Podcasts about bicarb

Grant Fisher and Yared Nuguse are world record holders in the 3000 and mile respectively as Cole Hocker and Hobbs Kessler ran faster than anyone else previously in the event. Josh Hoey's amazing 2025 continued with his 2nd American record. Shelby Houlihan ran the 2nd fastest indoor mile by an American in Boston and 16-year-old high school sophomore Cooper Lutkenhaus ran 1:46 at Millrose. We try and tell you what it all means? Want a 2nd podcast every week? And savings on running shoes? Join the LetsRun.com Supporters Club today for exclusive content, a bonus weekly podcast, shoe savings, and more. Cancel anytime .https://www.letsrun.com/subscribe Show notes: 00:00 letsrun.com/subscribe 00:56 Intro 06:46 LetsRun Millrose Watch Party 10:19 Millrose was Amazing 12:53 3000: Grant Fisher world record over Cole Hawker 21:23 Have Fisher and Hocker leveled up? 26:01 Bad news for Jakob? 31:22 Discussion on Track Times and Performances 32:31 Wanamaker Mile: Yared Nuguse world record over Hobbs Kessler 39:30 The other fast Americans 43:38 Text Message of the Week: How fast could Jim Ryun have gone? 47:44 Cam Myers vs Niels Laros vs Jakob Ingebrigtsen 49:51 What about Hobbs Kessler? 51:38 Cole Hawker's the favorite in 1500 for Worlds? 58:19 Grand Slam Track will have 3 of the 4 in 1500, how should they do tv? 01:02:36 Bicarb? 01:05:32 Josh Hoey American record 800 01:13:55 Shelby Houlihan 2nd fastest mile ever by an American indoors 01:18:34 High School Phenom Cooper Lutkenhaus 1:46.86 as 16-year-old 01:20:52 Rapid Fire Rest of Millrose 01:21:01 NIa Akins bombs 01:23:14 Will Sumner and crew impress in 600 01:25:28 Women's 3K: Whitney Morgan's Win & Katelyn Tuohy struggles 01:28:54 Georgia Bell FTW 01:30:09 Another WR for Fisher this weekend in 5000? Contact us: Email podcast@letsrun.com or call/text 1-844-LETSRUN podcast voicemail/text line. Want a 2nd podcast every week? And savings on running shoes? Join the LetsRun.com Supporters Club today for exclusive content, a bonus weekly podcast, shoe savings, and more. Cancel anytime .https://www.letsrun.com/subscribe Check out the LetsRun.com store. https://shop.letsrun.com/ We've got the softest running shirts in the business. Thanks for listening. Please rate us on your podcast app and spread the word to friend. Send us your feedback online: https://pinecast.com/feedback/letsrun/35ed91b1-1232-488b-9fe9-07593cbd3678

Even Brøndbo Dahl (30) en av landets raskeste 1500 m-løpere gjennom tidene, med NM-gull i 2022 på distansen og en pers på svimlende 3:37.89.Med sin utdanning som idrettsfysiolog liker han å gå vitenskapelig til verks i treningen, og har det siste året gått hardt til verks på varmetrening for å øke kapasiteten. Det er neppe tilfeldig at han for bare noen dager siden sprengte VO2 max-apparatet og målte høyere verdier enn noen gang.Er varmetrening noe for deg som sti/terreng/fjell/ultraløper? Hvordan går man til verks? Hvilken protokoll bør man bruke?På tampen tar vi selvfølgelig en del sidespor og havner innpå tema som f.eks sodium bikarbonat (aka bicarb) og høydetrening i kombinasjon med varmetrening.Lenker:EBD-bloggen: Varmetrening; erfaringer og effektEBD-bloggen: Varme + høyde = sant (86,3 ml/kg/min)NEDA-hjørnet på Fjellsport.noFøkk Asfalt PatreonSupport the show

Matt Fox - Marathon Weight Loss Protocol: https://docs.google.com/document/d/18jcXkyboLbvVvU0eSkVUVCNz3x3lmVnsNh99wTTskko/edit?usp=sharing Boulder Experience (April 2025):  https://www.thegloberunners.com/boulder-running-experience-april2025/ Check out Globe Runners on Instagram: https://www.instagram.com/thegloberunners/ Train with Matt: https://sweatelitecoaching.com/matt-fox/ Tune into the Private Podcast Feed and Join Our Discord Discussions:  https://www.sweatelite.co/shareholders/ Contact: matt@sweatelite.co Matt Instagram: https://www.instagram.com/mattinglisfox/ Matt Training Log - Strava: https://www.strava.com/athletes/6248359 In this episode of the Sweat Elite podcast, the host discusses his recent travel and health experiences, including fasting and enduring a calorie deficit. The episode delves into the benefits and potential drawbacks of resting periods for elite marathon runners, using specific examples from his decades-long running career. The host also explores the controversial comeback of Shelby Houlihan in competitive running, touching on broader themes of doping, rehabilitation, and the ethics of lifetime bans. Listener questions are addressed on topics like utilizing effort-based training in hilly terrain, introducing fatigue miles for 5k and 10k training, and optimizing sodium bicarbonate usage for performance enhancement. The host further discusses the merits of using treadmills for training and finds alternatives to maintain fitness while taking breaks from running. The episode concludes with cautionary advice about political repercussions for public stances and a preview of upcoming plans and episodes. Topics: 00:00 Introduction and Personal Update01:00 Training Insights and Rest Periods01:42 Voluntary Recovery and Injury Prevention02:48 Bicarb Experiment and Listener Feedback06:26 Shelby Houlihan Doping Controversy19:36 Cancel Culture and Public Figures23:00 Listener Questions and Running Advice30:28 Understanding Sodium Bicarbonate for Performance30:55 Sodium Bicarbonate Protocols and Personal Experiences32:21 Workouts of the Week: Effective Training Sessions34:39 Half Marathon and Marathon Training Insights38:11 The Role of Treadmills in Elite Running43:01 Political Climate and Its Impact on Athletes49:57 Alternative Training and Recovery Strategies59:51 Concluding Thoughts and Upcoming Events  

Boulder Experience (April 2025):  https://www.thegloberunners.com/boulder-running-experience-april2025/ Check out Globe Runners on Instagram: https://www.instagram.com/thegloberunners/ Train with Matt: https://sweatelitecoaching.com/matt-fox/ Tune into the Private Podcast Feed and Join Our Discord Discussions:  https://www.sweatelite.co/shareholders/ Contact: matt@sweatelite.co Matt Instagram: https://www.instagram.com/mattinglisfox/ Matt Training Log - Strava: https://www.strava.com/athletes/6248359 In this episode of the Sweat Elite Podcast, Matt shares his latest experiences while temporarily based in Tucson, Arizona. He discusses training sessions, his recent Houston Marathon, and preparation for the upcoming Osaka Marathon. Matt also dives deep into trying bicarb supplements for the first time and answers numerous listener questions about their effects, along with other training-related inquiries. Additionally, he provides innovative workout suggestions for 5K, 10K, half marathon, and marathon runners. Listener emails cover a range of topics, such as heavy weight training for cramp prevention, the impact of weight loss on marathon performance, advanced warm-up routines, and balancing training for both trail running and road marathons. Topics: 00:00 Welcome to the Sweat Elite Podcast00:49 Training Updates and Marathon Insights01:15 Bicarb Experiment and Workout Reflections04:08 Listener Questions and Globe Runners Experience08:26 More Listener Questions and Nutrition Insights22:46 The Importance of Rest and Recovery28:58 The Importance of Maintaining Weight During Breaks29:29 Hiking Adventures in Boulder30:24 Returning to Running After a Break31:30 Training Insights and Future Plans34:20 Workouts of the Week44:35 Listener Questions and Advice59:48 Concluding Thoughts and Upcoming Events WORKOUTS OF THE WEEK: 5/10k: 4 x 2k - 2k Threshold, 2k 100m/100m on/float, 2km threshold, 2km 100m/100m on/float HM: 14.4k (9mi): 1600m/1600m, 1400m/1400m, 1200m/1200m, 1k on / 1k float, 800m on/800m float, etc down to 200m. M: 8 miles/13k steady - 3 x Mile @ 5k (3min rest)  

We brought so much gratitude to this amazing episode! The main topic was the news announced this weekend: David's Leadville 100 performance won the International Trail Performance of the Year. Yes, tears were shed. To everyone who listens, THANK YOU. In ways that go deeper than words...thank you. We reflect on the training, the journey, how our lives have changed, and what's ahead. Shooters shoot. Next it was a "No Secrets" Q+A! Topics: why hydration recommendations of "drinking to thirst" are often wrong in races and training, fitness apps, early AM training, when training volume hits a saturation point, what weekly volumes might lead to breakthroughs, how love evolves (or doesn't), recovery runs, AI and energy use, gel flavors, adaptations to long-term heat training, the number of workouts we suggest per week, our frustrations with running media, and Listener Corner. This community kept us going with love and belief through some dark forests this year. This is OUR award. It would not have been possible if it was just us chasing history. But when we have this team lifting us up? Well, we might just F around and make history. We love you all! Huzzah! FAFOing forever, -David and Megan Watch the new video "Let's Shock The World" on David's Western States build: https://www.youtube.com/watch?v=7vpHk6Qoh_g Click "Claim Reward" for $80 at The Feed here: thefeed.com/swap Support Freetrail: https://freetrail.com/pro/ Subscribe to Semi-Rad: https://semi-rad.com/subscribe/ Buy Janji's amazing gear: https://janji.com/ (code "SWAP") For weekly bonus podcasts, articles, and videos (plus hat purchases): patreon.com/swap

Oh gosh guys, I am here swallowing my own advice and not waiting til I can do things 'perfectly' to put out a very (very!) overdue episode on our beloved Waflle Podcast! 15min pow wow on all things Bicarb today to get me (re)started, a supplement that is like the old/new kid on the performance block! So should you consider taking this humble baking cupboard supplement? Listen to find out - and don't forget to like and subscribe so you continue to snag little updates in the world of nutrition and performance :)

This is gonna be a salty podcast. That's right, I want to touch on the benefits of staying salty and the crucial role of electrolytes. The vast majority of my clientele I am finding has an electrolytes imbalance, and are chronically dehydrated. Drinking water is important. but without the minerals to help it get into the cell, you will spending more time in the bathroom than out living your best life with vitality and energy. The vast majority of my clientele are chronically fatigued too, and one of the first things I address with them is minerals and electrolytes. So to help you understand the crucial role of electrolytes, staying salty and other ways to optimize your health, because that's what this podcast is all about, I've brought on Charles Barber.....Charles is a nutrition educator and researcher, plant geneticist and soil scientist after struggling for years with chronic fatigue, weakened immunity and depression and found that when it comes to nutrition our world is missing 4 crucial things.... I”ll let him enlighten you as to what those are. To purchase any of the products mentioned here today, visit: Crucial Four Islandic Sea Salt: https://crucialfour.com/JODELLE Promo code: JODELLE for 15% off Find more of Charles highly educational free videos here:    / crucialfour   Would you like help navigating your health journey and achieving your pro-metabolic goals? I offer coaching worldwide for one flat rate initial consult of $199. Email me at getfitwithjodelle@gmail.com to get get started! Thanks to our show sponsors: Buffalo Gal Hair and Skin Products from High Quality Natural Sources Use Promo code: JODELLE for 15% off https://tallowskincare.idevaffiliate.... GlideSUP Paddleboards https://www.glidesup.comsca_ref=3347725.6bJYhtLqEp   use “JODELLE10” for 10 percent off C60 Purple Power https://c60purplepower.com/get-fit/ Promo code: JODELLE saves 10% SaunaSpace Red Light Sauna https://sauna.space/getfitwithjodelle for 5% off any purchase! Grounding Earthing Mat anyone will love and everyone can use from Ultimate Longevity! https://www.ultimatelongevity.com/ear... Swanwick Sleep https://www.bn10strk.com/FITFOR10/ Promo code: FITFOR10 or JODELLE10 Purity coffee - my favorite coffee: https://puritycoffee.com/?rfsn=640373... or https://bit.ly/3oK8woT JODELLE10 to save 10% LIFEBLUD METHYLENE BLUE & Mag+ https://lifeblud.co/?ref=cGFWJ1 PROMO CODE: JODELLE Flo's Daughter Etsy Store - my favorite natural skin care: https://www.etsy.com/shop/FlosDaughte... Promo code: JODELLE10 InfoPathy Infoceuticals...simply drink water to get any supplement you need......: https://www.infopathy.com/?invite=653... Promo Code: JODELLEFIT saves you 10%   Time Stamps:   Too much rigidity in health: 6:20 How to choose the best quality salt: 10:35 Salt and the other minerals crucial role in the body for many reasons: 20:00 EMF and why we need more electrolytes more than ever: 38:00 Magnesium Bicarbonate: 48:20 Ozone Therapy 1:10:30

In this episode, Dennis discusses the role of sodium bicarbonate in medical protocols, particularly in the context of rhabdomyolysis and hyperkalemia. He emphasizes the importance of fluid management and the potential over-hyping of bicarbonate as a treatment. The conversation explores the risks associated with rhabdomyolysis, the mechanisms of potassium management, and the clinical considerations for bicarbonate use in critical care settings. Takeaways Sodium bicarbonate is often over-hyped in medical treatments. Rhabdomyolysis can lead to serious kidney damage. Immediate fluid administration is crucial in suspected rhabdo cases. Bicarbonate has not shown clinical benefits in trials. Managing potassium levels is essential in rhabdomyolysis treatment. Insulin can help drive potassium back into cells. Urine output is a key indicator in treatment effectiveness. Alkalizing urine may not significantly prevent kidney injury. Correcting pH can be important in severe shock situations. Bicarbonate should be used judiciously in critical care. Thank you to Delta Development Team for in part, sponsoring this podcast. ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠deltadevteam.com⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ For more content go to ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠www.prolongedfieldcare.org⁠⁠⁠⁠⁠⁠ ⁠⁠⁠⁠ Consider supporting us: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠patreon.com/ProlongedFieldCareCollective⁠⁠⁠⁠⁠⁠ or ⁠⁠⁠⁠⁠⁠www.lobocoffeeco.com/product-page/prolonged-field-care⁠

We considered buying our very own pommel horse before this amazing episode! The main topic was a new study that may show a big reason for performance leaps across sports. In the study, just a few weeks of heat training caused 3% improvements in hemoglobin mass, associated with jumps in fitness. However, the adaptations reversed to baseline rapidly. What does it mean? Heat may be the next frontier of health and performance. Professor Nelly said we should take off all of our clothes, but the study authors beg to differ. We also talked about the Tecton 3, the new trail supershoe from HOKA. It's a total remake, with similar responsive softness as road supershoes. We are big fans, with some small gripes. All of these shoe companies are now on the clock to take a similar evolutionary leap. Adapt or die, trail shoe edition. And this one was packed full of the best topics! Other topics: putting the finishing touches on Leadville 100 training, saying big goals out loud, bad hot takes on gymnastics, medium hot takes on politics, built-in gaiters, another study showing performance improvements from sodium bicarbonate, the uncertain future of bicarb supplementation, our favorite stories from the Olympics, Pommel Horse Guy, Simone Biles and the power of FAAFO, our admiration for Noah Lyles, Grant Fisher's 10k bronze, Kristen Faulkner winning gold after quitting her VC job, Olli Hoare and critics, Snoop Dogg, the wild marathon course, and hot takes. What do Garfield and Clifford listen to when they want to get freaky? Tune in and find out. We love you all! HUZZAH! Click "Claim Reward" for $80 at The Feed here: thefeed.com/swap Support the podcast: patreon.com/swap Buy Janji's amazing gear: https://janji.com/ (code "SWAP")

