Hey folks,
I'm just kinda stupid but I really want to know, in cases of high anion gap metabolic acidosis, what is the level of chloride and why ?
Would appreciate your help.
The uworld explanation for why you get metabolic acidosis with large amounts of normal saline:
"Because chloride and bicarbonate are the most abundant anions in the blood, an increase in chloride ions drives bicarbonate intracellularly to maintain appropriate electronegativity, which decreases buffering capacity and causes non–anion gap metabolic acidosis (low pH and low bicarbonate)."
but how does infusion of NaCl, with equal quantity of positive and negative ions, disrupt electronegativity ? Aren't we infusing equal amounts of positive and negative charges. So why does bicarbonate need to go inside the cells ?
I am sure I am missing something about this so I'll really appreciate if someone smarter than me can point that out
I keep getting confused by this concept, because Triamterene and Amiloride only block channels in the CT
Hi! Can someone please explain why there's increased anion gap acidosis with uremia in advanced kidney disease? Thank you
can someone please explain why there is non anion gap met acidosis in addison disease/spironolactone/rta.. i know it will be the same reason for the above conditions but i cnt understand it right now..
for excess nacl infusion- i gathered that the cl content increases and to maintain electroneutrality the hco3 goes into cells causing acidosis but since there is hyperchloremia the anion gap remains normal.
On page 18 of DeVirgilio's guide to surgery, it says "An elevated serum lactate, particularly associated with a non-anion gap metabolic acidosis, may indicate an ischemic bowel". So it is my understanding that a lactic acidosis would cause a high anion gap acidosis, so why in this case would ischemic bowel cause a non-anion gap metabolic acidosis?
Any help would be much appreciated!
So I overthought this and now I have no idea anymore what anything is anymore. I get that chloride increases in non anion gap metabolic acidosis to create the "normal" anion gap, but WHY does it increase? For instance, in the case of potassium-sparing diuretics, how does chloride increase? For acetazolamide, how does chloride increase?
Sorry for the weird question and thank you all for your awesome answers!
https://www.ncbi.nlm.nih.gov/pubmed/31044050
Authors: Basnet S, Tachamo N, Nazir S, Dhital R, Jehangir A, Donato A.
Abstract
Low carbohydrate diets have been popularized as an effective solution for weight loss. Although rare, life-threatening anion gap metabolic acidosis has been reported in patients on these diets. We present a case of a 31-year-old man with atypical symptoms of chest pain and shortness of breath found to have severe metabolic acidosis after starting low carbohydrate diet for a week
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I changed the title. It didn't include that it is a case report which makes it sensational.
Anion gap
I have a puzzling case study and trying to think of creative things that might fit.
I understand non-AG acidosis are due to loss of HCO3- from kidneys or GI tract. But what is the mechanism that causes the high Cl- that compensates this?
I’m having a very hard time with this concept. My book says when a patient is in metabolic acidosis such as DKA that you can expect low ETC02 ratings. This makes no sense to me. Since the body is acidic wouldn’t it being blowing off more C02 to try and correct itself? The C02 readings make sense to me for both respiratory alkalosis and acidosis, but when it goes to metabolic I just don’t get it. Any help is greatly appreciated
Hey all, I am wondering if anyone had a diagnosis with similar “mild” symptoms and bloodwork. My doctor had me tested for M-Proteins this morning, and I’m awaiting results meanwhile completely freaking out! The red fags in my blood tests were mainly high level of IgA at 425 mg/dL and my anion gap was 3 mmol/L - quick research basically says theres one explanation for low anion gap and its MM…
My only real symptoms are that I have some rib pin that kindof comes and goes all over the place - it doesn’t really stay in one place. Some thing on the ribs of my back.
Other than that, possibly unrelated, but I have been peeing a lot, having diarrhea, and my mouth seems to be feeling dry a lot even though Im staying hydrated. I know that these are symptoms of hypercalcemia, but my blood test show my calcium levels in the normal range.
