    If you started in December, and haven't been solidly practicing keto throughout that period, you are probably still experiencing keto flu.
    Yes, adding electrolytes can help with some symptoms of keto flu, so consider adding that (do a search for Ketoaid in the box at the top of the forums...that's one way to get them in). Some folks also take some bone broth, with a little added salt & fat, to help.
    Keep the carbs below 20g/day, sufficient protein, and fat to satiety. Keep doing that. If you go another month and still having issues, then you might look at what else to change.

    Fat adaptation isn't instant. And it takes longer for some folks than for others. You'll start to feel it once you're fully fat-adapted. Hang in there.

  3. devhammer

    Moving to the Newbies category, BTW.

    Check the FAQ and pinned posts there (and in the subcategories) for good info.

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

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. greg_barton

    Title says it all, really. I've been eating keto for about a week. I have so much mental energy I have insomnia. :) No sleepy slump around 3pm like I usually have, and now it's 3am and I'm still wide awake. Anyone else have this happen?

  2. hrhomer

    Ha! When I read your post, I did!

  3. ShaShr89

    I just completed my first week and I've had this pretty much every night. I still feel tired at night but super wired at the same time. On the flip side, when I wake up in the morning I'm straight out of bed fully awake and ready to start, no matter what time it is or how many hours of sleep I've had. I love that feeling, I don't remember the last time I felt so good about waking up! Looots of energy :D

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Ever wondered what on earth the Anion Gap was all about? Yeah us neither. But when you've got yourself a metabolic acidosis, this is a good place to start. If you liked this, why not subscribe? And more importantly, let us know what you'd like to see us cover next.

Clinical Aspects Of The Anion Gap

The anion gap (AG) is a calculated parameter derived from measured serum/plasma electrolyte concentrations. The clinical value of this calculated parameter is the main focus of this article. Both increased and reduced anion gap have clinical significance, but the deviation from normal that has most clinical significance is increased anion gap associated with metabolic acidosis. This reflects the main clinical utility of the anion gap, which is to help in elucidating disturbances of acid-base balance. The article begins with a discussion of the concept of the anion gap, how it is calculated and issues surrounding the anion gap reference interval. CONCEPT OF THE ANION GAP - ITS DEFINITION AND CALCULATION Blood plasma is an aqueous (water) solution containing a plethora of chemical species including some that have a net electrical charge, the result of dissociation of salts and acids in the aqueous medium. Those that have a net positive charge are called cations and those with a net negative charge are called anions; collectively these electrically charged species are called ions. The law of electrochemical neutrality demands that, in common with all solutions, blood serum/plasma is e Continue reading >>

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  1. Steve Mount

    Ketoacidosis

    Intermittent Fasting

    Fasting



    How does ketoacidosis occur during fasting?




    1 Answer








    Ketosis (the presence of ketone bodies in the blood) is normal when fat is being used for fuel. This is perfectly healthy; the ketone bodies are an alternative to glucose for distributing energy throughout the body. Ketoacidosis (which includes acidification of the blood) does not occur when a healthy person fasts, but is a risk for diabetics. Ketoacidosis is a serious condition that can result in coma or even death.

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