The draft order:Sophia AmbrusoNayan AroraSwapnil HiremathAC GomezJoel TopfEditor Nayan AroraShow NotesPrevious drafts:2021 KDIGO Hypertension —Joel, Sophia, Swap, Nayan, Josh2021 ASN Kidney Week Draft—Joel, Sophia, Swap, Nayan, Jennie2022 The ISPD Peritonitis Guideline— Joel, Sophia, Swap, Nayan2022 ASN Kidney Week Draft—Joel, Sophia, Swap, Nayan2023 ASN Kidney Week Draft—Joel, Sophia, Swap, Nayan, AC, Josh2024 KDIGO CKD Clinical Practice Guideline —Joel, Sophia, Swap, Nayan, Josh, ACThe guidelineThe NephJC discussion Part 1 | Part 2First RoundSophia's Pick 3.7.1 We recommend treating patients with type 2 diabetes (T2D), CKD, and an eGFR ≥20 ml/min per 1.73 m2 with an SGLT2i (1A).Not Nayan's Pick 3.7.3: We suggest treating adults with eGFR 20 to 45 ml/min per 1.73 m2 with urine ACR

We thought long and hard about alien physiology before recording this great episode! The main topic was a wildly cool wrinkle in training science. Across all different types of events, the most predictive variable for performance is often how fast an athlete can go at VO2 max effort. That could have massive implications for how we think about training and what we consider "specificity" for long events! We discussed why we think that is, along with workout designs, the use of hills, and how much we want to get aliens on a treadmill. ET can phone home after ET does a VO2 max test. And this one was full of our favorite topics! Other topics: Addie dog going strong at nearly 12 years old, the upcoming Olympic Trials on the track, our wild travel schedule between the Trials and Western States, stroller running and our worrisome experience, sodium bicarbonate hacks, workout design, the power of using set-based structures, running economy and other predictors in ultras, a new study on fatigue resistance/durability and its relation to training status, Alex Honnold running the Lavaredo 50k, Roger Federer's wonderful speech on perseverance, messages about ferritin increases from liposomal iron, Joey Chestnut's ban from the hot dog eating contest and what it says about sponsorships, the increasing cost of shoes, Keely Hodgkinson's low-volume approach with lots of cross training, and hot takes. When the aliens arrive, we should give them a cup of chocolate Nesquik so they can experience our finest delicacies. Then it's straight onto the treadmill for some podcast content. We love you all! HUZZAH! Aliens! Click "Claim Reward" for $80 at The Feed here: thefeed.com/swap Support the podcast: patreon.com/swap Buy Janji's amazing gear: https://janji.com/ (code "SWAP")

Lemon juice, tea tree oil, baking soda & vinegar. All items you'd likely find in your pantry, but they are also being used in a lot of homes as natural cleaning products.  We're constantly told that the chemicals in household cleaning products are harmful to us and our families, so a lot of us are seeking natural alternatives that can be found around the home, but do they work? In this episode of The Quicky we dish the dirt on which products really will help keep your home clean and fresh and which are just bad science experiments.  Click here to take the latest Mamamia survey and you'll go in the running to win one of five $100 gift vouchers Want to try our new exercise app? Click here to start a seven day free trial of MOVE by Mamamia. Subscribe to Mamamia GET IN TOUCH Feedback? We're listening! Call the pod phone on 02 8999 9386 or email us at podcast@mamamia.com.au CONTACT US Got a topic you'd like us to cover? Send us an email at thequicky@mamamia.com.au CREDITS Host: Grace Rouvray With thanks to: Nathan Kilah - Lecturer in Synthetic Chemistry at the University of Tasmania  Producers: Grace Rouvray & Claire Murphy Executive Producer: Kally BorgAudio Producer: Tegan SadlerBecome a Mamamia subscriber: https://www.mamamia.com.au/subscribeSee omnystudio.com/listener for privacy information.

Episode 92 - Scott's Back With Vengeance, Cape Epic Upset, and The DJ v Dizzle Saga Continues  What's up party people. Happy Friday y'all and boy is it a good day to be alive. Scott's back from his underground Euro campaign, which of course we get into right at the onset of the show. DJ and Dizzle also brought the inter-squad competition to the lab and wind tunnel this week so we get a little scoop on the latest drama there, and we also touch on some Cape Epic news that might have some heads turning before the start of the Life Time Grand Prix kickoff next month. All that and more coming in hot.  If you have any questions or feedback for the show you can drop us a note at bonkbrospodcast@gmail.com or head over to the Bonk Bros insta and holla at your boys there (@bonkbros @dylanjawnson @adamsaban6 @tylerclouti @raddaddizzle @scottmcgilljr). Alright let's get this thing started.   Patreon: http://patreon.com/patreon_bonkbros   For more Dylan Johnson content: https://www.youtube.com/channel/UCIf1xvRN8pzyd_VfLgj_dow Intro/ Outro music by AlexGrohl on Pixabay.com: https://pixabay.com/music/id-111445/  Listener Question Form: https://docs.google.com/forms/d/1T37wGRLk6iYTCF6X_DQ9yfcaYtfAQceKpBJYR5W7DVA/edit?ts=642eb6d6   The Following Was Generated Using AI And Should Not Be Held To The Higher Standards Of Sentient Beings - Riverside.fm Summary The conversation covers topics such as arriving for the Bonk Roast, Scott's race victory, flying vs. driving to bike races, VO2 max testing, comparing fitness levels, aero testing and Lauf forks, and testing variables and real-world performance. The conversation covers topics such as comparing power files and drafting, factors affecting performance, talent and racing history, VO2 max and genetic potential, natural talent and training, late bloomers, VO2 max and performance, VO2 max testing, unique handlebars and aero positioning, Howard Grotz's performance, and weight and performance. The conversation covers topics such as collegiate road racing, Cape Epic, choosing a partner for Cape Epic, sponsorships, Dremel tools, Matteo Jorgensen and American talent, tire selection, and Training Peaks and coaching. In this episode, the hosts review a training plan, discuss race schedules and travel plans, and share their experiences with bicarb and ketones. They also talk about Adam's interest in archery and his upcoming bow setup. The conversation concludes with some closing remarks.   Takeaways Collegiate road racing can be unpredictable, and even riders from lower categories can win races. Choosing the right partner for Cape Epic is important, considering compatibility and skill level. Sponsorships can lead to unexpected benefits, such as receiving free products. Matteo Jorgensen's recent success in races like Perry Nice and Flanders is impressive. When selecting gravel tires, it's important to consider a balance between rolling resistance and puncture resistance. Training Peaks can be a useful tool for self-coaching, but working with a coach can provide more personalized guidance. Reviewing and following a structured training plan is important for consistent progress. Considerations for race tune-up include the proximity of the race to the main event and the specific demands of the race. Heart rate spikes during exercise may be a cause for concern and should be evaluated by a medical professional. Bicarb and ketones are popular supplements in the endurance sports community, but their effectiveness and safety should be carefully considered. Archery can be a fun and challenging sport to explore outside of cycling.   Chapters 00:00 Arriving for the Bonk Roast 02:21 Scott's Race Victory 03:38 Flying vs. Driving to Bike Races 06:02 VO2 Max Testing 09:18 Comparing Fitness Levels 12:15 Aero Testing and Lauf Forks 16:34 Testing Variables and Real-World Performance 18:04 Factors Affecting Performance 19:26 Talent and Racing History 20:35 VO2 Max and Genetic Potential 22:11 Natural Talent and Training 23:55 Late Bloomers 25:22 VO2 Max and Performance 29:36 VO2 Max Testing 32:27 Testing at VQ Labs 34:39 Unique Handlebars and Aero Positioning 36:13 Howard Grotz's Performance 37:06 Weight and Performance 37:22 Collegiate Road Racing and Cape Epic 40:41 Choosing a Cape Epic Partner 43:18 Sponsorships and Dremel Tools 52:29 Discussion on Tire Selection 56:35 Pathfinder Tires and Gravel Tire Recommendations 57:26 Training Peaks and Coaching 57:47 Training Plan Review 58:29 Discussion on Training Intensity 59:29 Race Schedule and Training Plan 01:00:34 Upcoming Races and Travel Plans 01:02:16 Considerations for Race Tune-up 01:03:11 Concerns about Heart Rate Spikes 01:04:18 Discussion on Bicarb and Ketones 01:05:00 Preferred Method of Ingesting Bicarb 01:06:06 Review of Dylan's Protein Powder 01:07:41 Adam's Interest in Archery 01:09:04 Adam's Bow Setup 01:11:00 Discussion on Surprise Release in Archery 01:14:49 Closing Remarks

The JournalFeed podcast for the week of Jan 1-5, 2024.These are summaries from just 2 of the 5 article we cover every week! For access to more, please visit JournalFeed.org for details about becoming a member.MondayThe best articles of 2023!!Friday Spoon Feed:A prospective, observational study demonstrated that giving sodium bicarbonate to patients undergoing mechanical ventilation or CPR resulted in an increase in end-tidal CO2 values in as quickly as 17 seconds and lasted for 7 minutes

Show notes at pharmacyjoe.com/episode874. In this episode, I’ll discuss what Impella purge solution can be used if the patient has a contraindication to heparin. The post 874: How Well Does a Bicarb-Based Impella Purge Solution Work for Patients With Contraindications to Heparin? appeared first on Pharmacy Joe.

Show notes at pharmacyjoe.com/episode874. In this episode, I’ll discuss what Impella purge solution can be used if the patient has a contraindication to heparin. The post 874: How Well Does a Bicarb-Based Impella Purge Solution Work for Patients With Contraindications to Heparin? appeared first on Pharmacy Joe.

Get ready to dive into the most shocking Talking Pools Podcast episode yet! Hosts Rudy and Andrea reveal jaw-dropping secrets about the International Code Council's sinister plot to make swimming pools less safe, with the shady backing of the PHTA, power cover manufacturers, and portable spa moguls. But that's not all! Rudy goes full science nerd, unraveling the mind-blowing mysteries of Bicarb's hidden reactions, where elements and compounds collide in an explosive twist. And don't miss the spine-tingling sneak peek of a chilling new pool horror movie that will leave you on the edge of your inflatable raft. Plus, we have a special guest, Kelli Clancy, shedding light on the Autism spectrum's connection to residential swimming pools. Buckle up, it's a splash of controversy, chemistry, and captivating conversations you won't want to miss!

High PaCO2, Low PaO2, Bicarb up, down...what does this all suggest? In this episode, join me as we introduce the principles of arterial blood gas tests and the interpretation of the results. This was a challenging subject to grasp in medical school, so hopefully this episode will help you have an idea about what to expect when the perfusionist or respiratory therapist hands you the reading.

Bicarbonate did not slow the loss of GFR in this well done Swiss, single-blind study of transplant patients.The Filtrate:Joel TopfNayan AroraSwapnil HiremathPirya YenebereWith Special Guest:Nav Tangri nephrologist and epidemiology at the University of ManitobaEditor:Nayan AroraShow Notes:Arsenal FCThe London study that kicked it all off!de Brito-Ashurst, I., Varagunam, M., Raftery, M. J., & Yaqoob, M. M. (2009). Bicarbonate supplementation slows progression of CKD and improves nutritional status. Journal of the American Society of Nephrology: JASN, 20(9), 2075–2084.The multi center (but unblinded) UBI Study with mortality benefit!Di Iorio, B. R., Bellasi, A., Raphael, K. L., Santoro, D., Aucella, F., Garofano, L., Ceccarelli, M., Di Lullo, L., Capolongo, G., Di Iorio, M., Guastaferro, P., Capasso, G., & UBI Study Group. (2019). Treatment of metabolic acidosis with sodium bicarbonate delays progression of chronic kidney disease: the UBI Study. Journal of Nephrology, 32(6), 989–1001.The BiCARB Study: Double blinded and negativeBiCARB study group. (2020). Clinical and cost-effectiveness of oral sodium bicarbonate therapy for older patients with chronic kidney disease and low-grade acidosis (BiCARB): a pragmatic randomised, double-blind, placebo-controlled trial. BMC Medicine, 18(1), 91.The initial Veverimer StudyWesson, D. E., Mathur, V., Tangri, N., Stasiv, Y., Parsell, D., Li, E., Klaerner, G., & Bushinsky, D. A. (2019). Long-term safety and efficacy of veverimer in patients with metabolic acidosis in chronic kidney disease: a multicentre, randomised, blinded, placebo-controlled, 40-week extension. In The Lancet (Vol. 394, Issue 10196, pp. 396–406). doi.org/10.1016/s0140-6736(19)31388-1The Valor CKD trial is still unpublished. But here is the press release. VALOR-CKD design manuscriptThe study of the night: Sodium bicarbonate for kidney transplant recipients with metabolic acidosis in Switzerland: a multicentre, randomized, single-blind, placebo-controlled, phase 3 trialNephJC | PubMed | LancetAlkali with normal bicarb? Sure, take a look at: Goraya, N., Simoni, J., Jo, C., & Wesson, D. E. (2012). Dietary acid reduction with fruits and vegetables or bicarbonate attenuates kidney injury in patients with a moderately reduced glomerular filtration rate due to hypertensive nephropathy. Kidney International, 81(1), 86–93.Metforminator!The BASE Trial: Raphael, K. L., Isakova, T., Ix, J. H., Raj, D. S., Wolf, M., Fried, L. F., Gassman, J. J., Kendrick, C., Larive, B., Flessner, M. F., Mendley, S. R., Hostetter, T. H., Block, G. A., Li, P., Middleton, J. P., Sprague, S. M., Wesson, D. E., & Cheung, A. K. (2020). A Randomized Trial Comparing the Safety, Adherence, and Pharmacodynamics Profiles of Two Doses of Sodium Bicarbonate in CKD: the BASE Pilot Trial. Journal of the American Society of Nephrology: JASN, 31(1), 161–174.Tubular SecretionsSwap The Three-Body Problem (novel) | NetflixNayan Women's World CupTangri English Premier Soccer and InflationPriya Silo on Apple TVJoel Live Podcast recording at ASN Kidney

The Filtrate:Joel TopfNayan AroraSwapnil HiremathPirya YenebereWith Special Guest:Nav Tangri nephrologist and epidemiology at the University of ManitobaEditor:Nayan AroraShow Notes:Arsenal FCThe London study that kicked it all off!de Brito-Ashurst, I., Varagunam, M., Raftery, M. J., & Yaqoob, M. M. (2009). Bicarbonate supplementation slows progression of CKD and improves nutritional status. Journal of the American Society of Nephrology: JASN, 20(9), 2075–2084.The multi center (but unblinded) UBI Study with mortality benefit!Di Iorio, B. R., Bellasi, A., Raphael, K. L., Santoro, D., Aucella, F., Garofano, L., Ceccarelli, M., Di Lullo, L., Capolongo, G., Di Iorio, M., Guastaferro, P., Capasso, G., & UBI Study Group. (2019). Treatment of metabolic acidosis with sodium bicarbonate delays progression of chronic kidney disease: the UBI Study. Journal of Nephrology, 32(6), 989–1001.The BiCARB Study: Double blinded and negativeBiCARB study group. (2020). Clinical and cost-effectiveness of oral sodium bicarbonate therapy for older patients with chronic kidney disease and low-grade acidosis (BiCARB): a pragmatic randomised, double-blind, placebo-controlled trial. BMC Medicine, 18(1), 91.The initial Veverimer StudyWesson, D. E., Mathur, V., Tangri, N., Stasiv, Y., Parsell, D., Li, E., Klaerner, G., & Bushinsky, D. A. (2019). Long-term safety and efficacy of veverimer in patients with metabolic acidosis in chronic kidney disease: a multicentre, randomised, blinded, placebo-controlled, 40-week extension. In The Lancet (Vol. 394, Issue 10196, pp. 396–406). https://doi.org/10.1016/s0140-6736(19)31388-1The Valor CKD trial is still unpublished. But here is the press release. VALOR-CKD design manuscript The study of the night: Sodium bicarbonate for kidney transplant recipients with metabolic acidosis in Switzerland: a multicentre, randomized, single-blind, placebo-controlled, phase 3 trialNephJC | PubMed | Lancet Alkali with normal bicarb? Sure, take a look at: Goraya, N., Simoni, J., Jo, C., & Wesson, D. E. (2012). Dietary acid reduction with fruits and vegetables or bicarbonate attenuates kidney injury in patients with a moderately reduced glomerular filtration rate due to hypertensive nephropathy. Kidney International, 81(1), 86–93.Metforminator!The BASE Trial: Raphael, K. L., Isakova, T., Ix, J. H., Raj, D. S., Wolf, M., Fried, L. F., Gassman, J. J., Kendrick, C., Larive, B., Flessner, M. F., Mendley, S. R., Hostetter, T. H., Block, G. A., Li, P., Middleton, J. P., Sprague, S. M., Wesson, D. E., & Cheung, A. K. (2020). A Randomized Trial Comparing the Safety, Adherence, and Pharmacodynamics Profiles of Two Doses of Sodium Bicarbonate in CKD: the BASE Pilot Trial. Journal of the American Society of Nephrology: JASN, 31(1), 161–174.Tubular SecretionsSwap The Three-Body Problem (novel) | Netflix Nayan Women's World CupTangri English Premier Soccer and InflationPriya Silo on Apple TVJoel Live Podcast recording at ASN Kidney

