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What Is Metabolic Acidosis?

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A review of the differential diagnosis of an elevated anion gap metabolic acidosis, focusing predominantly on lactic acid, ketoacids, and toxic alcohols (i.e. methanol, ethylene glycol, and propylene glycol). Also includes discussion of renal failure, oxoproline, toluene, and paraldeyhyde. Use of the VA and Stanford name/logos is only to indicate my academic affiliation, and neither implies endorsement nor ownership of the included material.

Basic Interpretation Of Metabolic Acidosis

Basic Interpretation of Metabolic Acidosis Melissa Beaudet Jones is a pediatric critical care nurse practitioner in the cardiac intensive care unit at Childrens National Medical Center, Washington, DC. She recently completed the pediatric critical care nurse practitioner program at the University of Pennsylvania in Philadelphia Corresponding author: Melissa Beaudet Jones, Cardiac Intensive Care Unit, Childrens National Medical Center, 111 Michigan Avenue NW, Washington, DC 20010 (e-mail: mejones{at}cnmc.org). Assessing the relationship between abnormal blood gas findings and a patients overall clinical condition is often challenging. Metabolic acidosis occurs in a variety of clinical contexts in pediatric intensive care units. Nurses must know the basic concepts of acid-base balance, the 2 types of metabolic acidosis (normal and elevated anion gap acidosis), and the common causes of each type of metabolic acidosis. This article has been designated for CE credit. A closed-book, multiple-choice examination follows this article, which tests your knowledge of the following objectives: Describe the significance of the anion gap in diagnosing metabolic acidosis in pediatric patients Dis Continue reading >>

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Popular Questions

  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

Evaluation Of Metabolic Acidosis

The presence of metabolic acidosis is a clue to the possible existence of several underlying medical conditions. Arterial pH <7.35 defines acidosis. Metabolic acidosis is indicated by a decrease in the plasma bicarbonate level and/or a marked increase in the serum anion gap (AG). Metabolic acidosis may occur due to the following reasons: Addition of strong acid that is buffered by and consumes bicarbonate ion Loss of bicarbonate ion from the body fluids, usually through the GI tract or kidneys Rapid addition to the extracellular fluid of a nonbicarbonate solution. Differentiating between the causes of metabolic acidosis begins with calculation of serum AG. Serum AG is calculated by subtracting the sum of major measured anions, chloride (Cl) and bicarbonate (HCO3), from the major measured cation, sodium (Na+). Normal serum AG is due to the difference between unmeasured anions such as sulfate (SO4), phosphate (PO4), albumin, and organic anions, and unmeasured cations such as potassium (K+), magnesium (Mg+), and calcium (Ca2+). Plasma proteins also play a role in maintaining normal serum AG. [1] Dubin A, Menises MM, Masevicius FD, et al. Comparison of three different methods of evalu Continue reading >>

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  1. MarkM

    Originally Posted by 10xdiabetic
    ... the units of insulin I am having to take seem excessive. I feel my body is no longer sensitive to the insulin. ... Getting most calories from fat can be expected to reduce insulin sensitivity. There is a whole lot of science behind this, but the bottom line is that when in ketosis (eating low carb, high fat), we need a lot more insulin than the consumed carbs suggests. So you will have to adjust insulin dosing accordingly. Once you have done that, maintaining good control should get a lot easier.
    I gave up on the ketogenic diet because sticking to it was just too hard. Especially in China, where I have been living for a while. After switching back to a 'normal' diet, my control became somewhat more difficult, but my insulin requirements went down. I have become more insulin sensitive, and my TDD is now lower than it has ever been. Using a pump also helps with that, but I suspect that much of the difference is because of less fat in the diet.

  2. hughman

    The only thing constant about insulin dosing for me over the last 40+ years is change. At one point I was taking at least a total of 120 units a day, but that was with massive aspartame consumption. Once I stopped diet pop (soda), I now take a total of around 60 units, and take it totally differently amounts at different times than I used to. I could take less insulin if I ate less carbs, but we all make our decisions on our lifestyle.
    Everyone is different, and our environment and what we consume effects us all differently. And women have it even tougher with those pesky hormones.

  3. 10xdiabetic

    Thank you for that insight. This is what my feeling was also. I tried to find science to confirm my hypothesis. Could you share an article / source where you read about that so I can explore this further?

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The Pharmacotherapy Preparatory Review Recertification Course Endocrine and Metabolic Disorders PDF at https://www.mediafire.com/view/8kucuu...

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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Popular Questions

  1. leanllama

    New to Keto...How Much Sodium is too much?

    Started this past Monday...Man am I love the change after being on a strict 50/30/20 last 7 months(lost 40+lbs).
    I know sodium can cause water retention. Wondering how much is too much. Today I am about 2/3rds way through daily caloric intake and already have 2830 mgs sodium...Too Much?
    Interested in anyones opion, I know less is better but I am finding everything I eat has alot more sodium.
    Cheers

  2. Barry1337

    Originally Posted by leanllama
    Started this past Monday...Man am I love the change after being on a strict 50/30/20 last 7 months(lost 40+lbs).
    I know sodium can cause water retention. Wondering how much is too much. Today I am about 2/3rds way through daily caloric intake and already have 2830 mgs sodium...Too Much?
    Interested in anyones opion, I know less is better but I am finding everything I eat has alot more sodium.
    Cheers

    The current recommendation is to consume less than 2,400 milligrams (mg) of sodium a day. This is about 1 teaspoon of table salt per day. It includes ALL salt and sodium consumed, including sodium used in cooking and at the table.
    I'd suggest you drink a lot of water and try to eat stuff that doesn't contain that much sodium. For example sausages and pre-prepared hamburgers contain a lot of salt. Try eating as natural as possible.

  3. Atavis

    Originally Posted by Barry1337
    The current recommendation is to consume less than 2,400 milligrams (mg) of sodium a day. This is about 1 teaspoon of table salt per day. It includes ALL salt and sodium consumed, including sodium used in cooking and at the table.

    Whose recommendation is that?
    Lyle McDonald's recommendation on his forums and books is:
    3-5 gr sodium
    1 gr potassium
    500mg magnesium
    600-1200 mg calcium
    Sodium, potassium and magnessium get depleted on this diet due to the diuretic effect of ketones and glycogen depletion.

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