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What Is Non Anion Gap Metabolic Acidosis?

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Inspired by Dr. Myat Soe, MD Internal Medicine Series: Clinical Clerkships Overview and Causes of Non-Anion Gap Metabolic Acidosis Made with help of Blueberry Flashback Recorder

Non-anion Gap Metabolic Acidosis: A Clinical Approachtoevaluation.

1. Am J Kidney Dis. 2017 Feb;69(2):296-301. doi: 10.1053/j.ajkd.2016.09.013. Epub2016 Oct 28. Non-Anion Gap Metabolic Acidosis: A Clinical ApproachtoEvaluation. (1)Nephrology Section, VA Greater Los Angeles Healthcare System, David Geffen School of Medicine at UCLA, Los Angeles, CA. (2)Nephrology Section, VA Greater Los Angeles Healthcare System, David Geffen School of Medicine at UCLA, Los Angeles, CA. Electronic address: [email protected] Acid-base disturbances can result from kidney or nonkidney disorders. We present a case of high-volume ileostomy output causing large bicarbonate losses andresulting in a non-anion gap metabolic acidosis. Non-anion gap metabolic acidosiscan present as a form of either acute or chronic metabolic acidosis. A completeclinical history and physical examination are critical initial steps to begin theevaluation process, followed by measuring serum electrolytes with a focus onpotassium level, blood gas, urine pH, and either direct or indirect urineammonium concentration. The present case was selected to highlight thedifferential diagnosis of a non-anion gap metabolic acidosis and illustrate asystematic approach to this problem.Published by Elsevier Continue reading >>

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  1. activia

    There are studies done that found that if women are on a ketogenic diet during pregnancy the gene expression on the baby is changed as the baby thinks it is going into a starvation environment and changes their metabolism permanently to store fat. Ketogenic diets over long periods of time can also cause your t3/t4 ratio out of whack which screws up your thyroid.
    Final Note: Primal/Paleo does not have to be ketogenic

  2. Nady

    I suppose if Grok's mate was PG and only ate meat, it would account for the *thrifty gene* we keep hearing about?

  3. activia

    Originally posted by Nady
    I suppose if Grok's mate was PG and only ate meat, it would account for the *thrifty gene* we keep hearing about? Seems very plausible. I'm glad I found that out before hand because I'll certainly make a point to eat a lot more carbs then I do now when I'm pregnant (since now I only eat >100g a couple days a week, with some days <50)

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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 ca

Hyperchloremic Acidosis

Author: Sai-Ching Jim Yeung, MD, PhD, FACP; Chief Editor: Romesh Khardori, MD, PhD, FACP more... This article covers the pathophysiology and causes of hyperchloremic metabolic acidoses , in particular the renal tubular acidoses (RTAs). [ 1 , 2 ] It also addresses approaches to the diagnosis and management of these disorders. A low plasma bicarbonate (HCO3-) concentration represents, by definition, metabolic acidosis, which may be primary or secondary to a respiratory alkalosis. Loss of bicarbonate stores through diarrhea or renal tubular wasting leads to a metabolic acidosis state characterized by increased plasma chloride concentration and decreased plasma bicarbonate concentration. Primary metabolic acidoses that occur as a result of a marked increase in endogenous acid production (eg, lactic or keto acids) or progressive accumulation of endogenous acids when excretion is impaired by renal insufficiency are characterized by decreased plasma bicarbonate concentration and increased anion gap without hyperchloremia. The initial differentiation of metabolic acidosis should involve a determination of the anion gap (AG). This is usually defined as AG = (Na+) - [(HCO3- + Cl-)], in whic Continue reading >>

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  1. Alan Williamson

    I have been lifting weights, running, and biking. I lift just about every day. I have good muscle definition everywhere except my belly. I have about 10 pounds of fat around my belly and waist. How does a person get rid of that fat? It doesn't seem to want to go away.

    Cheers!

  2. devhammer

    Visceral fat isn't the fat around your waistline, it's the fat around your internal organs (aka viscera).
    Subcutaneous fat is different.

    Both can be reduced with keto, but there's no magic trick to burning fat from a particular part of your body. Just as it took time to put it on, it'll take time to take it off.

  3. Fiorella

    Intermittent fasting and extended fasting helps disintegrate visceral fat, too.