En este 20 episodio del Find Your Everest Podcast by Javi Ordieres, hablamos de siguientes temas: - Contamos con la presencia del gran Chito, speaker del Trail Monte Dobra y hacemos un poquito de balance, de todo lo vivido este fin de semana en Torrelavega. - Hablamos tambien de la polémica surgida en la carrera de Skyrunning en Austria, donde los tres primeros se perdieron y fueron descalificados. - Queda menos de un mes para el UTMB, y ya empezamos con la previa! - Nos acompaña Marta Martinez Abellán, para contarnos como vivió la victoria del Campeonato de Europa. - Inauguramos dos nuevas sección: "¿Que dicen los PROs?" y también "La pregunta más importante de la semana" - Damos entrada a los nuevos colores de las zapatillas HOKA: Clifton Mujer: https://findyoureverest.es/producto/zapatillas-hoka-clifton-9-mujer/ Challenger Mujer: https://findyoureverest.es/producto/zapatillas-hoka-challenger-7-2023-mujer/ Challenger Hombre: https://findyoureverest.es/producto/zapatillas-hoka-challenger-7-2023/ - Y tambien damos la bienvenida a tres nuevas marcas de nutricion: Barebells: https://findyoureverest.es/categoria-producto/marcas/barebells/ Nocco: https://findyoureverest.es/categoria-producto/marcas/nocco/ Vitamin Well: https://findyoureverest.es/categoria-producto/marcas/vitamin-well/ Cerramos el podcast, en la sección “Diccionario del Trail", hablando de los efectos del bicarbonato y de la experiencia de Javi Ordieres con el Bicarb de Maurten. ESPERO QUE OS GUSTE EL PROGRAMA QUE HEMOS PREPARADO! Ya sabéis que podéis apoyarnos, visitando nuestra tienda online de Trail Running en: https://www.findyoureverest.es/

Another fun show, today live from the Emerald Hotel - always great when we do the show from a pub. Couple of quiet beers, bit of a chinwag, how good.Last week we tried to get Seb Costello from A Current Affair on the phone, has he called Marko back? We find out on the pod today.Ox starts banging on about silverside (again). Marko isn't a fan. Ox reckons silverside is one of the great meals. Ox has a Twisties update, and the boys discuss the new flavour - donut twists - however Ox's update is not good. He may have fallen off the wagon, but there is a plot 'twist', and he has a big announcement. Ox tells a funny story about a mate who overdosed on oysters in Robe in South Australia.....didn't end well, as you might imagine.Marko asks for your input. When have you OD'd on something? Nothing bad, but fun stuff - food OD's. Which reminds Ox of a bad smartie situation when he was a kid.Couple of weeks ago, Ox had a business idea about scented Bicarb soda, and he explores this further today - but he's got a new business idea that he thinks could make millions, and capitalises on a current trend. We're not sure if it will work. You be the judge. Keen on your thoughts if you have any suggestions on how this could work let us know on the socials.Ox went into the local VicRoads department a couple of days ago, and he was amazed to find that he was served immediately! Never happens!Plenty of feedback again this week, some good, some giving the boys a whack, but all in good fun. Marko gets a real spray from Richard, and Ox lines up the boss of Fox Footy Leigh Carlson for some ordinary work on the logo of the footy coverage.Bruce from Port Douglas calls up with an alien story. Marko loves it, Ox reckons it's rubbish. It's a fun story either way. And Ox gives us an update on Wayne Carey joining the show for a chat - we're a couple of weeks away, but it's a lock. Marko has heard a rumour about Duck that he's going to put to him live on the show.Ox names the dirtiest players that he ever played against for the Dees, and a few that he played with. And Marko has an idea to chat to players who got smashed - not the players who did the smashing.Follow a Couple of Blokes, Couple of Beers and get involved with the show on social media here: Facebook, Instagram, Twitter and TikTok. We'd love you to subscribe, rate and review the podcast - and if you feel like helping out a couple of mates, tell a friend about the podcast and help spread the word. Hosted on Acast. See acast.com/privacy for more information.

Max berichtet aus Wien und seiner neuen PB. Hindernisse geht ab im Moment. Bicarb auch, aber zu welchem Preis?

ReferencesWe considered the complexity of the machinery to excrete ammonium in the context of research on dietary protein and how high protein intake may increase glomerular pressure and contribute to progressive renal disease (many refer to this as the “Brenner hypothesis”). Dietary protein intake and the progressive nature of kidney disease: the role of hemodynamically mediated glomerular injury in the pathogenesis of progressive glomerular sclerosis in aging, renal ablation, and intrinsic renal diseaseA trial that studied low protein and progression of CKD The Effects of Dietary Protein Restriction and Blood-Pressure Control on the Progression of Chronic Renal Disease(and famously provided data for the MDRD eGFR equation A more accurate method to estimate glomerular filtration rate from serum creatinine: a new prediction equation. Modification of Diet in Renal Disease Study GroupWe wondered about dietary recommendations in CKD. of note, this is best done in the DKD guidelines from KDIGO Executive summary of the 2020 KDIGO Diabetes Management in CKD Guideline: evidence-based advances in monitoring and treatment.Joel mentioned this study on red meat and risk of ESKD. Red Meat Intake and Risk of ESRDWe referenced the notion of a plant-based diet. This is an excellent review by Deborah Clegg and Kathleen Hill Gallant. Plant-Based Diets in CKD : Clinical Journal of the American Society of NephrologyHere's the review that Josh mentioned on how the kidney appears to sense pH Molecular mechanisms of acid-base sensing by the kidneyRemarkably, Dr. Dale Dubin put a prize in his ECG book Free Car Prize Hidden in Textbook Read the fine print: Student wins T-birdA review of the role of the kidney in DKA: Diabetic ketoacidosis: Role of the kidney in the acid-base homeostasis re-evaluatedJosh mentioned the effects of infusing large amounts of bicarbonate The effect of prolonged administration of large doses of sodium bicarbonate in man and this study on the respiratory response to a bicarbonate infusion: The Acute Effects In Man Of A Rapid Intravenous Infusion Of Hypertonic Sodium Bicarbonate Solution. Ii. Changes In Respiration And Output Of Carbon DioxideThis is the study of acute respiratory alkalosis in dogs: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC293311/?page=1And this is the study of medical students who went to the High Alpine Research Station on the Jungfraujoch in the Swiss Alps https://www.nejm.org/doi/full/10.1056/nejm199105163242003Self explanatory! A group favorite! It Is Chloride Depletion Alkalosis, Not Contraction AlkalosisEffects of chloride and extracellular fluid volume on bicarbonate reabsorption along the nephron in metabolic alkalosis in the rat. Reassessment of the classical hypothesis of the pathogenesis of metabolic alkalosisA review of pendrin's role in volume homeostasis: The role of pendrin in blood pressure regulation | American Journal of Physiology-Renal PhysiologyInfusion of bicarbonate may lead to a decrease in respiratory stimulation but the shift of bicarbonate to the CSF may lag. Check out this review Neural Control of Breathing and CO2 Homeostasis and this classic paper Spinal-Fluid pH and Neurologic Symptoms in Systemic Acidosis.OutlineOutline: Chapter 11- Regulation of Acid-Base Balance- Introduction - Bicarb plus a proton in equilibrium with CO2 and water - Can be rearranged to HH - Importance of regulating pCO2 and HCO3 outside of this equation - Metabolism of carbs and fats results in the production of 15,000 mmol of CO2 per day - Metabolism of protein and other “substances” generates non-carbonic acids and bases - Mostly from sulfur containing methionine and cysteine - And cationic arginine and lysine - Hydrolysis of dietary phosphate that exists and H2PO4– - Source of base/alkali - Metabolism of an ionic amino acids - Glutamate and asparatate - Organic anions going through gluconeogenesis - Glutamate, Citrate and lactate - Net effect on a normal western diet 50-100 mEq of H+ per day - Homeostatic response to these acid-base loads has three stages: - Chemical buffering - Changes in ventilation - Changes in H+ excretion - Example of H2SO4 from oxidation of sulfur containing AA - Drop in bicarb will stimulate renal acid secretion - Nice table of normal cid-base values, arterial and venous- Great 6 bullet points of acid-base on page 328 - Kidneys must excrete 50-100 of non-carbonic acid daily - This occurs by H secretion, but mechanisms change by area of nephron - Not excreted as free H+ due to minimal urine pH being equivalent to 0.05 mmol/L - No H+ can be excreted until virtually all of th filtered bicarb is reabsorbed - Secreted H+ must bind buffers (phosphate, NH3, cr) - PH is main stimulus for H secretion, though K, aldo and volume can affect this.- Renal Hydrogen excretion - Critical to understand that loss of bicarb is like addition of hydrogen to the body - So all bicarb must be reabsorbed before dietary H load can be secreted - GFR of 125 and bicarb of 24 results in 4300 mEq of bicarb to be reabsorbed daily - Reabsorption of bicarb and secretion of H involve H secretion from tubular cells into the lumen. - Thee initial points need to be emphasized - Secreted H+ ion are generated from dissociation of H2O - Also creates OH ion - Which combine with CO2 to form HCO3 with the help of zinc containing intracellular carbonic anhydrase. - This is how the secretion of H+ which creates an OH ultimately produces HCO3 - Different mechanisms for proximal and distal acidification - NET ACID EXCRETION - Free H+ is negligible - So net H+ is TA + NH4 – HCO3 loss - Unusually equal to net H+ load, 50-100 mEq/day - Can bump up to 300 mEq/day if acid production is increased - Net acid excretion can go negative following a bicarb or citrate load - Proximal Acidification - Na-H antiporter (or exchanger) in luminal membrane - Basolateral membrane has a 3 HCO3 Na cotransporter - This is electrogenic with 3 anions going out and only one cation - The Na-H antiporter also works in the thick ascending limb of LOH - How about this, there is also a H-ATPase just like found in the intercalated cells in the proximal tubule and is responsible for about a third of H secretion - And similarly there is also. HCO3 Cl exchanger (pendrin-like) in the proximal tubule - Footnote says the Na- 3HCO3 cotransporter (which moves sodium against chemical gradient NS uses negative charge inside cell to power it) is important for sensing acid-base changes in the cell. - Distal acidification - Occurs in intercalated cells of of cortical and medullary collecting tubule - Three main characteristics - H secretion via active secretory pumps in the luminal membrane - Both H-ATPase and H-K ATPase - H- K ATPase is an exchange pump, k reabsorption - H-K exchange may be more important in hypokalemia rather than in acid-base balance - Whole paragraph on how a Na-H exchanger couldn't work because the gradient that H has to be pumped up is too big. - H-ATPase work like vasopressin with premise H-ATPase sitting on endocarditis vesicles a=which are then inserted into the membrane. Alkalosis causes them to be recycled out of the membrane. - H secretory cells do not transport Na since they have few luminal Na channels, but are assisted by the lumen negative tubule from eNaC. - Minimizes back diffusion of H+ and promotes bicarb resorption - Bicarbonate leaves the cell through HCO3-Cl exchanger which uses the low intracellular Cl concentration to power this process. - Same molecule is found on RBC where it is called band 3 protein - Figure 11-5 is interesting - Bicarbonate resorption - 90% in the first 1-22 mm of the proximal tubule (how long is the proximal tubule?) - Lots of Na-H exchangers and I handed permeability to HCO3 (permeability where?) - Last 10% happens distally mostly TAL LOH via Na-H exchange - And the last little bit int he outer medullary collecting duct. - Carbonic anhydrase and disequilibrium pH - CA plays central role in HCO3 reabsorption - After H is secreted in the proximal tubule it combines with HCO# to form carbonic acid. CA then dehydrates it to CO2 and H2O. (Step 2) - Constantly moving carbonic acid to CO2 and H2O keeps hydrogen combining with HCO3 since the product is rapidly consumed. - This can be demonstrated by the minimal fall in luminal pH - That is important so there is not a luminal gradient for H to overcome in the Na-H exchanger (this is why we need a H-ATPase later) - CA inhibitors that are limited tot he extracellular compartment can impair HCO3 reabsorption by 80%. - CA is found in S1, S2 but not S3 segment. See consequence in figure 11-6. - The disequilibrium comes from areas where there is no CA, the HH formula falls down because one of the assumptions of that formula is that H2CO3 (carbonic acid) is a transient actor, but without CA it is not and can accumulate, so the pKa is not 6.1. - Bicarbonate secretion - Type B intercalated cells - H-ATPase polarity reversed - HCO3 Cl exchanger faces the apical rather than basolateral membrane- Titratable acidity - Weak acids are filtered at the glom and act as buffers in the urine. - HPO4 has PKA of 6.8 making it ideal - Creatinine (pKa 4.97) and uric acid (pKa 5.75) also contribute - Under normal cinditions TA buffers 10-40 mEa of H per day - Does an example of HPO4(2-):H2PO4 (1-) which exists 4:1 at pH of 7.4 (glomerular filtrate) - So for 50 mEq of Phos 40 is HPO4 and 10 is H2PO4 - When pH drops to 6.8 then the ratio is 1:1 so for 50 - So the 50 mEq is 25 and 25, so this buffered an additional 15 mEq of H while the free H+ concentration increased from 40 to 160 nanomol/L so over 99.99% of secreted H was buffered - When pH drops to 4.8 ratio is 1:100 so almost all 50 mEq of phos is H2PO4 and 39.5 mEq of H are buffered. - Acid loading decreases phosphate reabsorption so more is there to act as TA. - Decreases activity of Na-phosphate cotransporter - DKA provides a novel weak acid/buffer beta-hydroxybutyrate (pKa 4.8) which buffers significant amount of acid (50 mEq/d).- Ammonium Excretion - Ability to excrete H+ as ammonium ions adds an important amount of flexibility to renal acid-base regulation - NH3 and NH4 production and excretion can be varied according to physiologic need. - Starts with NH3 production in tubular cells - NH3, since it is neutral then diffuses into the tubule where it is acidified by the low pH to NH4+ - NH4+ is ionized and cannot cross back into the tubule cells(it is trapped in the tubular fluid) - This is important for it acting as an important buffer eve though the pKa is 9.0 - At pH of 6.0 the ratio of NH3 to NH4 is 1:1000 - As the neutral NH3 is converted to NH4 more NH3 from theintracellular compartment flows into the tubular fluid replacing the lost NH3. Rinse wash repeat. - This is an over simplification and that there are threemajor steps - NH4 is produced in early proximal tubular cells - Luminal NH4 is partially reabsorbed in the TAL and theNH3 is then recycled within the renal medulla - The medullary interstitial NH3 reaches highconcentrations that allow NH3 to diffuse into the tubular lumen in the medullary collecting tubule where it is trapped as NH4 by secreted H+ - NH4 production from Glutamine which converts to NH4 and glutamate - Glutamate is converted to alpha-ketoglutarate - Alpha ketoglutarate is converted to 2 HCO3 ions - HCO3 sent to systemic circulation by Na-3 HCO3 transporter - NH4 then secreted via Na-H exchanger into the lumen - NH4 is then reabsorbed by NaK2Cl transporter in TAL - NH4 substitutes for K - Once reabsorbed the higher intracellular pH causes NH4 to convert to NH3 and the H that is removed is secreted through Na-H exchanger to scavenge the last of the filtered bicarb. - NH3 diffuses out of the tubular cells into the interstitium - NH4 reabsorption in the TAL is suppressed by hyperkalemia and stimulated by chronic metabolic acidosis - NH4 recycling promotes acid clearance - The collecting tubule has a very low NH3 concentration - This promotes diffusion of NH3 into the collecting duct - NH3 that goes there is rapidly converted to NH4 allowing more NH3 to diffuse in. - Response to changes in pH - Increased ammonium excretion with two processes - Increased proximal NH4 production - This is delayed 24 hours to 2-3 days depending on which enzyme you look at - Decreased urine pH increases diffusion of ammonia into the MCD - Occurs with in hours of an acid load - Peak ammonium excretion takes 5-6 days! (Fig 11-10) - Glutamine is picked up from tubular fluid but with acidosis get Na dependent peritublar capillary glutamine scavenging too - Glutamine metabolism is pH dependent with increase with academia and decrease with alkalemia - NH4 excretion can go from 30-40 mEq/day to > 300 with severe metabolic acidosis (38 NaBicarb tabs) - Says each NH4 produces equimolar generation of HCO3 but I thought it was two bicarb for every alpha ketoglutarate?- The importance of urine pH - Though the total amount of hydrogren cleared by urine pH is insignificant, an acidic urine pH is essential for driving the reactions of TA and NH4 forward.- Regulation of renal hydrogen excretion - Net acid excretion vary inverse with extracellular pH - Academia triggers proximal and distal acidification - Proximally this: - Increased Na-H exchange - Increased luminal H-ATPase activity - Increased Na:3HCO3 cotransporter on the basolateral membrane - Increased NH4 production from glutamine - In the collecting tubules - Increased H-ATPase - Reduction of tubular pH promotes diffusion of NH3 which gets converted to NH4…ION TRAPPING - Extracellular pH affects net acid excretion through its affect on intracellular pH - This happens directly with respiratory disorders due to movement of CO2 through the lipid bilayer - In metabolic disorders a low extracellular bicarb with cause bicarb to diffuse out of the cell passively, this lowers intracellular pH - If you manipulate both low pCO2 and low Bicarb to keep pH stable there will be no change in the intracellular pH and there is no change in renal handling of acid. It is intracellular pH dependent - Metabolic acidosis - Ramps up net acid secretion - Starts within 24 hours and peaks after 5-6 days - Increase net secretion comes from NH4 - Phosphate is generally limited by diet - in DKA titratable acid can be ramped up - Metabolic alkalosis - Alkaline extracellular pH - Increased bicarb excretion - Decrease reabsorption - HCO3 secretion (pendrin) in cortical collecting tubule - Occurs in cortical intercalated cells able to insert H-ATPase in basolateral cells (rather than luminal membrane) - Normal subjects are able to secrete 1000 mmol/day of bicarb - Maintenance of metabolic alkalosis requires a defect which forces the renal resorption of bicarb - This can be chloride/volume deficiency - Hypokalemia - Hyperaldosteronism - Respiratory acidosis and alkalosis - PCO2 via its effect on intracellular pH is an important determinant of renal acid handling - Ratios he uses: - 3.5 per 10 for respiratory acidosis - 5 per 10 for respiratory alkalosis - Interesting paragraph contrasting the response to chronic metabolic acidosis vs chronic respiratory acidosis - Less urinary ammonium in respiratory acidosis - Major differences in proximal tubule cell pH - In metabolic acidosis there is decreased bicarb load so less to be reabsorbed proximally - In respiratory acidosis the increased serum bicarb increases the amount of bicarb that must be reabsorbed proximally - The increased activity of Na-H antiporter returns tubular cell pH to normal and prevents it from creating increased urinary ammonium - Mentions that weirdly more mRNA for H-Na antiporter in metabolic acidosis than in respiratory acidosis - Net hydrogen excretion varies with effective circulating volume - Starts with bicarb infusions - Normally Tm at 26 - But if you volume deplete the patient with diuretics first this increases to 35+ - Four factors explain this increased Tm for bicarb with volume deficiency - Reduced GFR - Activation of RAAS - Ang2 stim H-Na antiporter proximally - Ang2 also stimulates Na-3HCO3 cotransporter on basolateral membrane - Aldosterone stimulates H-ATPase in distal nephron - ALdo stimulates Cl HCO3 exchanger on basolateral membrane - Aldo stimulates eNaC producing tubular lumen negative charge to allow H secretion to occur and prevents back diffusion - Hypochloremia - Increases H secretion by both Na-dependent and Na-independent methods - If Na is 140 and Cl is 115, only 115 of Na can be reabsorbed as NaCl, the remainder must be reabsorbed with HCO3 or associated with secretion of K or H to maintained electro neutrality - This is enhanced with hypochloridemia - Concurrent hypokalemia - Changes in K lead to trans cellular shifts that affect inctracellular pH - Hypokalemia causes K out, H in and in the tubular cell the cell acts if there is systemic acidosis and increases H secretion (and bicarbonate resorption) - PTH - Decreases proximal HCO3 resorption - Primary HyperCard as cause of type 2 RTA - Does acidosis stim PTH or does PTH stim net acid excretion

