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What Is The Cause Of Metabolic Acidosis?

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

Causes Of Metabolic Acidosis

In practically every CICM exam paper, the candidates are presented with an ABG (sometimes several) which expect the diagnosis of a metabolic acidosis of some sort. It is therefore essential to develop some sort of mnemonic aid to recall the differential diagnosis of metabolic acidosis. In spite of its many obvious disadvantages, the anion gap classification of metabolic acid-base disorders is useful tool. Causes of Metabolic Acidosis High anion gap Normal anion gap MUD PILES Methanol and other toxic alcohols Uraemia Diabetic (or other) ketoacidosis Pyroglutamic acidosis Iron overdose Lactic acidosis Ethylene glycol Salicylates PANDA RUSH Pancreatic secretion loss Acetazolamide Normal saline intoxication Diarrhoea Aldosterone antagonists Renal tubular acidosis Type 1 (distal) Ureteric diversion Small bowel fistula Hyperalimentation (TPN) The MUDPILES mnemonic is showing its age. Nowhere is there space for citrate, for instance. This is a problem, as several SAQs (eg. Question 3.3 from the second paper of 2013) present the candidate with a citrate-based acidosis. The "P" in PILES used to be "Paraldehyde", but paraldehyde has fallen out of favour since the 1980s, and so "Pyroglutamic Continue reading >>

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  1. Paraish Misra

    This side effect was very common with phenformin (metformin’s “parent drug”), and in fact led to its withdrawal from many markets. However, lactic acidosis appears to be very uncommon with metformin. In fact, whether or not lactic acidosis occurs at all with metformin is a matter of intense debate among some physicians. Nonetheless, out of safety, physicians will not prescribe metformin to patients at high risk of lactic acidosis (such as patients with advanced kidney disease).

  2. George Johnson

    This answer is not a substitute for professional medical advic...

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What is INSULIN SHOCK THERAPY? What does INSULIN SHOCK THERAPY mean? INSULIN SHOCK THERAPY meaning - INSULIN SHOCK THERAPY definition - INSULIN SHOCK THERAPY explanation. Source: Wikipedia.org article, adapted under https://creativecommons.org/licenses/... license. Insulin shock therapy or insulin coma therapy (ICT) was a form of psychiatric treatment in which patients were repeatedly injected with large doses of insulin in order to produce daily comas over several weeks. It was introduced in 1927 by Austrian-American psychiatrist Manfred Sakel and used extensively in the 1940s and 1950s, mainly for schizophrenia, before falling out of favour and being replaced by neuroleptic drugs in the 1960s. It was one of a number of physical treatments introduced into psychiatry in the first four decades of the twentieth century. These included the convulsive therapies (cardiazol/metrazol therapy and electroconvulsive therapy), deep sleep therapy and psychosurgery. Insulin coma therapy and the convulsive therapies are collectively known as the shock therapies. Insulin coma therapy was a labour-intensive treatment that required trained staff and a special unit. Patients, who were almost invaria

Causes Of Metabolic Acidosis In Canine Hemorrhagic Shock: Role Of Unmeasured Ions

Abstract Metabolic acidosis during hemorrhagic shock is common and conventionally considered to be due to hyperlactatemia. There is increasing awareness, however, that other nonlactate, unmeasured anions contribute to this type of acidosis. Eleven anesthetized dogs were hemorrhaged to a mean arterial pressure of 45 mm Hg and were kept at this level until a metabolic oxygen debt of 120 mLO2/kg body weight had evolved. Blood pH, partial pressure of carbon dioxide, and concentrations of sodium, potassium, magnesium, calcium, chloride, lactate, albumin, and phosphate were measured at baseline, in shock, and during 3 hours post-therapy. Strong ion difference and the amount of weak plasma acid were calculated. To detect the presence of unmeasured anions, anion gap and strong ion gap were determined. Capillary electrophoresis was used to identify potential contributors to unmeasured anions. During induction of shock, pH decreased significantly from 7.41 to 7.19. The transient increase in lactate concentration from 1.5 to 5.5 mEq/L during shock was not sufficient to explain the transient increases in anion gap (+11.0 mEq/L) and strong ion gap (+7.1 mEq/L), suggesting that substantial amoun Continue reading >>

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  1. Paraish Misra

    This side effect was very common with phenformin (metformin’s “parent drug”), and in fact led to its withdrawal from many markets. However, lactic acidosis appears to be very uncommon with metformin. In fact, whether or not lactic acidosis occurs at all with metformin is a matter of intense debate among some physicians. Nonetheless, out of safety, physicians will not prescribe metformin to patients at high risk of lactic acidosis (such as patients with advanced kidney disease).

  2. George Johnson

    This answer is not a substitute for professional medical advic...

  3. -> Continue reading
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Bala Venkatesh (University of Queensland, Australia) busting lactate myths at #SGANZICS on 22 April 2017. Mark your calendar for SGANZICS 17-21 May 2018!

Metabolic Acidosis In The Critically Ill: Part 2. Causes And Treatment

The correct identification of the cause, and ideally the individual acid, responsible for metabolic acidosis in the critically ill ensures rational management. In Part 2 of this review, we examine the elevated (corrected) anion gap acidoses (lactic, ketones, uraemic and toxin ingestion) and contrast them with nonelevated conditions (bicarbonate wasting, renal tubular acidoses and iatrogenic hyperchloraemia) using readily available base excess and anion gap techniques. The potentially erroneous interpretation of elevated lactate signifying cell ischaemia is highlighted. We provide diagnostic and therapeutic guidance when faced with a high anion gap acidosis, for example pyroglutamate, in the common clinical scenario ‘I can’t identify the acid – but I know it's there'. The evidence that metabolic acidosis affects outcomes and thus warrants correction is considered and we provide management guidance including extracorporeal removal and fomepizole therapy. In Part 1 of this review article, we considered the classification and diagnostic approach to metabolic acidosis in the critically ill, including base excess, CO2/HCO–3, and anion gap, and proposed albumin-corrected anion gap Continue reading >>

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Popular Questions

  1. Paraish Misra

    This side effect was very common with phenformin (metformin’s “parent drug”), and in fact led to its withdrawal from many markets. However, lactic acidosis appears to be very uncommon with metformin. In fact, whether or not lactic acidosis occurs at all with metformin is a matter of intense debate among some physicians. Nonetheless, out of safety, physicians will not prescribe metformin to patients at high risk of lactic acidosis (such as patients with advanced kidney disease).

  2. George Johnson

    This answer is not a substitute for professional medical advic...

  3. -> Continue reading
read more

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