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

Causes Of Non-anion Gap Metabolic Acidosis

Bicarbonate-rich fluid excreted into the intestines where it is lost (GI loss of HCO3). There is an additional mechanism by which NH4Cl causes a non-AG metabolic acidosis. It is similar to the mechanism by which TPN causes a non-AG metabolic acidosis. Either the NH4Cl or the amino acids in TPN are meatbolized to HCl which causes a transient non-AG metabolic acidosis. The decreased pH and decreased HCO3 stimulate renal tubular reabsorption and generation of HCO3 (secretion of H+). You only end up with a metabolic acidosis if the addition of acid overrides the ability of the renal tubules to secrete H+ and generate NH3+ for excretion in the urine, usually a short-lived process. In prolonged hypercapnia renal tubular cells compensate for a prolonged respiratory alkalosis by decreasing reclaimation and generation of HCO3 (which takes 12-24 hrs for full affect). If the respiratory alkalosis resolves rapidly, reclaimation and generation of HCO3 will return to normal over 1-2 days. During this period you can get a (resolving) non-AG metabolic acidosis. The two main causes you for non-anion gap metabolic acidosis are diarrhea and RTA . Most of the time you can distinguish between these tw Continue reading >>

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  1. Birchinio

    Confused about protein intake on Keto...

    Ok I've been doing keto for about 3 weeks. I've been working out on and off for about two years and for the next 6-8 weeks I've trying to lose the only visible fat I have (on my stomach). I decided to try keto after reading up on it.
    So far I've lost about 2-3lbs, which I'm happy with considering my BF% is around 17% and I don't have too much to lose. I'm confused now though and thinking I might not actually be in Ketosis because of my protein intake. With food + Whey protein shakes I consume on average 150-190g per day (I weigh 180lbs). I've started reading now that high protein on Keto is bad as it is converted into glucose and causes insulin spikes. Is this true?
    I don't want to cut the protein intake and lose muscle mass..
    Cliffs -
    On keto for 3 weeks,
    Worried my 150-180g of protein is kicking me out of Ketosis
    Don't want to cut down protein intake/lose muscle mass.
    Thanks.

  2. manlutbrah

    Originally Posted by Birchinio
    Ok I've been doing keto for about 3 weeks. I've been working out on and off for about two years and for the next 6-8 weeks I've trying to lose the only visible fat I have (on my stomach). I decided to try keto after reading up on it.
    So far I've lost about 2-3lbs, which I'm happy with considering my BF% is around 17% and I don't have too much to lose. I'm confused now though and thinking I might not actually be in Ketosis because of my protein intake. With food + Whey protein shakes I consume on average 150-190g per day (I weigh 180lbs). I've started reading now that high protein on Keto is bad as it is converted into glucose and causes insulin spikes. Is this true?
    I don't want to cut the protein intake and lose muscle mass..
    Cliffs -
    On keto for 3 weeks,
    Worried my 150-180g of protein is kicking me out of Ketosis
    Don't want to cut down protein intake/lose muscle mass.
    Thanks.

    How much do you weigh? How much calories are you eating per day ? What's your f/p/c caloric ratio atm? Can't really say without knowing these, also need to know your m9aintenance calories.
    If you eat too much protein and not enough fats then you won't enter ketosis at all

  3. startingKETO

    Originally Posted by Birchinio
    Ok I've been doing keto for about 3 weeks. I've been working out on and off for about two years and for the next 6-8 weeks I've trying to lose the only visible fat I have (on my stomach). I decided to try keto after reading up on it.
    So far I've lost about 2-3lbs, which I'm happy with considering my BF% is around 17% and I don't have too much to lose. I'm confused now though and thinking I might not actually be in Ketosis because of my protein intake. With food + Whey protein shakes I consume on average 150-190g per day (I weigh 180lbs). I've started reading now that high protein on Keto is bad as it is converted into glucose and causes insulin spikes. Is this true?
    I don't want to cut the protein intake and lose muscle mass..
    Cliffs -
    On keto for 3 weeks,
    Worried my 150-180g of protein is kicking me out of Ketosis
    Don't want to cut down protein intake/lose muscle mass.
    Thanks.

    You want to eat 1 gram per pound of lean body mass. 180 x .17 = 30 -> 180 - 30 = 150 grams of protein.
    Then 20-30 grams of carbs
    Fill the rest with fats
    Also, I think your 3-week loss is slightly low considering that the first week on keto I lost 5lbs of water weight alone (I started at 16-17% body fat). I would try to lower the protein slightly and up the fats so that the body aims to use fat for energy good luck!

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