Episode Notes In this episode, PGY3 and rising chief resident, Terra Swanson teaches us about when to use bicarbonate in different scenarios in the hospital. Get ready for a wild ride on the Bicarb Train! This podcast is powered by Pinecast.

In this episode of The Knowledge Podcast by Wahoo, hosts Jinger Gottschall and Mac Cassin explore the age-old question of whether to load or not to load on carbs, water, and bicarb before exercise. They discuss the benefits and limitations of carbohydrate-loading, including how it can increase both muscle and liver glycogen, essential fuel stores for sustained high-intensity exercise. Jinger and Mac also examine the role of water in preventing dehydration and how pre-exercise hyperhydration can improve endurance capacity. Additionally, they discuss the use of sodium citrate and sodium bicarbonate in increasing plasma volume and delaying exhaustion during high-intensity exercise. Tune in to discover the latest research on these strategies and decide for yourself whether loading up is the way to go!

Over the past few years English schools have begun to introduce non-competitive sport in an effort to be more inclusive. But is that the right strategy when it comes to producing future champions and developing a 'winning' mentality? The team take an in-depth look into the evidence surrounding the debate and examples of countries that have already rolled out similar plans.> Jump to 45:17 for the main topic.PLUS RED-S in male athletes / Bicarb in endurance sport / shinty drug testing / Remembering Dick Fosbury, the inventor of modern high jumping.SHOW NOTES:Caught My Eye SegmentJake Smith's Instagram post about his RED-SThe 1984 study on bicarbonate as a performance enhancerA 1993 meta-analysis on bicarbonateA 2022 systematic review on bicarb and performanceA recent article that contains some of Maurten's promises and promotionsPrimoz Roglic's glowing endorsement of bicarb. “With 600W it always hurts, huh?"The BBC piece on Shinty's drug testing plansDavid Epstein's article on Dick FosburyMain SegmentArticle on how early specialisation and training rather than fun increases injury risk Get bonus content on Patreon Hosted on Acast. See acast.com/privacy for more information.

A brief overview of Maurten's Bicarb System, the science behind sodium bicarbonate (baking soda) for buffering hydrogen ions, and curiosity around sodium bicarbonate for endurance athletes.

Bicarbonate supplementation is by no means a new thing. But there is a new supplement on the block from one of the big sports nutrition companies. So what on earth is it? And should you be *adding to cart*.   In this episode I explain: What is sodium bicarbonate? Why would we want to use it to enhance exercise performance? What sort of sporting situations would it be useful for? Is it worth trialling as an age-group triathlete? Tune in to find out!   References: Carr AJ, Hopkins WG, Gore CJ. (2011). Effects of acute alkalosis and acidosis on performance: a meta-analysis. Sports Medicine, 41 (10), 801-814. Peart DJ, Siegler JC, Vince RV. (2012). Practical recommendations for coaches and athletes: a meta-analysis of sodium bicarbonate use for athletic performance. J Strength Cond Res, 26 (7), 1975-1983. Hadzic M, Eckstein ML, Schugardt M. (2019). The impact of sodium bicarbonate on performance in response to exercise duration: a systematic review. J Sports Sci Med, 18 (2), 271-281.   LINKS Join the waitlist for our next Triathlon Nutrition Academy opening:  www.dietitianapproved.com/academy Triathlon Nutrition Checklist: Check how well you're doing when it comes to your nutrition: dietitianapproved.com/checklist Website: www.dietitianapproved.com Instagram: @Dietitian.Approved  @triathlonnutritionacademy Facebook: www.facebook.com/DietitianApproved The Triathlon Nutrition Academy is a podcast by Dietitian Approved. All rights reserved. www.dietitianapproved.com/academy Dietitian Approved acknowledges the Traditional custodians of the Land we have recorded this podcast on, The Turrbal and Jagera peoples. We pay our respects to their elders past and present and extend that respect to all Aboriginal and Torres Strait Islander cultures. See omnystudio.com/listener for privacy information.

Reference: Cashen K, Reeder RW, Ahmed T, et al. Sodium bicarbonate use during pediatric cardiopulmonary resuscitation: a secondary analysis of the icu-resuscitation project trial. Pediatric Crit Care Med. 2022 Date: February 15, 2023 Guest Skeptic: Dr. Carlie Myers is Pediatric Critical Care Attending at Cincinnati Children's Hospital Medical Center. Case: A 6-month-old boy presents to […] The post SGEM#394: Say Bye Bye Bicarb for Pediatric In-Hospital Cardiac Arrest first appeared on The Skeptics Guide to Emergency Medicine.