I had a CBC and CMP lab done and results are:
- CRP is high at 4.3 mg/L, but this is actually less than it was a few weeks ago
- ESR is normal at 12mm/he
- BUN is low at 6 mg/dL
- Total Protein is high at 8.4 g/dL
- AST-SGOT is low at 13 U/L
- All of the rest of my Metabolic panel results were in the normal range
- All of my Complete Blood Count results were within the normal range
Is any of this familiar or am I just worrying myself for nothing?
Anyone on here know what could be the cause with this? Of course my doctor is not open until Monday but my results already posted with no way for me to know if I should worry. Everything else on the metabolic screening was within normal range.
I am six weeks pregnant- 5’4- 120 lbs
Anion Gap Your Value 9 mmol/L Standard Range 10 - 20 mmol/L
BUN/ Creatinine Ratio Your Value 33 Standard Range 7 - 25 Flag H
I've been getting routine bloodwork every six months and today's test show that my Anion Gap has reduced to the lowest it's every been at 1 and my Chloride is over 109. Both are beyond their markers. Everything else was normal. They didn't check Bicarbonate so I suspect that is high. I wonder if electrolyte imbalances can cause these PVCs because reading says you can have heart rhythm problems with electrolyte imbalance. Anyone else ever get bloodwork to find their electrolyte panel is off?
https://doi.org/10.1097/01.JAA.0000800304.52410.9c
https://pubmed.ncbi.nlm.nih.gov/34813533
ABSTRACT
This article describes a rare case of lactation ketoacidosis in a patient who started a ketogenic diet while nursing an infant and toddler. The patient presented to the ED with a history of nausea, vomiting, and postural dizziness, and was found to have a significant metabolic acidosis and elevated lipase level. The metabolic changes induced in this patient could occur in anyone with high metabolic demands who also is on a strict ketogenic diet. The case highlights the importance of a dietary history in patients with unexplained metabolic derangements.
I've been trying to understand this question for a Physiology class I'm taking, and I still don't quite get it. I know that an increase in protein intake will result in a higher amount of NH4+ in the urine, but I'm not really too sure as to why this results in metabolic acidosis. It has to do with HCO3- production too, I'm sure, but other than that I'm completely lost.
Thanks for your help in advance!
https://imgur.com/a/vxHRExT
29,female,Caucasian
I'm really struggling with the concept of increased Cl- causing metabolic acidosis- I understand that the body is going to attempt to maintain electronegativity such that + and - charges are balanced/ have a sum of 0. I've also read about H20 dissociating to H+ and OH- to balance out that charge. But I guess I get confused about how the OH- doesn't prevent the H+ from really making a difference in the anion gap since it would technically be cancelled out?
Am I going the completely wrong direction with this? I've read that increased Cl- decreases bicarb concentrations, which likely also contributes to metabolic acidosis. But where does the bicarb go?
I feel like I'm going mad trying to figure this out and maybe it's obvious and my acid base physiology needs some major work. Thanks in advance for any help!
Age: 32
Sex: F
Symptoms: a random bruise on foot and a finger that swelled up but is now fine.
Weight: 283
Height: 5’ 10”
Current tests all show fine but these concern me. Haven’t been able to talk to doc yet since tests came in last night.
Results: https://ibb.co/h215ftZ
Anion Gap: value < 1 (standard 3-14)
Carbon Dioxide: 32 (standard 20-32)
WBC: 8.4 (standard 4-11)
RBC: 4.6 (standard 3.8-5.2)
GFR: value > 90
Previous tests from July showed an anion of 4 and carbon dioxide of 29.
One before that in 2018 showed carbon dioxide of 28 and anion of 6.
Now is this something my wife should be overly concerned about, she is freaking out currently and I am trying to reassure her that it could be lab error from what I am seeing being that it isn’t normal that anion is usually low.
Anyone familiar with this?
Thanks all.
Ghb is so much cleaner, however when I drink and redose gbl its not as physically forgiving as I'd be decreasing my blood ph. If I take antacid tablets (Tums/generic) along with gbl diluted with alkaline water and some magnesium powder in gel caps would it prevent excess acidity forming in my blood?
