ACIDOSIS METABOLICA CON ANION GAP ELEVADO PDF

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A rare cause of severe metabolic acidosis: Presurgical fasting. No encontramos reportes a nivel nacional. Su incidencia aumenta durante el embarazo.

Objectives: To discuss a clinical case and a non-systematic literature review on severe metabolic acidosis due to pre-surgical fasting, its incidence, etiology, and pathophysiology. Materials and methods: Discussion of a case of a patient with fasting-induced severe metabolic acidosis during a laparoscopic cholecystectomy, its management and outcomes. The Ethics Committee of our institution approved the case discussion. The literature search included Pub Med, Scielo and Bireme.

Results: Fasting-induced metabolic acidosis is underdiagnosed and is related to the search for an alternate energy source in the absence of glucose and glycogen. Free fatty acids are these alternate source and generate ketone bodies that accumulate and lead to the development of acidosis.

This is the first case of a non-diabetic patient at our institution. We found no other reports at the national level. There are some cases in the world literature associated with fasting from vomiting during the third trimester of pregnancy, psychiatric disorders, strict dieting, gastric band dysfunction and alcohol abuse.

Conclusions: The anesthesiologist must be aware of this possibility in patients with fasting induced metabolic acidosis with normal lactate values and hemodynamic impairment that are either too young or too old, non-diabetic and with no history of alcohol abuse. The anion gap calculation tool is a simple diagnostic approach. The incidence of the condition increases during pregnancy. La segunda, por exceso de hidrogeniones debido a intoxicaciones con salicilatos, metanol y sepsis entre otras 1,2.

Antecedentes personales: dislipidemia en tratamiento con lovastatina. Se traslada a UCI con soporte ventilatorio invasivo y vasopresor tablas 1 y 2.

En UCI, la curva de enzimas cardiacas es negativa. Gasto urinario normal. Parcial de orina con cetonas positivas 3 cruces. En Feling y Linch describieron la mayor incidencia en el tercer trimestre del embarazo. David et al. Manejado con dextrosa Nuestro caso es inusual porque se trata de una persona mayor, sin historia de diabetes ni consumo de alcohol. Unmeasured anions in metabolic acidosis: Unravelling the mystery.

Crit Care. Carrillo R. Rev Mex Anestesiol. Mendoza A. Cahill GF. Starvation in man. Clin Endocrinol Metab. The difference between critical care initiation anion gap and prehospital admission anion gap is predictive of mortality in critical illness.

Crit Care Med. An unusual cause for ketoacidosis. Fuel metabolism in starvation. Annu Rev Nutr. Changes in the anion gap: A novel marker of outcome in critically ill patients. Back to the basis. Reyes R, Alvarez L. Rev Colomb Anestesiol. Starvation ketoacidosis in pregnancy. Kellum J. Determinants of plasma acid-base balance. Critical Care Clinics. Circulating anions usually associated with the Krebs cycle in patients with metabolic acidosis.

Reilly R, Anderson RJ. Interpreting the anion gap. Severe diabetic ketoacidosis in combination with starvation and anorexia nervosa at onset of type 1 diabetes: A case report. Ups J Med Sci. Acute starvation in pregnancy: A cause of severe metabolic acidosis. Int J Obstet Anesth. Starvation-induced true diabetic euglycemic ketoacidosis in severe depression. J Gen Intern Med. Severe metabolic acidosis as a consequence of acute starvation in pregnancy. Arch Gynecol Obstet. Keay S, Fox R.

Maternal ketoacidosis complicating acute starvation in pregnancy. J Obstet Gynaecol. Mahoney CA. Extreme gestational starvation ketoacidosis: Case report and review of pathophysiology. Am J Kidney Dis. A case of nondiabetic ketoacidosis in third term twin pregnancy.

J Clin Endocrinol Metab. Severe ketoacidosis secondary to starvation in a frutarian patient. Nutr Hosp. Severe metabolic ketoacidosis induced by starvation and exercise. Am J Med Sci. Starvation ketoacidosis in a patient with gastric banding. Clin Med. Bruegger D, Rehm M, da Silva l. Severe metabolic acidosis resulting from a dislocated gastric band.

Obes Surg. A patient with an unusual aetiology of a severe ketoacidosis. Intensive Care Med. Severe acidosis caused by starvation and stress. Services on Demand Article. Abstract Objectives: To discuss a clinical case and a non-systematic literature review on severe metabolic acidosis due to pre-surgical fasting, its incidence, etiology, and pathophysiology.

Keywords : Fasting, Ketoacidosis, Metabolic acidosis, Anion gap. How to cite this article.

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