ReferencesWe considered the effect of a high protein diet and potential metabolic acidosis on kidney function. This review is of interest by Donald Wesson, a champion for addressing this issue and limiting animal protein: Mechanisms of Metabolic Acidosis-Induced Kidney Injury in Chronic Kidney DiseaseHostetter explored the effect of a high protein diet in the remnant kidney model with 1 ¾ nephrectomy. Rats with reduced dietary acid load (by bicarbonate supplementation) had less tubular damage. Chronic effects of dietary protein in the rat with intact and reduced renal massWesson explored treatment of metabolic acidosis in humans with stage 3 CKD in this study. Treatment of metabolic acidosis in patients with stage 3 chronic kidney disease with fruits and vegetables or oral bicarbonate reduces urine angiotensinogen and preserves glomerular filtration rateIn addition to the effect of metabolic acidosis from a diet high in animal protein, this diet also leads to hyperfiltration. This was demonstrated in normal subjects; ingesting a protein diet had a significantly higher creatinine clearance than a comparable group of normal subjects ingesting a vegetarian diet. Renal functional reserve in humans: Effect of protein intake on glomerular filtration rate.This finding has been implicated in Brenner's theory regarding hyperfiltration: The hyperfiltration theory: a paradigm shift in nephrologyOne of multiple publications from Dr. Nimrat Goraya whom Joel mentioned in the voice over: Dietary Protein as Kidney Protection: Quality or Quantity?We wondered about the time course in buffering a high protein meal (and its subsequent acid load on ventilation) and Amy found this report:Effect of Protein Intake on Ventilatory Drive | Anesthesiology | American Society of Anesthesiologists Roger mentioned that the need for acetate to balance the acid from amino acids in parenteral nutrition was identified in pediatrics perhaps because infants may have reduced ability to generate acid. Randomised controlled trial of acetate in preterm neonates receiving parenteral nutrition - PMCHe also recommended an excellent review on the complications of parenteral nutrition by Knochel https://www.kidney-international.org/action/showPdf?pii=S0085-2538%2815%2933384-6 which explained that when the infused amino acids disproportionately include cationic amino acids, metabolism led to H+ production. This is typically mitigated by preparing a solution that is balanced by acetate. Amy mentioned this study that explored the effect of protein intake on ventilation: Effect of Protein Intake on Ventilatory Drive | Anesthesiology | American Society of AnesthesiologistsAnna and Amy reminisced about a Skeleton Key Group Case from the renal fellow network Skeleton Key Group: Electrolyte Case #7JC wondered about isolated defects in the proximal tubule and an example is found here: Mutations in SLC4A4 cause permanent isolated proximal renal tubular acidosis with ocular abnormalitiesAnna's Voiceover re: Gastric neobladder → metabolic alkalosis and yes, dysuria. The physiology of gastrocystoplasty: once a stomach, always a stomach but not as common as you might think Gastrocystoplasty: long-term complications in 22 patientsSjögren's syndrome has been associated with acquired distal RTA and in some cases, an absence of the H+ ATPase, presumably from autoantibodies to this transporter. Here's a case report: Absence of H(+)-ATPase in cortical collecting tubules of a patient with Sjogren's syndrome and distal renal tubular acidosisCan't get enough disequilibrium pH? Check this out- Spontaneous luminal disequilibrium pH in S3 proximal tubules. Role in ammonia and bicarbonate transport.Acetazolamide secretion was studied in this report Concentration-dependent tubular secretion of acetazolamide and its inhibition by salicylic acid in the isolated perfused rat kidney. | Drug Metabolism & DispositionIn this excellent review, David Goldfarb tackles the challenging case of a A Woman with Recurrent Calcium Phosphate Kidney Stones (spoiler alert, many of these patients have incomplete distal RTA and this problem is hard to treat). Molecular mechanisms of renal ammonia transport excellent review from David Winer and Lee Hamm. OutlineOutline: Chapter 11- Regulation of Acid-Base Balance- Introduction - Bicarb plus a proton in equilibrium with CO2 and water - Can be rearranged to HH - Importance of regulating pCO2 and HCO3 outside of this equation - Metabolism of carbs and fats results in the production of 15,000 mmol of CO2 per day - Metabolism of protein and other “substances” generates non-carbonic acids and bases - Mostly from sulfur containing methionine and cysteine - And cationic arginine and lysine - Hydrolysis of dietary phosphate that exists and H2PO4– - Source of base/alkali - Metabolism of an ionic amino acids - Glutamate and asparatate - Organic anions going through gluconeogenesis - Glutamate, Citrate and lactate - Net effect on a normal western diet 50-100 mEq of H+ per day - Homeostatic response to these acid-base loads has three stages: - Chemical buffering - Changes in ventilation - Changes in H+ excretion - Example of H2SO4 from oxidation of sulfur containing AA - Drop in bicarb will stimulate renal acid secretion - Nice table of normal cid-base values, arterial and venous- Great 6 bullet points of acid-base on page 328 - Kidneys must excrete 50-100 of non-carbonic acid daily - This occurs by H secretion, but mechanisms change by area of nephron - Not excreted as free H+ due to minimal urine pH being equivalent to 0.05 mmol/L - No H+ can be excreted until virtually all of th filtered bicarb is reabsorbed - Secreted H+ must bind buffers (phosphate, NH3, cr) - PH is main stimulus for H secretion, though K, aldo and volume can affect this.- Renal Hydrogen excretion - Critical to understand that loss of bicarb is like addition of hydrogen to the body - So all bicarb must be reabsorbed before dietary H load can be secreted - GFR of 125 and bicarb of 24 results in 4300 mEq of bicarb to be reabsorbed daily - Reabsorption of bicarb and secretion of H involve H secretion from tubular cells into the lumen. - Thee initial points need to be emphasized - Secreted H+ ion are generated from dissociation of H2O - Also creates OH ion - Which combine with CO2 to form HCO3 with the help of zinc containing intracellular carbonic anhydrase. - This is how the secretion of H+ which creates an OH ultimately produces HCO3 - Different mechanisms for proximal and distal acidification - NET ACID EXCRETION - Free H+ is negligible - So net H+ is TA + NH4 – HCO3 loss - Unusually equal to net H+ load, 50-100 mEq/day - Can bump up to 300 mEq/day if acid production is increased - Net acid excretion can go negative following a bicarb or citrate load - Proximal Acidification - Na-H antiporter (or exchanger) in luminal membrane - Basolateral membrane has a 3 HCO3 Na cotransporter - This is electrogenic with 3 anions going out and only one cation - The Na-H antiporter also works in the thick ascending limb of LOH - How about this, there is also a H-ATPase just like found in the intercalated cells in the proximal tubule and is responsible for about a third of H secretion - And similarly there is also. HCO3 Cl exchanger (pendrin-like) in the proximal tubule - Footnote says the Na- 3HCO3 cotransporter (which moves sodium against chemical gradient NS uses negative charge inside cell to power it) is important for sensing acid-base changes in the cell. - Distal acidification - Occurs in intercalated cells of of cortical and medullary collecting tubule - Three main characteristics - H secretion via active secretory pumps in the luminal membrane - Both H-ATPase and H-K ATPase - H- K ATPase is an exchange pump, k reabsorption - H-K exchange may be more important in hypokalemia rather than in acid-base balance - Whole paragraph on how a Na-H exchanger couldn't work because the gradient that H has to be pumped up is too big. - H-ATPase work like vasopressin with premise H-ATPase sitting on endocarditis vesicles a=which are then inserted into the membrane. Alkalosis causes them to be recycled out of the membrane. - H secretory cells do not transport Na since they have few luminal Na channels, but are assisted by the lumen negative tubule from eNaC. - Minimizes back diffusion of H+ and promotes bicarb resorption - Bicarbonate leaves the cell through HCO3-Cl exchanger which uses the low intracellular Cl concentration to power this process. - Same molecule is found on RBC where it is called band 3 protein - Figure 11-5 is interesting - Bicarbonate resorption - 90% in the first 1-22 mm of the proximal tubule (how long is the proximal tubule?) - Lots of Na-H exchangers and I handed permeability to HCO3 (permeability where?) - Last 10% happens distally mostly TAL LOH via Na-H exchange - And the last little bit int he outer medullary collecting duct. - Carbonic anhydrase and disequilibrium pH - CA plays central role in HCO3 reabsorption - After H is secreted in the proximal tubule it combines with HCO# to form carbonic acid. CA then dehydrates it to CO2 and H2O. (Step 2) - Constantly moving carbonic acid to CO2 and H2O keeps hydrogen combining with HCO3 since the product is rapidly consumed. - This can be demonstrated by the minimal fall in luminal pH - That is important so there is not a luminal gradient for H to overcome in the Na-H exchanger (this is why we need a H-ATPase later) - CA inhibitors that are limited tot he extracellular compartment can impair HCO3 reabsorption by 80%. - CA is found in S1, S2 but not S3 segment. See consequence in figure 11-6. - The disequilibrium comes from areas where there is no CA, the HH formula falls down because one of the assumptions of that formula is that H2CO3 (carbonic acid) is a transient actor, but without CA it is not and can accumulate, so the pKa is not 6.1. - Bicarbonate secretion - Type B intercalated cells - H-ATPase polarity reversed - HCO3 Cl exchanger faces the apical rather than basolateral membrane- Titratable acidity - Weak acids are filtered at the glom and act as buffers in the urine. - HPO4 has PKA of 6.8 making it ideal - Creatinine (pKa 4.97) and uric acid (pKa 5.75) also contribute - Under normal cinditions TA buffers 10-40 mEa of H per day - Does an example of HPO4(2-):H2PO4 (1-) which exists 4:1 at pH of 7.4 (glomerular filtrate) - So for 50 mEq of Phos 40 is HPO4 and 10 is H2PO4 - When pH drops to 6.8 then the ratio is 1:1 so for 50 - So the 50 mEq is 25 and 25, so this buffered an additional 15 mEq of H while the free H+ concentration increased from 40 to 160 nanomol/L so over 99.99% of secreted H was buffered - When pH drops to 4.8 ratio is 1:100 so almost all 50 mEq of phos is H2PO4 and 39.5 mEq of H are buffered. - Acid loading decreases phosphate reabsorption so more is there to act as TA. - Decreases activity of Na-phosphate cotransporter - DKA provides a novel weak acid/buffer beta-hydroxybutyrate (pKa 4.8) which buffers significant amount of acid (50 mEq/d).- Ammonium Excretion - Ability to excrete H+ as ammonium ions adds an important amount of flexibility to renal acid-base regulation - NH3 and NH4 production and excretion can be varied according to physiologic need. - Starts with NH3 production in tubular cells - NH3, since it is neutral then diffuses into the tubule where it is acidified by the low pH to NH4+ - NH4+ is ionized and cannot cross back into the tubule cells(it is trapped in the tubular fluid) - This is important for it acting as an important buffer eve though the pKa is 9.0 - At pH of 6.0 the ratio of NH3 to NH4 is 1:1000 - As the neutral NH3 is converted to NH4 more NH3 from theintracellular compartment flows into the tubular fluid replacing the lost NH3. Rinse wash repeat. - This is an over simplification and that there are threemajor steps - NH4 is produced in early proximal tubular cells - Luminal NH4 is partially reabsorbed in the TAL and theNH3 is then recycled within the renal medulla - The medullary interstitial NH3 reaches highconcentrations that allow NH3 to diffuse into the tubular lumen in the medullary collecting tubule where it is trapped as NH4 by secreted H+ - NH4 production from Glutamine which converts to NH4 and glutamate - Glutamate is converted to alpha-ketoglutarate - Alpha ketoglutarate is converted to 2 HCO3 ions - HCO3 sent to systemic circulation by Na-3 HCO3 transporter - NH4 then secreted via Na-H exchanger into the lumen - NH4 is then reabsorbed by NaK2Cl transporter in TAL - NH4 substitutes for K - Once reabsorbed the higher intracellular pH causes NH4 to convert to NH3 and the H that is removed is secreted through Na-H exchanger to scavenge the last of the filtered bicarb. - NH3 diffuses out of the tubular cells into the interstitium - NH4 reabsorption in the TAL is suppressed by hyperkalemia and stimulated by chronic metabolic acidosis - NH4 recycling promotes acid clearance - The collecting tubule has a very low NH3 concentration - This promotes diffusion of NH3 into the collecting duct - NH3 that goes there is rapidly converted to NH4 allowing more NH3 to diffuse in. - Response to changes in pH - Increased ammonium excretion with two processes - Increased proximal NH4 production - This is delayed 24 hours to 2-3 days depending on which enzyme you look at - Decreased urine pH increases diffusion of ammonia into the MCD - Occurs with in hours of an acid load - Peak ammonium excretion takes 5-6 days! (Fig 11-10) - Glutamine is picked up from tubular fluid but with acidosis get Na dependent peritublar capillary glutamine scavenging too - Glutamine metabolism is pH dependent with increase with academia and decrease with alkalemia - NH4 excretion can go from 30-40 mEq/day to > 300 with severe metabolic acidosis (38 NaBicarb tabs) - Says each NH4 produces equimolar generation of HCO3 but I thought it was two bicarb for every alpha ketoglutarate?- The importance of urine pH - Though the total amount of hydrogren cleared by urine pH is insignificant, an acidic urine pH is essential for driving the reactions of TA and NH4 forward.- Regulation of renal hydrogen excretion - Net acid excretion vary inverse with extracellular pH - Academia triggers proximal and distal acidification - Proximally this: - Increased Na-H exchange - Increased luminal H-ATPase activity - Increased Na:3HCO3 cotransporter on the basolateral membrane - Increased NH4 production from glutamine - In the collecting tubules - Increased H-ATPase - Reduction of tubular pH promotes diffusion of NH3 which gets converted to NH4…ION TRAPPING - Extracellular pH affects net acid excretion through its affect on intracellular pH - This happens directly with respiratory disorders due to movement of CO2 through the lipid bilayer - In metabolic disorders a low extracellular bicarb with cause bicarb to diffuse out of the cell passively, this lowers intracellular pH - If you manipulate both low pCO2 and low Bicarb to keep pH stable there will be no change in the intracellular pH and there is no change in renal handling of acid. It is intracellular pH dependent - Metabolic acidosis - Ramps up net acid secretion - Starts within 24 hours and peaks after 5-6 days - Increase net secretion comes from NH4 - Phosphate is generally limited by diet - in DKA titratable acid can be ramped up - Metabolic alkalosis - Alkaline extracellular pH - Increased bicarb excretion - Decrease reabsorption - HCO3 secretion (pendrin) in cortical collecting tubule - Occurs in cortical intercalated cells able to insert H-ATPase in basolateral cells (rather than luminal membrane) - Normal subjects are able to secrete 1000 mmol/day of bicarb - Maintenance of metabolic alkalosis requires a defect which forces the renal resorption of bicarb - This can be chloride/volume deficiency - Hypokalemia - Hyperaldosteronism - Respiratory acidosis and alkalosis - PCO2 via its effect on intracellular pH is an important determinant of renal acid handling - Ratios he uses: - 3.5 per 10 for respiratory acidosis - 5 per 10 for respiratory alkalosis - Interesting paragraph contrasting the response to chronic metabolic acidosis vs chronic respiratory acidosis - Less urinary ammonium in respiratory acidosis - Major differences in proximal tubule cell pH - In metabolic acidosis there is decreased bicarb load so less to be reabsorbed proximally - In respiratory acidosis the increased serum bicarb increases the amount of bicarb that must be reabsorbed proximally - The increased activity of Na-H antiporter returns tubular cell pH to normal and prevents it from creating increased urinary ammonium - Mentions that weirdly more mRNA for H-Na antiporter in metabolic acidosis than in respiratory acidosis - Net hydrogen excretion varies with effective circulating volume - Starts with bicarb infusions - Normally Tm at 26 - But if you volume deplete the patient with diuretics first this increases to 35+ - Four factors explain this increased Tm for bicarb with volume deficiency - Reduced GFR - Activation of RAAS - Ang2 stim H-Na antiporter proximally - Ang2 also stimulates Na-3HCO3 cotransporter on basolateral membrane - Aldosterone stimulates H-ATPase in distal nephron - ALdo stimulates Cl HCO3 exchanger on basolateral membrane - Aldo stimulates eNaC producing tubular lumen negative charge to allow H secretion to occur and prevents back diffusion - Hypochloremia - Increases H secretion by both Na-dependent and Na-independent methods - If Na is 140 and Cl is 115, only 115 of Na can be reabsorbed as NaCl, the remainder must be reabsorbed with HCO3 or associated with secretion of K or H to maintained electro neutrality - This is enhanced with hypochloridemia - Concurrent hypokalemia - Changes in K lead to trans cellular shifts that affect inctracellular pH - Hypokalemia causes K out, H in and in the tubular cell the cell acts if there is systemic acidosis and increases H secretion (and bicarbonate resorption) - PTH - Decreases proximal HCO3 resorption - Primary HyperCard as cause of type 2 RTA - Does acidosis stim PTH or does PTH stim net acid excretion

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References for Chapter 10We did not mention many references in our discussion today but our listeners may enjoy some of the references below. Effects of pH on Potassium: New Explanations for Old Observations - PMC although the focus of this article is on potassium, this elegant review by Aronson and Giebisch reviews intracellular shifts as it relates to pH and K+.Josh swooned for Figure 10-1 is this right? Which figure was it? which shows the relationship between [H+] and pH. You can find this figure in the original reference from Halperin ML and others, Figure 1 here. Factors That Control the Effect of pH on Glycolysis in Leukocytes Here's Leticia Rolon's favorite Henderson-Hasselbalch calculator website: ​​Henderson-Hasselbalch Calculator | Buffer Solutions [hint! for this site, use the bicarbonate (or “total CO2”) for A- and PCO2 for the HA] There's also a cooking tab for converting units! Fundamentals of Arterial Blood Gas Interpretation - PMC this review published posthumously from the late but beloved Jerry Yee and his group at Henry Ford Hospital, explores the details and underpinnings of our understandings of arterial blood gas interpretation (and this also addresses how our colleagues in clinical chemistry measure total CO2 - which JC referenced- but JC said “machine” and our colleagues prefer the word “instrument.”)Amy went deep on bicarbonate in respiratory acidosis. Here are her refs:Sodium bicarbonate therapy for acute respiratory acidosisSodium Bicarbonate in Respiratory AcidosisBicarbonate therapy in severe metabolic acidosisEffect of Intravenous Sodium Bicarbonate on Ventilation, Gas Exchange, and Acid-Base Balance in Patients with Chronic Pulmonary InsufficiencyBicarbonate Therapy in Severe Metabolic Acidosis | American Society of Nephrology this review article from Sabatini and Kurtzman addresses the issues regarding bicarbonate therapy including theoretical intracellular acidosis. Bicarbonate in DKA? Don't do it: Bicarbonate in diabetic ketoacidosis - a systematic review Here's a review from Bushinsky and Krieger on the effect acidosis on bone https://www.sciencedirect.com/science/article/abs/pii/S0085253822002174Here is the primary resource that Anna used in here investigation of meat replacements Nutritional Composition of Novel Plant-Based Meat Alternatives and Traditional Animal-Based MeatsWe enjoyed this paper that Dr. Rose references from the Journal of Clinical Investigation 1955 in which investigators infused HCl into nephrectomized dogs and observed changes in extracellular ions. https://www.jci.org/articles/view/103073/pdWe wondered about the amino acids/protein in some available meat alternatives they are explored in this article in the journal Amino Acids: Protein content and amino acid composition of commercially available plant-based protein isolates - PMC and you may enjoy this exploration of the nutritional value of these foods: Full article: Examination of the nutritional composition of alternative beef burgers available in the United StatesOutlineChapter 10: Acid-Base Physiology - H concentration regulated tightly - Normal H+ is 40 nm/L - This one millionth the concentration of Na and K - It needs to be this dilute because H+ fucks shit up - Especially proteins - Cool foot note H+ actually exists as H3O+ - Under normal conditions the H+ concentration varies little from normal due to three steps - Chemical buffering by extracellular and intracellular bufffers - Control of partial pressure of CO2 by alterations of alveolar ventilation - Control of plasma bicarbonate by changes in renal H+ excretion - Acid and bases - Use definition by Bronsted - Acid can donate protons - Base can accept protons - There are two classes of acids** - Carbonic acid H2CO3 - Each day 15000 mmol of CO2 are generated - CO2 not acid but combines with water to form carbonic acid H2CO3 - CO2 cleared by the lungs - Noncarbonic acid - Formed from metabolism of protein. Sulfur containing AA generate H2SO4. Only 50-100 mEq of acid produced from these sources. - Cleared by the kidneys - Law of Mass Action - Velocity of reaction proportional to the product of the concentrations of the reactants - Goes through mass action formula for water - Concludes that water has H of 155 nanoM/L, more than the 40 in plasma - Says you can do the same mass experiment for every acid in the body - Can do it also for bases but he is not going to. - Acids and Bases can be strong or weak - Strong acids completely dissociate - Weak acids not so much - H2PO4 is only 80% dissociated - Weak acids are the principle buffers in the body - Then he goes through how H is measured in the blood and it becomes clear why pH is a logical way to measure. - Then there is a lot of math - HH equation - Derives it - Then uses it to look at phos. Very interesting application - Buffers - Goes tot he phosphate well again. Amazing math describing how powerful buffers can be - Big picture the closer the pKa is to the starting pH the better buffer, i.e. it can absorb lots of OH or H without appreciably changing pH - HCO3 CO2 system - H2CO3 to H + HCO3 has a PKA of 2.72 but then lots of Math and the bicarb buffer system has a pKa of 6.1 - But the real power of the bicarb buffer is that it is not a sealed system. The ability to ventilate and keep CO2 constant increases the buffering efficiency by 11 fold and the ability to lower the CO2 below normal increases 18 fold. - Isohydric principle - There is only one hydrogen ion concentration and since that is a critical part of the buffer equation, all buffer eq are linked and you can understand all of them by understanding one of them. So we just can look at bicarb and understand the totality of acid base. - Bicarb is the most important buffer because - High concentration in plasma - Ability for CO2 to ventilate - Other buffers include - Bone - Bone is more than just inorganic reaction - Live bone releases more calcium in response to an acid load than dead bone - More effect with metabolic acidosis than respiratory acidosis - Hgb - Phosphate - Protein

