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What Is 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. Heather

    I've been on the diet now for 7 days. Day 1 and 2 I dropped 2 kilos, and since that I haven't budged.
    I check my pee twice a day and am always in the top or second top keto reading...
    Is it possible to be in ketosis, but still doing something wrong ?

  2. Helen

    Ketosis just means that you are burning fat instead of carbs/glucose for energy. If you are having too many calories (or even not enough), you may find that you do not lose weight.
    Also, if you only have a few kgs to lose, then your weight loss will be slower than someone who has a lot of weight to lose. What is your BMI?
    Are you doing a lot of intensive exercise? Sometimes you may be losing fat, but building muscle, so the scales appear to not move.
    Regardless of what diet you follow, you will not lose weight each and every day. 2 kgs in 1 week is a pretty good loss, especially if you don't have a lot of weight to lose.
    Chances are that if you continue to follow the program properly and keep avoiding carbs, you will lose more weight in the next few days. Some call it the "whoosh" effect, lol. Some people lose weight slowly and steadily. Many more of us, lose it in stops and starts. We lose a bit, then a few days of nothing and then another "whoosh".
    Keep at, and you should get results.
    Cheers
    Helen
    [ed. note: Helen (1169825) last edited this post 3 years, 7 months ago.]

  3. Heather

    My Bmi is 30.51. I've got about 15 kilos to lose, but on a bazillion diets I never seem to get past 6 or 7kg.
    I'm not currently exercising because I'm just too tired. I'm hoping to get back to the gym soon though.
    I'll stick it out in hopes for this whoosh hehe. Thanks Helen.

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

Best Case Ever 56 Anion Gap Metabolic Acidosis

In this month’s Best Case Ever on EM Cases Dr. Ross Claybo and Dr. Keerat Grewal tell the story of a patient with a complicated anion gap metabolic acidosis. We discuss how to sort through the differential diagnosis with a better mnemonic than MUDPILES, the controversy around administering sodium bicarbonate for metabolic acidosis, the indications for fomepizole and the value of taking time to to build a therapeutic relationship with your ED patients. Podcast production and sound design by Anton Helman. Show notes by Anton Helman, March 2017 The MUDPILES mnemonic for anion gap metabolic acidosis is out of date Why? Metabolic acidosis due to paraldehyde overdose is exceedingly rare Iron and isoniazid are just two of many drugs and toxins that cause hypotension and lactic acidosis (isoniazid can also generate a component of ketoacidosis). Three “newer” anion-gap-generating acids have been recognised recently: D-lactic acid, which can occur in some patients with short bowel syndromes. 5-oxoproline (or pyroglutamic acid) associated with chronic acetaminophen use. Propylene glycol infusions – solvent used for several IV medications including lorazepam and phenobarbital. The GOLD Continue reading >>

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  1. Injecto

    I can't seem to find anything that backs this up. I know that high BG will damage them over time (duh!!), but what about ketones?

  2. fgummett

    Ketone bodies are water-soluble compounds that are produced as by-products when fatty acids are broken down for energy. They are a vital source of energy during fasting -- such as overnight.
    The brain gets its energy from ketone bodies when insufficient glucose is available. In the event of low blood glucose, most other tissues have additional energy sources besides ketone bodies (such as fatty acids), but the brain does not.
    Remember that when you are not fasting, the body can use Amino Acids (from dietary Protein) to synthesize Glucose (Gluconeogenesis).
    Any production of Ketones is called ketogenesis, and this is necessary in small amounts. When even larger amounts of ketone bodies accumulate such that the blood's pH is lowered to dangerously acidic levels, this state is called ketoacidosis. This happens in untreated Type I diabetes (DKA).
    In short, the human body has evolved over the millennia to burn either Glucose or Fatty Acids -- think of these as the short-term fuel and longer-term reserve, respectively.
    So if it is normal to burn Fatty Acids and produce Ketones why would they be harmful unless they accumulate to dangerous levels? Yes I know... we always get the "dangerous levels" lecture but consider that BG can be toxic at high enough levels... that does not mean it is bad for us at any level

  3. REDLAN

    can we get the production of ketones correct??
    The primary cause of ketogenesis in the body is.....
    gluconeogenesis from dietary protein, when there is insufficient dietary glucose to fill the body needs, aka the ketogenic diet.
    The process of gluconeogenesis utilises a key component of the citric acid cycle (oxaloacetate), which blocks the oxidation of Acetyl CoA. Fatty acid (and glucose oxidation) require their conversion to Acetyl CoA. It is Acetyl CoA which is converted to ketone bodies and this process occurs pretty exclusively in the liver (also happens in the kidney)
    Normally oxidation of fatty acids does NOT produce ketone bodies, even during fasting overnight, as usually there are more than sufficient stores of glycogen.
    - starvation is an entirely different matter. Fasting for longer than a day or so can be sufficient for ketogenesis to start.
    Astrocytes in the brain can produce ketone bodies in response to hypoglycemia, but this will not provide adequate protection in the event of hypoglycemia caused by insulin overdose.
    The simple reason why ketogenesis as caused by a ketogenic diet is probably safe is because ketones only transiently rise in response to food, and the levels sustained should not be sufficient to disturb the body's buffer system.
    if however you spent long periods without food, or lacking insulin then that is a very different matter.
    I can't find anything definitive about ketones and kidney function - the only thing of note is an association with kidney stones for children on ketogenic diets to control epilepsy - but this could be due to the components of the diet (high protein) rather than ketones. There are no long term safety studies on ketogenic diets, but they are though to be safe (probably).
    Those on this forum on low carbohydrate diets 50g to 120g of carbs probably do not experience ketogenesis to any significant degree. Significant ketogenesis only occurs at <30g.

