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| {{Infobox Disease |
| | Second, the use of medications tends to lead a person to believe that he or she is now "protected" from anxiety disorders, and the sense of being protected often leads an anxiety sufferer to feel more vulnerable in the long run. The emotional roller coaster of preparing and waiting for the date --- not to mention the actual outcome of it --- can put even the most stable of women in panic. A number of intensely unpleasant mental, physical, and behavioural symptoms may also accompany the general sense of apprehension. Feeling of nausea, tightness in the chest area and not knowing what to do before entering a bank or opening the gate of your villa can be an exasperating thing. Missing time at school can have a negative affect on their grades and ability to learn. <br><br>Again, there are some great resources online for you to look into and I hope you do. Therefore, it may be beneficial to increase your intake of this vital mineral. Reassure each child by repeating often that parents will return at the end of the day. At the hospital said they had had symptoms of panic attacks and that over time could have been the re symptoms from anticipatory anxiety, or that events similar to that triggered the panic attack could have the ability to make him wake anxiety disorder symptoms. Herbs for Anxiety are very useful in treating acute symptoms of stress and anxiety, but you need to supplement them with other types of coping mechanisms. <br><br>Eating healthier with good vitamins and minerals will support your anxiety reduction efforts and keep your body feeling healthy and relaxed. The more complex the condition, the more difficult it is to treat. It will also make you more conscious that your respiratory system will be improving each day that you do not have a cigarette. If this has been happening to you lately, you are likely having panic attacks. It is very important to have someone to talk to especially when there is something bothering on your mind to somehow ease the burden's that is inside you. <br><br>I can't tell you how frightening that sensation was. These are also the signs as well as signs and symptoms of a heart attack. When we pray we accept our faults and shortcomings. Why not have a look at to find out what you can do about Social Anxiety and other types of Anxiety and Panic disorders. When there is danger, these sad messengers are true life-savers, alerting the body into action to prevent harm. <br><br>Studies show that if a close family member suffers from anxiety, another member may likely develop some type of anxiety. An international pharmacy can be a complement to doctors and pharmacists to get those the help that they need, but should not be used as a substitute. Likewise anxiety disorders can often lead to depression. Neuroplasticity is all about the brain reorganizing its neuron-to-neuron connections in response to new circumstances and environments. They are hence useful for situations where the user is aware of the possibility of panic attacks occurring, such as before public speaking.<br><br>If you have any questions regarding where and how you can utilize [http://www.stress-lavoro-correlato.info/sitemap/ anxiety and panic attack], you could call us at our web site. |
| Name = Metabolic acidosis |
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| Image = Davenport Fig 12.jpg |
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| Caption = [[Davenport diagram]] |
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| DiseasesDB = 92 |
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| ICD10 = {{ICD10|E|87|2|e|70}} |
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| ICD9 = {{ICD9|276.2}} |
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| ICDO = |
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| OMIM = |
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| MedlinePlus = 000335 |
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| eMedicineSubj = emerg |
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| eMedicineTopic = 312 |
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| eMedicine_mult = {{eMedicine2|med|1458}} {{eMedicine2|ped|15}} |
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| MeshID = |
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| }}
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| In [[medicine]], '''metabolic acidosis''' is a condition that occurs when the body produces too much acid or when the [[kidney]]s are not removing enough acid from the body. If unchecked, metabolic acidosis leads to [[acidemia]], i.e., blood [[pH]] is low (less than 7.35) due to ''increased'' production of [[hydrogen ions]] by the body or the inability of the body to form [[bicarbonate]] (HCO<sub>3</sub><sup>-</sup>) in the kidney. Its causes are diverse, and its consequences can be serious, including [[coma]] and [[death]]. Together with [[respiratory acidosis]], it is one of the two general causes of acidemia.
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| ==Terminology==
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| *Acidosis refers to a ''process'' that causes a low pH in blood and tissues.
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| *Acidemia refers specifically to a low pH in the blood.
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| In most cases, acidosis occurs first for reasons explained below. Free hydrogen ions then diffuse into the blood, lowering the pH. [[Arterial blood gas]] analysis detects acidemia (pH lower than 7.35). When acidemia is present, acidosis is presumed.
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| ==Signs and symptoms==
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| Symptoms are not specified, and diagnosis can be difficult unless the patient presents with clear indications for [[arterial blood gas]] sampling. Symptoms may include [[chest pain]], [[palpitations]], [[headache]], altered mental status such as
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| severe anxiety due to [[Hypoxia (medical)|hypoxia]], decreased visual acuity, [[nausea]], [[vomiting]], [[abdominal pain]], altered appetite (either loss of or increased) and [[weight loss]] (longer term), [[muscle weakness]] and [[bone pain]]s. Those in metabolic acidosis may exhibit deep, rapid breathing called [[Kussmaul respiration]]s which is classically associated with diabetic [[ketoacidosis]]. Rapid deep breaths increase the amount of carbon dioxide exhaled, thus lowering the serum carbon dioxide levels, resulting in some degree of compensation. Over compensation via respiratory alkalosis to form an alkalemia does not occur.