Welcome back to our weekend Cabral HouseCall shows!   This is where we answer our community's wellness, weight loss, and anti-aging questions to help people get back on track!   Check out today's questions:    Margie: Hi Dr. Cabral! My questions are about Vit A toxicity. In April I started using a retinol cream at night then developed dry lips that eventually became cracked, bleeding, and painful in July! I also experienced general dryness in my mouth, eyes, and bowels. After listening to your podcast about what your lips tell about your health, I realized that it was the retinol cream & stopped using it immediately. My Vit A history includes 3 treatments of Accutane. It makes sense that adding retinol to my night time routine finally “tipped that scale”, overloading my liver. I've done 2 CBO protocols & several detoxes since 2018. Before I realized that the cream was the source of my problems, I did a 7-day detox & noticed that my lips worsened esp. during the 2 days of fasting. I stopped using the DNS powder, all supplements that listed Vit A on the label & stopped eating foods known to have high levels of Vit A. After several weeks, my symptoms improved. I heard you mention in a podcast that you were going to talk about a low Vitamin A diet but haven't been able to find anything on that topic. What would a low Vitamin A diet consist of? Once my lips are completely healed, would it be safe to resume DNS, supplements, & foods with Vit A? Thanks a bunch!   Paula: Hello and thank you for all that you do Dr Cabral! My 77 yr old mother has had intermittent amnesia episodes for over 13 years now, occurring on average 3 to 4 times per year. She has had extensive testing with no definitive outcome. Tests & scans looking at epilepsy, blood supply to the brain & heart were normal. There have been no head traumas that she is aware of in the past. I have recently started looking into it further myself and have come across a condition called Global Transient Amnesia which describes her symptoms almost exactly. When having an "episode" as she calls them, she loses short term memory for about 1/2 an hour and has no idea what she was doing at the time, nor what has happened in her recent past. She is still able to perform normal functions and is alert and very aware that the episode is happening but is just unable to recall anything from days/weeks prior for about 25 minutes or so which is distressing for her. Her memory returns gradually over that time and is then often very tired afterward. I am wondering if there could be an underlying issue that could be causing this and if you recommend any functional testing? She has been taking Ginkgo Biloba and liquid magnesium on and off for years without any notable differences. Thanks so much in advance.   Dani: Hi Dr cabral, grateful for your work and would love to hear your thoughts. A few months ago I had my first eczema and dermatitis flare up since 2019 when I healed my gut and rebalanced my body with my naturopath. The dermatitis is on my face, either seborrheic or perioral. I have used native and no pong deodorants for years but they irritated and inflamed the eczema on my armpits, it was very painful so I didn't apply anything all winter (based in Aus). My first though was gut-skin connection so I've been using a gut powder. Also ran the big 5 (just have one more test to do). Have already received my intolerance test back as it felt urgent to me but everything was fine on it (not one intolerance?!) I finished the 21 day detox last week. Still some dermatitis on my face, and I just tried some Bicarb free no pong Deodorant and a few hours later a rash and itching started. So now I'm wondering what other causes should I be looking at for this skin flare up. I'm sure I'll get some more answers from my big 5 but I was hoping it would have been something as simple as the food intolerance which I've experienced in the past. I do have some hormonal issues which were the main reason for my big 5 but wasn't sure if that could be a link to my eczema. Thanks again, appreciate you!   Luis: Hi Dr. Cabral, I wanted to get your thoughts on the Salt Water Flush. I believe this is also a ayurvedic practice, but I could be wrong. It involves drinking about a pint of warm to hot water, with about 2 table spoons of salt (pink or sea salt). After some time, it will purge the contents of the intestines until the water eventually comes out clear. The only downside I know of is that it may cause electrolyte imbalances, but replenishing those isn't a problem for me. I have done this many times over the past few years, but wanted your opinion on this procedure as well. Thanks for all you do!   Nikki: Hi Dr. Cabral, -I'm 55 yo female, mainly vata with some kapha, exercising 6 days weekly, 5'6” 112 lbs. -I've done the 21 day detox and the 7 day detox 3 times this past year. I've also done the Big 5 Labs and neurotransmitter test. I have candida and yeast overgrowth along with several food sensitivities (probably from leaky gut). I've done the CBO protocol with citricidal drops, noticing digestive improvement only while on the citricidal drops. Each time I introduced new foods I had gas, bloating and loose stools throughout the remainder of the CBO protocol so I didn't keep eating them. -I then did the 3 day stool test (no h-Pylori or parasites), spoke with one of your health coaches and did the Limited Yeast protocol with the citricidal drops but continued to have the bloating, gas and loose stools after introducing new foods so, I'm still not eating anything off the sensitive gut guide except for once or twice a week when I try a new food. I take Healthy Belly 3 x daily and Healthy Gut Support each morning along with digestive enzymes when I try new foods. -I've done the Para Protocol, Intestinal Cleanse and Heavy Metal Detox. -My hormones are still not aligned although I've taken the Equilife estrogen and progesterone supplements-presumable my digestion isn't able to absorb the nutrients from the supplements. I also tried seed cycling but my digestive problems worsened. -I have restless leg which is somewhat helpful with magnesium cream. I take cal/mag at dinner and full spectrum magnesium at bedtime. I drink 2 DNS shakes daily. -I also have the antiphospholipid syndrome and take fish oils which has kept my platelets in range. -My right thumb is constantly swollen and in pain. -My stomach acid was slightly low so I've been taking 3 Betaine HCL daily but haven't noticed any improvement in digestion. -My allergies (of 52 yrs) are better since eliminating dairy in January and I'm not on meds any longer, just Quercitin 3 x daily. -My health coach says to do another round of the CBO protocol and that should help so I'll be doing that again and will just be finishing when you get this. I'm concerned I will still feel the same and won't be able to introduce foods I can actually continue eating without problems. -Please let me know if you have any thoughts you think may help.     Thank you for tuning into today's Cabral HouseCall and be sure to check back tomorrow where we answer more of our community's questions!      - - - Show Notes and Resources: StephenCabral.com/2500 - - - Get a FREE Copy of Dr. Cabral's Book: The Rain Barrel Effect - - - Join the Community & Get Your Questions Answered: CabralSupportGroup.com - - - Dr. Cabral's Most Popular At-Home Lab Tests: > Complete Minerals & Metals Test (Test for mineral imbalances & heavy metal toxicity) - - - > Complete Candida, Metabolic & Vitamins Test (Test for 75 biomarkers including yeast & bacterial gut overgrowth, as well as vitamin levels) - - - > Complete Stress, Mood & Metabolism Test (Discover your complete thyroid, adrenal, hormone, vitamin D & insulin levels) - - - > Complete Food Sensitivity Test (Find out your hidden food sensitivities) - - - > Complete Omega-3 & Inflammation Test (Discover your levels of inflammation related to your omega-6 to omega-3 levels) - - - Get Your Question Answered On An Upcoming HouseCall: StephenCabral.com/askcabral - - - Would You Take 30 Seconds To Rate & Review The Cabral Concept? The best way to help me spread our mission of true natural health is to pass on the good word, and I read and appreciate every review!

This is the one where Rudy & Andrea are talking the most accurate means of calculating pool gallonage in the pool shapes that are normally the hardest to measure. Free form pool gallons accurate within 1,000 gallons. All Business. No Boundaries.A collection of supply chain stories by the North American leader in contract logisticsListen on: Apple Podcasts Spotify Take our 2-minute listener survey! Help us to provide you with more of the content you want to hear. Take our quick 2-minute survey!AquaStar Pool Products The Global Leader in Safety, Dependability, & Innovation in Pool Technology.POOL MAGAZINE Pool Magazine is leading up to the minute news source for Swimming Pool News and Pool Features. OuBLUERAY XL The real mineral purifier! Reduce your pool maintenance costs & efforts by 50%NC Pro Training FREE online/virtual training with NC Brands!Support the show

When it comes to dealing with crush syndrome, guys are super motivated to push sodium bicarb, but is it actually doing anything?

Surely that can't be true...

Should we provide our DKA patients with sodium bicarbonate (bicarb) pushes or drips to improve their pH? Let's look at the data. Show Notes: https://eddyjoemd.com/bicarb-dka/ --- This episode is sponsored by · Anchor: The easiest way to make a podcast. https://anchor.fm/app Support this podcast: https://anchor.fm/eddyjoemd/support

Some baked-in practices in medicine don't hold up to closer inspection. This episode of EMRA*Cast turns attention to the use of sodium bicarbonate in cardiac arrest. Host Matt Dillon, MD, (@mdmd_8889) recently spoke with clinical ED pharmacist Mike Perza, PharmD, BCPS, (@pillpushermike) and Dustin Slagle, MD, regarding sodium bicarbonate use during cardiac arrest and why you might want to think twice.

Class: Electrolyte replacement /Alkalizing AgentMOA: Counteracts existing acidosisIndications: Acidosis, Drug intoxications (barbiturates, salicylates, methyl alcohol)Contraindications:  Metabolic alkalosis, hypocalcemiaSide effects: metabolic alkalosis, hypernatremia, injection site reaction, sodium and fluid retention, peripheral edema.Dosing Metabolic acidosis during cardiac arrest Adult:1 mEq/kg slow IV/IO may repeat at 0.5 mEq/kg in 10 minsPedi:SAA

Y'all have had lots of questions about using sodium bicarbonate in cardiac arrest after we ran an interview with Dr. Menegazzi talking about an abstract he presented showing benefit with bicarb. You wanted more so here it is! Dr. Jarvis reviews a paper from British Columbia from 2017 that looks at just this thing! If you like the show, please give us a 5-star rating wherever you get your podcasts. Did you know our podcast is on YouTube, too? Check us out and subscribe on the Flightbridgeed channel. Drop us questions/comments/suggestion for future pods at: Jeff.jarvis@flightbridgeed.com @DrJeffJarvis Citations: 1. Kawano T, Grunau B, Scheuermeyer FX, et al. Prehospital sodium bicarbonate use could worsen long term survival with favorable neurological recovery among patients with out-ofhospital cardiac arrest. Resuscitation. 2017;119:63-69. doi:10.1016/j.resuscitation.2017.08.008 See omnystudio.com/listener for privacy information.

Is baking soda the next big thing in sports performance supplementation?Does soda bicarb actually work as a performance enhancer?In this episode, I deep dive into soda bicarb as a sports performance supplement and breakdown what you need to know and what the evidence says. The belief is that soda bicarb (or baking soda), can help improve performance for athletes undergoing high intensive training. For this reason, more and more active people are trying out bicarb to try help them elevate their potential.Is there any truth to all this?In today's podcast, I will cover:What is soda bicarb?The benefits explained (deep dive into the proposed action of bicarb in performance)What does the evidence say? (Is it truth or myth)Exploring dosage + side effects Listen to the full episode to learn more about real nutrition and the experiences of a Sports Dietitian.Hope you enjoy!____________________________________________DOWNLOAD MY FREE MACRO NUTRITION CHEATSHEET Your Guide To Improving Your Macros & Food Knowledgehttps://theclimbingdietitian.lpages.co/macro-cheatsheet-the-climbing-dietitian/Apply for 90-Day Macro Sherpa Program: https://bit.ly/395QmGsCheck out and SUBSCRIBE to my YouTube channel: https://bit.ly/2Mxqs4WEmail me: aleksa@theclimbingdietitian.com.auTo find me on socials:Instagram: https://www.instagram.com/theclimbingingdietitianTikTok: https://www.tiktok.com/@theclimbingdietitianFacebook: https://www.facebook.com/theclimbingdietitianTwitter: https://twitter.com/beardyAPDLink to blog: https://bit.ly/330ULq4Check out my website for more information on me and what I do:https://www.theclimbingdietitian.com.au

Welcome to PICU Doc On Call, A Podcast Dedicated to Current and Aspiring Intensivists. I'm Pradip Kama and I'm Rahul Damania, a third-year PICU fellow. I'm Kate Phelps, a second-year PICU fellow and we are all coming to you from Children's Healthcare of Atlanta, Emory University School of Medicine, joining Pradip and Rahul today. Welcome to our episode, where will be discussing rhabdomyolysis and associated acute kidney injury in the ICU. Rahul: Here's the case, a 7-year-old female presents to the ED with three days of fever, poor PO, and diffuse myalgia. In the ED, her vital signs are T 39.1C, HR 139, BP 82/44, RR 32. She is pale and diaphoretic, complaining weakly about how much her legs hurt. Her parents note that she has not been peeing very well since yesterday, and when she does pee it is “very concentrated, almost brown.” She's also been spending all her time on the couch and has asked to be carried to the bathroom when she does need to go. An IV is placed by the emergency room team, and she is given a fluid bolus, acetaminophen, and initial labs are drawn (CMP, CBC, RSV/Flu swab) before she is admitted to the PICU. In the PICU, her fever is better and her vitals have improved to T 37.7, HR 119, BP 115/70, and RR 25. Her respiratory swab has just resulted positive for Influenza A. Further labs are sent, including creatine kinase (CK), coagulation studies, and a urinalysis. Labs are notable for K 3.9, Bicarb 22, BUN 15, Cr 0.8, and CK 5768 IU/L. Her urinalysis is notable for 1 WBC, 2 RBC, +3 blood, negative nitrites, and leukocyte esterase. Kate: To summarize key elements from this case, this patient has: Influenza A, as evidenced by her respiratory swab, as well as her clinical prodrome. She has diffuse myalgias, as well as fevers, diaphoresis, and hypotension. Labs are most notable for elevated creatinine and elevated creatine kinase, as well as an abnormal urinalysis. All of which brings up a concern for rhabdomyolysis and myoglobin-induced acute kidney injury. Before we get into this episode — let's create a mental framework for this episode — we will dissect our case by highlighting key H&P components, visit a differential diagnosis, pivot to speaking about pathophysiology, and finally, speak about management! Rahul: Let's transition into some history and physical exam components of this case. The classic presentation of rhabdomyolysis is myalgias, muscle weakness, and tea-colored urine, all of which our patient has. Decreased urinary output can also accompany, a variety of reasons, but most notably if the patient has myoglobin-induced acute kidney injury. In our patient, poor PO is also probably contributing to her decrease in urine output. Red flag signs or symptoms will include anuria, hypotension, and altered mental status (which is rare but may indicate severe acidemia and deterioration) Pradip: As we think about our case, what other disease processes might be in our differential? As we dive in a bit more, we'll come up with ways to distinguish between rhabdo and other things! Viral myositis - inflammation in the muscles in the setting of a viral illness, which can definitely happen with influenza and other common viruses Some other things which may cause reddish-brown urine, including hematuria, hemoglobinuria, porphyria, some specific foods or drugs (like rifampin, beets, food coloring — even ibuprofen) We also have to investigate a bit more to convince ourselves that our patient's AKI is due to rhabdomyolysis, as it could be from dehydration, sepsis, NSAIDS, etc. Kate: Let's dive further into rhabdomyolysis! Rhabdomyolysis affects over 25,000 adults and children every year. While toxins (including prescription drugs, alcohol, and illicit drugs) and trauma are two common causes of rhabdo in adults (and teens), infections, especially viruses, are the most common cause in young children. Influenza, EBV, and CMV are three most commonly reported. What's the pathophysiology of...