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For access to the slide deck and additional materials for this presentation, visit https://www.fallsloop.com/webinar-res.... Login to Loop is required- registration is free! Webinar Description: Its well known that being truly healthy is very difficult if you have diseases in your mouth. Research has shown associations between oral diseases and diabetes, osteoporosis, respiratory and heart diseases, nutritional deficiencies, development of frailty, low birth weight babies and pre term births. Oral diseases and missing teeth also affect a persons ability to get and keep employment, eat a healthy diet, socialize and live independently. Primary oral health care is not covered by OHIP, and as a result, not everyone in Ontario has access to oral health care. Studies have found that an estimated 17 per cent of people in Ontario have not visited a dentist in the past year. The main reason is the cost. The private dentistry model is not working for everyone in Ontario. It definitely is not working for the at-risk older adult whose nutrition suffers because of inadequate oral care. The connection amongst inadequate nutrition, muscle wasting, frailty and falls is a strong quality of life issue for those on limited incomes. In 2014, the Ontario Government made a promise to expand dental care to include low income adults. Since then, the Ontario Oral Health Alliance has led campaigns to promote the need for this to happen sooner because adults and seniors are suffering now. With over 61,000 Ontarians visiting an Emergency Room for dental related issues each year, costing the system at least $31 million dollars for nothing but the provision of a painkiller or antibiotic, the need for change is evident. With an election coming up in June, OOHA has prepared a strategy to help ensure that all parties include access to dental care for low income adults and seniors on their platforms. Presenters' Bios: Anna Rusak graduated from the University of Torontos Master of Public Health program with a speciality in Health Promotion in 2005. Since then shes worked at the Haliburton Kawartha Pine Ridge District Health Unit as a health promoter supporting the Oral Health Department and has been the coordinator of the Ontario Oral Health Alliance since its inception in 2007. Sue Hochu graduated from the Dental Hygiene program at Durham College in 1979 and received the Dr. Zakarow scholarship. She practiced in private dental offices, both in Ontario and British Columbia, and in 1984 she began working at the Haliburton, Kawartha, Pine Ridge District Health Unit in Port Hope, on until her retirement from there last year. Sue has a certificate in Multidisciplinary Gerontology from Fleming College and has been working on a BA in Gerontology from Laurentian University. Marguerite Oberle Thomas, RN., BScN., has worked in Injury Prevention since 1996, primarily as a public health nurse, currently as the Coordinator for the Fall Prevention Community of Practice with the Ontario Neurotrauma Foundation. Thomas was also a caregiver who lived the dental issue caregiving experience.

Anion Gap (blood) - Health Encyclopedia - University Of Rochester Medical Center

If you may have swallowed a poison, such as wood alcohol, salicylate (in aspirin), and ethylene glycol (in antifreeze), your provider may test your blood for it. If your provider thinks you have ketoacidosis, you might need a urine dipstick test for ketone compounds. Ketoacidosis is a health emergency. Many things may affect your lab test results. These include the method each lab uses to do the test. Even if your test results are different from the normal value, you may not have a problem. To learn what the results mean for you, talk with your healthcare provider. Results are given in milliequivalents per liter (mEq/L). Normal results are 3 to 10mEq/L, although the normal level may vary from lab to lab. If your results are higher, it may mean that you have metabolic acidosis. Hypoalbuminemia means you haveless albumin protein than normal. If you have this condition, your expected normal result must be lower. The test requires a blood sample, which is drawn through a needle from a vein in your arm. Taking a blood sample with a needle carries risks that include bleeding, infection, bruising, or feeling dizzy. When the needle pricks your arm, you may feel a slight stinging sensation Continue reading >>

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  1. iwiggy58

    How quickly can you kick yourself OUT of ketosis?

    I am just starting week 3 . I have been OP totally. One thing that keeps me from cheating is the fear that I will kick myself out of ketosis. What amount of non program food would it take to throw you out of ketosis? And does a person start all over and have to go thru the headaches and trauma that happen that first week? I have heard several people go off program while on vacation and start back up again later. Is it like having to start all over again???

  2. mompattie

    It would take prob more than 40-50 carbs to kick you out of ketosis. Some can handle more carbs. But it's a slippery slope. Yes, you have to go through all the symptoms to get back in. And 3-5 days worth of food and time and money. It's like a weeks worth of money and time gone. Not worth it.

  3. IP43

    Quote:

    Originally Posted by mompattie
    It would take prob more than 40-50 carbs to kick you out of ketosis. Some can handle more carbs. But it's a slippery slope. Yes, you have to go through all the symptoms to get back in. And 3-5 days worth of food and time and money. It's like a weeks worth of money and time gone. Not worth it. I know a few times that I've had things I shouldn't, the next day or two I was starving, had cravings etc. so I think I kicked myself out of ketosis. They weren't big cheats but I think we're so close to the limit if you have a restricted item a day. I was "perusing" the Atkins site for some of their carb counts etc. and they start with 12-15g net carbs (carb-fibre) on their phase one and then add 5g netcarbs per week or something.

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