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| Extreme acidemia leads to neurological and cardiac complications:
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| * Neurological: lethargy, stupor, [[coma]], [[seizure]]s.
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| * Cardiac: [[arrhythmia]]s ([[ventricular tachycardia]]), decreased response to [[epinephrine]]; both lead to [[hypotension]] (low blood pressure).
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| [[Physical examination]] occasionally reveals signs of disease, but is otherwise normal. [[Cranial nerve]] abnormalities are reported in [[ethylene glycol]] poisoning, and [[retina]]l [[edema]] can be a sign of [[methanol]] (methyl alcohol) intoxication. Longstanding chronic metabolic acidosis leads to [[osteoporosis]] and can cause [[fracture]]s.
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| ==Diagnosis==
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| [[Arterial blood gas]] sampling is essential for the diagnosis. If the pH is low (under 7.35) and the bicarbonate levels are decreased (<24 mmol/l), metabolic acidemia is present, and metabolic acidosis is presumed. Due to respiratory compensation (hyperventilation), carbon dioxide is decreased and conversely oxygen is increased. An [[ECG]] can be useful to anticipate cardiac complications.
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| Other tests that are relevant in this context are [[electrolyte]]s (including [[chloride]]), [[glucose]], [[renal function]] and a [[full blood count]]. [[Urinalysis]] can reveal acidity ([[salicylate]] poisoning) or alkalinity (renal tubular acidosis type I). In addition, it can show ketones in ketoacidosis.
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| To distinguish between the main types of metabolic acidosis, a clinical tool called the ''[[anion gap]]'' is considered very useful. It is calculated by subtracting the chloride and bicarbonate levels from the sodium.
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| Anion gap = ( [Na<sup>+</sup>]+ [K<sup>+</sup>]) - ( [Cl<sup>-</sup>]+[HCO<sub>3</sub><sup>-</sup>] )
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| As sodium is the main extracellular cation, and chloride and bicarbonate are the main anions, the result should reflect the remaining anions. Normally, this concentration is about 8-16 mmol/l (12±4). An elevated ''anion gap'' (i.e. > 16 mmol/l) can indicate particular types of metabolic acidosis, particularly certain poisons, lactate acidosis and ketoacidosis.
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| As the [[differential diagnosis]] is made, certain other tests may be necessary, including toxicological screening and imaging of the kidneys. It is also important to differentiate between acidosis-induced hyperventilation and asthma; otherwise, treatment could lead to inappropriate bronchodilation.[http://www.ncbi.nlm.nih.gov/sites/entrez/17906597?dopt=Abstract&holding=f1000,f1000m,isrctn]
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| ==Causes==
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| Metabolic acidosis occurs when the body produces too much acid, or when the kidneys are not removing enough acid from the body. There are several types of metabolic acidosis. The main causes are best grouped by their influence on the ''[[anion gap]]''.
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| It bears noting that the anion gap can be spuriously normal in sampling errors of the sodium level, e.g. in extreme [[hypertriglyceridemia]]. The anion gap can be increased due to relatively low levels of cations other than sodium and potassium (e.g. calcium or magnesium).
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| ===Increased anion gap===
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| {{Main|High anion gap metabolic acidosis}}
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| Causes include:
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| * [[lactic acidosis]]
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| * [[ketoacidosis]]
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| * [[chronic renal failure]] (accumulation of [[sulfate]]s, [[phosphate]]s, [[urea]])
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| * intoxication:
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| ** [[organic acid]]s ([[salicylate]]s, [[ethanol]], [[methanol]], [[formaldehyde]], [[ethylene glycol]], [[paraldehyde]], [[Isoniazid|INH]])
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| ** [[sulfates]], [[metformin]] (Glucophage)
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| * massive [[rhabdomyolysis]]
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| ===Normal anion gap===
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| {{Main|Normal anion gap acidosis}}
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| Causes include:<ref>{{MedicalMnemonics|2001|||}}</ref>
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| * longstanding [[diarrhea]] (bicarbonate loss)
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| * [[pancreatic fistula]]
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| * uretero-sigmoidostomy
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| * [[Renal tubular acidosis]] (RTA)
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| * intoxication:
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| ** [[ammonium chloride]]
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| ** [[acetazolamide]] (Diamox)
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| ** [[bile acid sequestrant]]s
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| ** [[isopropyl alcohol]]
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| * [[renal failure]] (occasionally)
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| * [[inhalant abuse]]
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| * [[toluene]]
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| ==Pathophysiology==
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| ===Compensatory mechanisms===
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| Metabolic acidosis is either due to increased generation of acid or an inability to generate sufficient bicarbonate. The body regulates the acidity of the blood by four buffering mechanisms.