00:00 - Intro00:58 - To reduce alkalinity, use acid. But there are a few types of acid. And what, exactly, does acid do? It converts alkalinity into carbonic acid (dissolved CO2).04:17 - The amount of dissolved CO2 in your water determines the pH.04:36 - Clarifying "carbonate alkalinity" vs. "total alkalinity". 07:45 - The Orenda App adjusts alkalinity automatically for you when you update the CYA level.08:45 - How to actually add acid to reduce alkalinity: do not column pour! Dilute dilute dilute.13:55 - How to deal with tap water with high alkalinity (150+ ppm) or very high alkalinity (200+ ppm).17:16 - Reduce alkalinity slowly. Do not remove more than 20 ppm at a time. Aim for 10-15 ppm of alkalinity reduction at a time. The more dilution, the better.18:12 - To reduce risk of 'tanking the pH' while reducing alkalinity, aerate the water. And there are other ways of stirring up the water without circulating it through the system.20:00 - How to raise alkalinty: Sodium bicarbonate (baking soda) and Sodium carbonate (soda ash). Bicarb is more appropriate for raising alkalinity because it barely raises pH, whereas soda ash will raise the pH significantly for the same alkalinity addition.23:49 - Summary. Thanks for listening! ------------------------------------Connect with Orenda TechnologiesWebsite: https://www.orendatech.comBlog: https://blog.orendatech.comYouTube: https://www.youtube.com/user/OrendaTechnologiesFacebook: https://www.facebook.com/orendatech/Instagram: https://www.instagram.com/orendatechnologies/

02:00  NPC  Fresh Plaster Start-up16:55  Pool Nation Podcast Net Challenge19:15  Talking Pools Column in Pool Magazine19:35  Borate Fresh Plaster Start-up25:45  Bicarbonate Fresh Plaster Start-up (The one with the 55-gallon drum) Jump right in. The water's fine. Join us, Poolside!Find us onWebsite: https://talkingpools.com/Instagram: https://www.instagram.com/talkingpools/Facebook: https://www.facebook.com/TalkingPools Twitter: https://twitter.com/TalkingPoolsYouTube: Talking Pools Podcast - YouTubeOnline Pool Education Classes: https://poolclass.teachable.com/Rudy's Books:  Rudy Stankowitz - Author Aquatic Facility Training & Consultants Online CPO & AFO Certification ClassesPOOL MAGAZINE Pool Magazine is leading up to the minute news source for Swimming Pool News and Pool Features. OuBLUERAY XL The real mineral purifier! Reduce your pool maintenance costs & efforts by 50%

Show notes at pharmacyjoe.com/episode665. In this episode, I’ll discuss when using IV bicarb in the ICU is actually helpful. The post 665: When is using IV bicarb in the ICU actually helpful? appeared first on Pharmacy Joe.

Show notes at pharmacyjoe.com/episode665. In this episode, I’ll discuss when using IV bicarb in the ICU is actually helpful. The post 665: When is using IV bicarb in the ICU actually helpful? appeared first on Pharmacy Joe.

In this episode of The Reach Your Peak Experience podcast, Aleksa the sports dietitian explores the alkaline diet.In recent years there has been an increase in popularity of the alkaline diet and trying to modify one's blood pH level for “health” and “results”. However, is there any merit to the alkaline diet and the proposed benefits?Are alkaline diets necessary? Are they even safe?These questions need to be answered for all diets and especially ones that suggest it will directly modify the body's physiology. In today's podcast, I will cover:What is the alkaline diet and why has it increased in popularity?Do alkaline diets work and are they safe?The truth behind diets and blood pH (what you NEED to know)Bicarb supplementation (the what, how & why)Listen to the full episode to learn the truth. Hope you enjoy!Link to blog: https://bit.ly/330ULq4Apply for 90-Day Macro Sherpa Program: https://bit.ly/395QmGsGet my e-book: https://bit.ly/31HEdRpCheck out and SUBSCRIBE to my YouTube channel: https://bit.ly/2Mxqs4WEmail me: aleksa@theclimbingdietitian.com.auTo find me on socials:Instagram: https://www.instagram.com/theclimbingingdietitianFacebook: https://www.facebook.com/theclimbingdietitianTwitter: https://twitter.com/beardyAPDCheck out my website for more information on all things 'The Climbing Dietitian':https://www.theclimbingdietitian.com.au

Mould is a common organism belonging to the family of funguses and yeasts that includes mushrooms. The spores are everywhere, but especially in damp places both indoors and outside. If you have mould growing on a wall or ceiling it not only looks awful, but it can be bad for your health so it needs to be cleaned right away. Many believe that the best method of mould removal is vinegar, however, others still swear by bleach. If you have a large area that needs mould removal you shouldn't attempt to clean it yourself. Instead, consider professional cleaning services from houston patriot maids.Ceiling mould is undesirable, ugly and can be difficult to tidy. It can likewise completely harm your ceilings. Mould has to be dealt with as soon as you observe it. Adhering to a few easy steps can help make sure a healthy environment as well as tidy ceiling. Clean mould of ceiling using 1 of 3 methods: 1. Vinegar-- pour distilled white vinegar into spray container, spray on mould, leave for 1 hour, rub out & allow it location dry. 2. Bicarb of Soft drink-- combine 1 tsp of bicarb with water in container, tremble & spray on mould, leave for a couple of minutes, scrub with brush or sponge. Spray once again & let it completely dry. 3. Hydrogen Peroxide-- pour concentrate right into bottle, spray on mould, leave for 10 minutes, clean with water & allow it dry.Exactly how to naturally clean mould off a ceiling.VinegarVinegar is a staple in the majority of houses. This all-natural fluid is useful for several points, consisting of removing stains and also eliminating bacteria. This mild acid kills 82% of mould types. 1Put distilled white vinegar into a spray bottle. Spray it straight onto the mould as well as leave for an hour. Clean the vinegar off with water as well as allow the area dry. The vinegar scent should clear after a couple of hrs. If it does not, position a bowl of lemon water in the location.Bicarbonate of SodaYou can make use of bicarbonate of soda to clean mould from your washroom ceiling. In addition, this light powder takes in dampness, maintaining mould away. It is additionally safe to make use of around youngsters and also pets.Integrate a tsp of bicarbonate of soda with water in a spray bottle and also shake up until it has actually liquified. Splash it directly onto the mould and leave for a few mins. Utilize a scrubbing brush or sponge to get rid of the mould, then clean the service off with water. Splash the service on the area again and let it dry.Hydrogen PeroxideHydrogen peroxide may be among the most reliable mould-killing options. It is anti-viral, anti-fungal and also anti-bacterial. You can clean up mould from your ceiling, walls as well as floorings making use of hydrogen peroxide. Simply keep in mind that hydrogen peroxide acts like bleach as well as affects fragile surfaces. Therefore, we would certainly always suggest doing a tiny patch test to begin with to make sure surface areas are not harmed.Put concentrated hydrogen peroxide right into a spray container. Splash it directly onto the mould as well as leave it for 10 mins. Make use of a scrubbing brush to eliminate the mould as well as spots. Clean the surface area with water and also let it completely dry.Every one of these choices are excellent non-toxic as well as effective mould cleansing solutions. They are both secure to use and environmentally friendly. These items are likewise low-cost and also can be found in your local grocery store *. With all supplied techniques, we would certainly recommend using non-allergenic disposable clothes to shield your skin versus any kind of potential irritations.

Chapter Three: How the proximal tubule is like Elizabeth Warren and other truths my friends from Boston taught me References for Chapter 3: Faisy C, Meziani F, PLanquette B et al. Effect of Acetazolamide vs. Placebo on Duration of Invasive Mechanical Ventilation among patients with chronic obstructive pulmonary disease: a randomized clinical trial. JAMA 2016 https://pubmed.ncbi.nlm.nih.gov/26836730/This randomized controlled double blinded multi-center study of acetazolamide to shorten the duration of mechanical ventilation (known as DIABLO) there was no statistically significant difference (though it may have been underpowered to do so).Salazar H, Swanson J, Mozo K, White AC, Cabda MM Acute Mountain sickness impact among travelers to Cusco, Peru J Travel Med 2012 https://pubmed.ncbi.nlm.nih.gov/22776382/ Investigators found that altitude sickness is common and alters travel plans for 1 in 5 travelers but was prescribed infrequently.Buzas GM and Supuran CT. Journal of enzyme inhibition and medicinal chemistry 2015 https://www.tandfonline.com/doi/full/10.3109/14756366.2015.1051042This review describes the use of acetazolamide to treat peptic ulcers and how it was later learned that H. pylori have carbonic anhydrase NORDIC idiopathic intracranial Hypertension Study Writing Committee. The effect of acetazolamide on visual function in patients with idiopathic intracranial hypertension and mild visual loss: the idiopathic intracranial hypertension treatment trial. JAMA 2014 https://pubmed.ncbi.nlm.nih.gov/24756514/In this multi-centered trial, acetazolamide and low sodium weight reduction diet improved mild visual loss more than diet alone. Mullens W et al. Rationale and design of the ADVOR (acetazolamide in decompensated heart failure with volume overload trial) Eur J Heart Failure 2018 https://pubmed.ncbi.nlm.nih.gov/30238574/This reference explains the rationale for this ongoing trial.Gordon CE, Vantzelfde S and Francis JM. Acetazolamide in Lithium-induced nephrogenic diabetes insipidus NEJM 2016 https://www.nejm.org/doi/full/10.1056/NEJMc1609483A case report of efficacy of acetazolamide in a patient with severe polyuria.Zehnder D et al. Expression of 25-hydroxyvitamin D-1alpha hydroxylase in the human kidney. JASN 1999 This report explores the activity in the enzyme in nephron segments and suggests that the distal nephron may play an important part in the formation of 1,25 vitamin D https://jasn.asnjournals.org/content/10/12/2465Outline: Chapter 3 - This is chapter three, kind of the first real chapter of the book- Proximal Tubule- Reabsorbs 55-60% of the filtrate - Active sodium resorption - 65% of the sodium - 55% of the chloride - 90% of HCO3 - 100% glucose and amino acids - Passive water resorption - Water resorption is isosmotic - Secretion of - Hydrogen - Organic anions - Organic cations - Anatomy - S1, S2, S3 can be differentiated by peptidases - S1 more sodium resorption and hydrogen secretion, high capacity - S2 more organic ion secretion - Cell model - Basolateral membrane - Na-K-ATPase powers all the resorption - Luminal membrane - 100 liters a day crosses the proximal tubule cells - Microvilli to increase surface area - Microvilli has brush border which has carrier proteins as well as carbonic anhydrase - Water permeable, so sodium resorption leads to water resorption - Aquaporin-1 (sounds like this transporter is unique to the proximal tubule and RBC) - HCO3 is reabsorbed early, along with Na, resulting in increased chloride concentration which passively reabsorbed via paracellular route. - Tight junction has only one strand (on freeze fracture) as opposed to 8 in distal nephron - The Na-K-ATPase - Lower activity than in the LOH and distal nephron - Maintained intracellular Na at effective concentration of 30 mmol/L - Interior of the cell is negative due to 3 sodium out and 2 K in, then K leaks back out. - 3 Na out for 2 K in - An ATP sensitive K outflow channel on the basolateral membrane - Increased ATP slows potassium eflux - The idea is if Na-K slows, ATP will accumulate and this will slow K leaving, because there is less potassium entering. - K channel is ATP sensitive, ATP antagonizes K leak. - Highly favorable ELECTROCHEMICAL gradient for sodium to flow into the cell through the luminal membrane - Must be via a channel or carrier - Cotransporters - Amino acids - Phosphate - Glucose - Called secondary active transport - Countertransporters - Only example is H excretion - Basolateral membrane - Na-3HCO3 transporter - Powered by the negative charge in the cell- Chloride resorption - Formate chloride exchanger - Formate combines with hydrogen in the lumen, becomes neutral formic acid, and is reabsorbed where the higher pH causes it to dissociate and recycle again. - Dependent on continued H+ secretion - Chloride moves across basolateral membrane thanks to Cl and KCl transporters, taking advantage of negative intracellular charge- Passive mechanisms of proximal tubule transport - Accounts for one third of fluid resorption - Mechanism - Early proximal tubule resorts most of the bicarb and less of the chloride - Tubular fluid gets a high chloride concentration - Chloride flows through the tight junction down its concentration gradient - Sodium and water follow passively behind - Water moves osmotically into intercellular space from tubular fluid even though the osmolalities are equal since chloride is an ineffective osmole, so tonicity is not the same. ****** - Argues that bicarb is primarily important solute for passive resorbtion - Acetazolamide blocks Na and chloride resorption - Similar thing happens with metabolic acidosis where less bicarb is available to drive passive resorbtion of Na and Cl - Summary - Other than Na-K-ATPase Na-H antiporter main determinant of proximal Na and water resorption - 1. Direct bicarb resorption - Preferential bicarb resorbtion proximally drives passive chloride resorption - Drives active the formate exchanger for chloride resorption- Neurohormonal influence - AT2 drives a lot of Na resorption, primarily in S1 segment - Does not have a net effect on H-CO3 movement - Dopamine antagonizes sodium resorption - Blocks both Na-K-ATPase and - Na H antiporter- Capillary uptake - Starlings. Again - Low hydraulic pressure due to glomerular arteriole - High plasma on oncotic pressure from loss of the filtrate - The two together promote resorption - There maybe movement from interstitial back into tubular fluid (back diffusion) conflicting data- Glomerular tubular balance - The fractional tubular reabsorption remains constant despite changes in GFR (tubular load) - It is essential the GFR is matched by resorption - The rise in capillary osmotic pressure with increased GFR via increased filtration fraction is one mechanism of GT balance - Glomerular tubular balance os one of three mechanisms that prevents fluid delivery from exceeding the resorptive capacity of the tubules - GT balance - TG feedback - Autoregulation - GT balance can be altered if patients are volume overloaded or depleted - Closes this section with a story of a kid born without a brush border - Primacy of sodium in proximal tubule activity - Discusses bicarb resorbtion - There is no Tm for Bicarb as long as volume overload is prevented, in rats can rise over 60! - If you give NaHCO3 you get volume overload and the Tm I about 60 - Glucose - S1 and S2 have high capacity, low affinity glucose resorption - S3 has high affinity 2 Na fo every glucose - Tm glucose is 375 mg/min - For a GFR of 125t that comes out to 300mg/dL - 125 ml/min * 3mg/ml (300 mg/dL) = 375 mg/min - Functionally this is 200 mg/dL due to splay - Urea - Only 50-60 of filtered urea is excreted - Calcium Loop and distal tubule - Phosphate - 3Na-Phosphate high affinity transporters late in proximal tubule - three types of Na-Phos transporters, type 2 are the most important - regulated by PTH and plasma phosphate - PTH suppresses Phos resorption -Metabolic acidosis also reduces phosphate resorption (good to have phosphate in the tubule to soak up H+ - Decreased tubular pH converts HPO42- to H2PO4- which has lower affinity for phosphate binding site - Mg Loop and distal tubule - Uric AcidWhy do I love acetazolamide?- I love the proximal tubule- Many uses- Often forgottenMOA- Inhibit carbonic anhydraseMain effects- Renal: less bicarb reabsorption (ie less H secretion) à more distal Na/bicarb delivery à hypokalemic metabolic acidosis- Brain: reduce CSF production, reduce ICP/IOP, aqueous humor- Pulm: COPDNotes- Tolerance develops in 2-3 days- Sulfonamide derivative- Highly protein bound, eliminated by kidneys Source: Buzas and upuran, JEIMC, 2016S Data:1968 - High altitudeHigh altitude usually results in respiratory alkalosisAcetazolamide – lessens symptoms of altitude sickness (insomnia, headache) which occur because of periodic breathing/apnea1979- NEJM study took 9 mountaineers asleep at 5360 meters à improvement in sleep, improved SaO2 from 72 to 78.7 mmHg, reduce periodic breathing, increased alveolar ventilation (pCO2 change from 37 mmHg to 30.8mm Hg)1950s - Seizures/migrainesCAI reduces pH (more H intracellularly), K movement extracellularly à hyperpolarization and increase in seizure thresholdWeak CAI (Topamax, zonisamide) but not though to be important mechanism of antiseizure effect (topamax enhances inhibitory effect of GABA, block voltage dependent Na and Ca channels)Pulmonary/COPDThought to help with the metabolic alkalosis and as a respiratory stimulant to increase RR, TV, reduce ventilator timeIn 2001 Cochrane review – no difference in clinical outcomes, but did reduce pH and bicarb minimallyDIABLO study (RCT) on ventilated COPD patients – no difference in median duration of mechanical ventilation despite correction of metabolic alkalosisHigh altitude erythropoiesis (Monge disease)First described in 1925 via Dr. Carlos Monge Medrano (Peruvian doctor), seen in people living > 2500-3000 meters (more common in South America than other high altitude areas)Usually chronic altitude sickness with HgB > 21 g/dL + chronic hypoxemia, pHTNAcetazolamide – reduces polycythemia because induces a met acidosis à increases ventilation and arterial PPO2 and SaO2 à blunts erythropoiesis and reduces HCT and improves pulmonary vascular resistanceGI ulcersWhen H2 and PPI available, less useHistory: 1932 – observed alkaline tide, presumed existence of gastric CA (demonstrated in 1939)Acetazolamide was used to inhibit acid secretion in 1960s, ulcer symptoms, with reversible metabolic acidosis, BUT lots of SE (electrolyte losses, used Na/K/Mg salts to help, renal colic, headache, fatigue, etc)Later found H. Pylori encodes for two different CasHelps to acclimatize to acidic environmentBasically, the Ca changes CO2 into H+ and HCO3They also have a urease which produces NH3The NH3 binds with H+, leaving an alkaline environment for them to live inInhibition of CA with acetazolamide is lethal for pathogen in vitro1940sFound there was CA in pancreasThought acetazolamide to reduce volume of secretions from NGT (output from exocrine pancreas) Source: Human Anatomy at Colby Blog Diuretic resistanceIf develop hyperchloremic metabolic alkalosis, short course of acetazolamide + spironolactone (b/c need distal Na blockage) à can helpMay help with urine alkalization (ie uric acid stone) but increases risk of calcium phosphate stonesADVOR trial acetazolamide in HF exacerbation in Belgiumuse may help to prevent new episode, lower total diuretic doseCSF reduction (pseudotumor cerebri)Reduces CSF by as much as 48% when > 99.5% of CA in choroid plexus is inhibitedNORDIC trial (acetazolamide v. placebo) – improvement in visual symptoms especially if advanced papilledema, and reduced opening pressure)Side note also used off label to help with increased ICP and CSF leaks, as alternative to VP shunts, repeat LPs, etc Source: Eftekari et al, Fluid Barriers CNS, 2019.