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| * [[bicarbonate buffering system]]
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| * [[Intracellular]] buffering by absorption of hydrogen atoms by various molecules, including proteins, phosphates and carbonate in bone.
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| * [[Respiratory compensation]]
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| * [[Renal compensation]]
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| ===Buffer===
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| The decreased bicarbonate that distinguishes metabolic acidosis is therefore due to two separate processes: the buffer (from water and carbon dioxide) and additional renal generation. The buffer reactions are:
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| :<math>H^++\text{HCO}_3{}^- \Longleftrightarrow H_2\text{CO}_3\Longleftrightarrow \text{CO}_2+H_2O</math>
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| The [[Henderson-Hasselbalch equation]] mathematically describes the relationship between blood pH and the components of the bicarbonate buffering system:
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| <math>\text{pH}=\text{pK}_a+\text{Log}\frac{\left[\text{HCO}_3^-\right]}{\left[\text{CO}_2\right]}</math>
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| :Using Henry's Law, we can say that [CO<sub>2</sub>]=0.03xPaCO<sub>2</sub>
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| : (PaCO<sub>2</sub> is the pressure of CO<sub>2</sub> in arterial blood)
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| :Adding the other normal values, we get
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| <math>\text{pH}=6.1+\text{Log}\left[\frac{24}{0.03\times 40}\right]</math>
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| :<math> = 6.1 + 1.3 </math>
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| :<math> = 7.4 </math>
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| ==Treatment==
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| A pH under 7.1 is an emergency, due to the risk of [[cardiac arrhythmia]]s, and may warrant treatment with [[intravenous bicarbonate]]. Bicarbonate is given at 50-100 mmol at a time under scrupulous monitoring of the arterial blood gas readings. This intervention, however, has some serious complications in [[lactic acidosis]] and, in those cases, should be used with great care.
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| If the acidosis is particularly severe and/or there may be intoxication, consultation with the [[nephrology]] team is considered useful, as [[dialysis]] may clear both the intoxication and the acidosis.
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| ==See also==
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| * [[Trauma triad of death]]
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| * [[Metabolic alkalosis]]
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| * [[Respiratory acidosis]]
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| * [[Respiratory alkalosis]]
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| ==References==
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| {{Refimprove|date=January 2008}}
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| {{reflist}}
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| {{Fluid, electrolyte, acid base metabolic pathology}}
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| [[Category:Acid-base disturbances]]
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| [[ru:Ацидоз]]
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Second, the use of medications tends to lead a person to believe that he or she is now "protected" from anxiety disorders, and the sense of being protected often leads an anxiety sufferer to feel more vulnerable in the long run. The emotional roller coaster of preparing and waiting for the date --- not to mention the actual outcome of it --- can put even the most stable of women in panic. A number of intensely unpleasant mental, physical, and behavioural symptoms may also accompany the general sense of apprehension. Feeling of nausea, tightness in the chest area and not knowing what to do before entering a bank or opening the gate of your villa can be an exasperating thing. Missing time at school can have a negative affect on their grades and ability to learn.
Again, there are some great resources online for you to look into and I hope you do. Therefore, it may be beneficial to increase your intake of this vital mineral. Reassure each child by repeating often that parents will return at the end of the day. At the hospital said they had had symptoms of panic attacks and that over time could have been the re symptoms from anticipatory anxiety, or that events similar to that triggered the panic attack could have the ability to make him wake anxiety disorder symptoms. Herbs for Anxiety are very useful in treating acute symptoms of stress and anxiety, but you need to supplement them with other types of coping mechanisms.
Eating healthier with good vitamins and minerals will support your anxiety reduction efforts and keep your body feeling healthy and relaxed. The more complex the condition, the more difficult it is to treat. It will also make you more conscious that your respiratory system will be improving each day that you do not have a cigarette. If this has been happening to you lately, you are likely having panic attacks. It is very important to have someone to talk to especially when there is something bothering on your mind to somehow ease the burden's that is inside you.
I can't tell you how frightening that sensation was. These are also the signs as well as signs and symptoms of a heart attack. When we pray we accept our faults and shortcomings. Why not have a look at to find out what you can do about Social Anxiety and other types of Anxiety and Panic disorders. When there is danger, these sad messengers are true life-savers, alerting the body into action to prevent harm.
Studies show that if a close family member suffers from anxiety, another member may likely develop some type of anxiety. An international pharmacy can be a complement to doctors and pharmacists to get those the help that they need, but should not be used as a substitute. Likewise anxiety disorders can often lead to depression. Neuroplasticity is all about the brain reorganizing its neuron-to-neuron connections in response to new circumstances and environments. They are hence useful for situations where the user is aware of the possibility of panic attacks occurring, such as before public speaking.
If you have any questions regarding where and how you can utilize anxiety and panic attack, you could call us at our web site.