#Adrian # health Make sure to sign up for my newsletter so you never miss any new content and offers: https://fortheloveoftruth.co.uk/newsletter-signup/Original full length video of Episode 204 can be located here:https://fortheloveoftruth.co.uk/2021/02/05/ep-204-conversations-tom-barnett-and-adrian-discuss-health/Other Soundbite episodes from Episode 204 will be found here:https://fortheloveoftruth.co.uk/2021/05/04/soundbites-from-episode-204--interview-with-tom-barnett-on-health/(they are scheduled for upload so not all will be available immediately.

Sodium bicarbonate ( or "bicarb") is a well-researched and proven supplement when it comes to promoting athletic performance.   It is often used by the highest performing athletes, but there are barriers that keep others from trying this supplement.  Its safety is well established.  (Bicarb is just baking soda!)  However, ingesting bicarb can lead to unpleasant gastric side effects.In this episode, I am joined by Jeff Byers, the CEO of Amp Human.  We discuss the history of bicarb in sports and the ways it is used to improve performance.  Additionally, we delve into those side effects and a novel application of bicarb that might hold the key to harvesting the benefits while avoiding the standard side effects.

In this month's EM Quick Hits podcast: Justin Morgenstern on colchicine for COVID pneumonia, Victoria Myers on sodium bicarbonate in cardiac arrest, Brit Long on troponin in chronic kidney disease, Michelle Klaiman on GHB overdose, Ian Walker on iloprost for frostbite, Sarah Reid on tips on avoiding patient and parent complaints.... The post EM Quick Hits 27 Colchicine for COVID, Bicarb in Cardiac Arrest, Troponin in CKD, GHB Withdrawal, Iloprost for Frostbite, Patient Complaints appeared first on Emergency Medicine Cases.

 THE KITCHEN GARDEN La Niña and your produce garden Torrential rain is lashing the east coast of Australia as a write this while the west coast of enjoys a hot spell. Without sounding too dramatic, we’re starting off the kitchen garden segment with a topic about how the changing weather patterns are affecting the vegetable garden. At the moment Australia is in the grip of La Niña, a complex weather pattern, that bought rain for much of summer and now is causing flooding in many areas. Last year's summer was quite different with bushfires in most parts of Australia. Torrential rain driven by La Niña in my garden. We’re not so much spruiking climate change, but really it’s more about what you the gardener can do to mitigate problems in the veggie patch because of climate events like La Niña. This summer, the produce garden is seeing cooler temperatures during the day, increased humidity, and higher night temperatures because of the consistent cloud cover. For those gardeners on clay soil, the soil is staying damp even during the drier periods. Veggies do not like their roots in constant water. For those gardeners who haven't prepared their gardens for these events, they may find collar rot around citrus and other fungal problems in the kitchen garden. The answer for clay soil in produce gardens is build raised beds. Not only does this improve drainage, but saves all that bending to ground level. Powdery mildew is a problem with all gardens in humid weather, particularly when the crops are coming to their end of their production. Toni recommends using a bi-carbonate spray to change the pH of the leaf surface so that the fungus cannot thrive. This is only a preventative measure. Once the mildew takes hold. Bicarb soda recipe: 1/2 teaspoon of sodium bi-carbonate 450ml water couple of drops of vegetable oil to help emulsify it. Spray both leaf surfaces well until run-off. Re-apply after rain. Other problems can be fruit not ripening such as tomatoes staying green because of the lack of sunny days. Dwarf beans are all descended from climbing beans when they perceive low light levels they will begin throwing out tendrils and revert to climbing beans. This can be just a run of cloudy days or overshadowing by trees or a neighbouring building. Let’s find out-I'm talking with Toni Salter, the Veggie Lady. www.theveggielady.com 

In Episode 26 of the Pool Nation Podcast, we talk to Bob Lowry on his monthly visit to the podcast. We talk about Pool Startups. We also talk about how long you should run the pump when doing a startup, what chemicals you can and can’t add during the startup process and what chemicals you should never mix. We also answer some questions that were sent in. We cover how Bicarb works  in a pool, why Acid Demand is so high on Quartz startups vs other finishes, and continued calcium buildup.

Introduction Sodium bicarbonate was previously recommended for hyperkalemia treatment and was once considered a first-line agent for the transcellular shift. Studies evaluating the beneficial effects Continue reading The post EPISODE 31: The Beef with Bicarb! The Use of Sodium Bicarbonate in Hyperkalemia with Jimmy Pruitt appeared first on The Pharm So Hard Podcast.

This is the final of 3 podcasts recapping our most recent journal club. In this podcast Dr. Olivia Urbanowicz walks us through a meta-analysis by Wu et al published in the Journal of Emergency Medicine in 2020. We tackle the question as to whether or not there is evidence that supports the routine use of sodium bicarbonate in patients with cardiac arrest.

Welcome back to the Elevat3d Project podcast!!! In this episode Mike, Kristine & Jamie talk with Kyle Ruth, performance based coach at Training Think Tank. We get into topics of body comp in performance athletes, chronic low dose of sodium bicarb for performance, and returning to competition as a master. Your Hosts: Mike Kesthely @mikedynamic Jamie Granville @jamieelevated Kristine Andali @kristineandali Your Guest: Kyle Ruth, @kyleruth_ttt

Have you ever wondered why we don't give sodium bicarbonate to patients with a metabolic acidosis or a lactic acidosis? In this podcast I discuss the historical context of it and bring forth more recent data that may change the mind of the naysayers. Show Notes: https://eddyjoemd.com/lactic-acid-sepsis Receive a FREE audiobook (TWO for Amazon Prime members) with your FREE 30-day trial by using my link for Audible: CLICK HERE! You will be reminded when your trial is ending, by the way.

Hyperkalemia Intro Potassium is primarily an intracellular ion responsible for maintenance of the resting membrane potential for normal cell conduction. Serum measured potassium is typically between 3.5 and 5.0 mEq/L. Serum K greater than 5.0 mEq/L is generally considered the threshold for hyperkalemia. Potassium is mostly excreted via the kidneys, and the "classic" hyperkalemia patient is one who has missed several dialysis appointments complaining of paralysis or diffuse weakness. Causes of HyperK Most commonly, renal failure.  Transcelluar shift  DKA Acidosis  Other acid-base disturbances Medications  RAAS or ACE inhibitors Effects of HyperK  Most drastically affect cardiac myocytes  Conduction between myocytes is depressed, leading to slower conduction and widened QRS complexes, however, the rate of repolarization is increased.  Leads to ominous “sine wave” pattern on ECG.  Arrythmogenic  May produce classic tall, “peaked” T waves on ECG. Stepwise ECG changes in hyperkalemia: 5.5-6.5 mEq/L - Peaked T Waves 6.5-7.5 mEq/L - P waves amplitude becomes smaller and PR intervals prolong 7.5-8.0 mEq/L - QRS becomes wide ECGs are not always sensitive for hyperkalemia. Patients may have a critical K with no changes on the ECG.  Skeletal muscle tissue is also sensitive to hyperkalemia, and patients may present with weakness or paralysis as a result.  Nondescript symptoms such as muscle cramps, diarrhea, vomiting, nausea, and focal paralysis may also be present - but are also not reliable findings.  Management  Prioritized by a strategy of: Stabilization of cardiac cell membranes  Shifting potassium back into the cells  Eliminating potassium Calcium (Chloride or gluconate) administered to stabilize cell membranes  Stabilizing effect is transient and relatively short lived  Calcium Chloride contains roughly 3 times the amount of elemental calcium as compared to Ca gluconate, but is associated with severe complications if extravasation occurs.  Effects (narrowing of QRS complex, return of more hemodynamic stability) occurs within minutes  Calcium Chloride - generally, 1 gram is administered over 3 minutes. Calcium Gluconate - 1 gram over 2-3 minutes  Repeat either q5min Albuterol / Beta 2 agonists These act on beta 2 receptors to assist in moving potassium back into the intracellular space  Albuterol - 10-20mg (inhalation), with most effect noted in 30 minutes  IV Insulin  Drives K back into the cells (shift) Generally administered with dextrose unless the patient’s BGL is below 250mg/dL 10 units IVP followed by 25G dextrose Incidence of hypoglycemia is high, and this therapy should be administered cautiously Dialysis  Treating reversible cause d/c RASS or ACE inhibiting medicaitions  Volume administration

Inspired by this summer's commentary on the lack of evidence supporting both AMP Human and Halo products. White papers are more marketing material and far less than evidence.

Bicarb - should you give it or should you not? We break down the physiology of bicarb and its role in critically ill patients. See shownotes and attributions at pulmcast.com

In Season 3, Episode 26 Dr. Bubbs interviews renowned exercise physiologist Dr. Andy Sparks PhD. In this episode, Andy shares his passion for expert-generalism, his serendipitous path to research, the early days of high-fat, low-carb pre-exercise fueling in endurance sport, his work in measurement error and why it matters, inter-individual differences in how beetroot juice impacts endurance performance, personalized dosing of sodium bicarb, fueling practices in ultra-endurance athletes and much more!

In our second News Flash, Dr. Stern-Nezer summarizes the results and the implications of the recently published PRESERVE trial, which tested the hypothesis that sodium bicarbonate or acetylcysteine could prevent contrast-associated nephropathy. The NCS Podcast is the official podcast of the Neurocritical Care Society. The senior producer for the News Flash series is Sara Stern-Nezer. Our editor is Jim Siegler. Our production staff includes Fawaz Almufti, Michael Brogan, Starane Shepherd, Benjamin Miller, Chris Zammit, and Ramani Balu. Our administrative staff include Becca Stickney, Sara Memmen, and Angel Gindele. Sound effect by Maximilien. Weisbord SD, Gallagher M, Jneid H, Garcia S, Cass A, Thwin SS, et al. Outcomes after angiography with sodium bicarbonate and acetylcysteine. The New England journal of medicine. 2018;378:603-614.

Recently I gave a lecture at Arrowhead EMS Conferenceon when to treat metabolic acidosis with sodium bicarbonate. I attempted to record the lecture live and had some AV difficulties that prevented me from being able to. Soooo I re-did an abbreviated version of this talk into a screen-cast.    I think we can all agree that there is never a reason to treat a metabolic acidosis with sodium bicarbonate. So we really are asking:   When do we treat a metabolic acidosis with sodium bicarb?

In this episode, episode 98, I discuss the BICAR-ICU trial and what it tells us about using sodium bicarbonate to treat metabolic acidosis. References: BICAR-ICU Trial: https://www.ncbi.nlm.nih.gov/pubmed/29910040 BICAR-ICU Editorial: https://www.ncbi.nlm.nih.gov/pubmed/29910039 Forsythe: https://www.ncbi.nlm.nih.gov/pubmed/10631227 Sabatini: https://www.ncbi.nlm.nih.gov/pubmed/18322160 Pulmcrit post: https://emcrit.org/pulmcrit/bicar-icu/  

I wanted to expound on this a little more and discuss my thoughts on when it makes sense to give sodium bicarbonate to a patient in a metabolic acidosis. Check out the show notes for further reading and pics.

Pelvic exams and STIs, Non-operative vs operative management of hip fractures, Tamsulosin for kidney stones, NG tube decompression for SBO, Procedural sedation with one vs two physicians, CXR in everyone with chest pain ? , Fluids and Pediatric DKA, NIPPV + NC, PRISMS trial - alteplase vs aspirin, ESBL UTI, Bicarb in the ICU, Backboards and imaging, SVT and troponin leak, Pediatric pneumonia, Lactate after HD, Tetracaine for corneal abrasions, fixed dose vs weight based PCC, ED Urgent Care transfers, Diplopia in the ED   Quick Summary   July 2018 Articles

Bicar-ICU changes my practice with bicarb infusions and let's end the great lactate debate on EMCrit 227:

Author: Gretchen Hinson, M.D. Educational Pearls: Controversial topic. Pathophysiology - acidosis leads to an extracellular potassium shift. Patients in DKA will be intracellularly potassium deplete, but will have a falsely normal/elevated serum potassium. 3 risk of giving bicarb in DKA - alkalosis will drive potassium intracellularly but can overshoot (hypokalemia) and  increase risk of arrhythmias; bicarb slows clearance of ketones and will transiently increase their precursors; bicarb can cause elevated CSF acidosis. 3 instances when appropriate to give bicarb in DKA: DKA in arrest; hyperkalemic in DKA with arrhythmia; fluid and vasopressor refractory hypotension. References: Bratton, S. L., & Krane, E. J. (1992). Diabetic Ketoacidosis: Pathophysiology, Management and Complications. Journal of Intensive Care Medicine, 7(4), 199-211. doi:10.1177/088506669200700407 Chua, H., Schneider, A., & Bellomo, R. (2011). Bicarbonate in diabetic ketoacidosis - a systematic review. Annals of Intensive Care, 1(1), 23. doi:10.1186/2110-5820-1-23

Andrea is hot off another successful cookbook club meeting, and has several desserts to report on from the new Smitten Kitchen cookbook, Every Day. Meantime, Stefin is cleaning her stainless steel sink with an old-fashioned cleaning agent: Bicarb! (That's baking soda in the USA.) Both hosts debate how dangerous a bread and cake delivery service could be after Andrea tries one with delicious results. Speaking of delicious, Andrea has a new favorite birthday cake, the Fudgy Chocolate Cake with Vanilla Buttercream Frosting from, yes, Smitten Kitchen! Next, Stefin cues the violins and the hosts recount birthday treats they pined after as children (Barbie and the Matterhorn is all we'll say). And finally, Cate Brubaker, founder of International Desserts Blog, joins Stefin to talk about travel, global food trends, "freakshakes" and quark, and recreating favorites at home. Bake along with Stefin and Andrea in their baking Facebook group, Preheated. You can find links to recipes on their baking website, www.preheatedpodcast.com. Join the fun!

What is it about public health issues that lends itself to bandwagons? John Pienta, Levi Endelman, Hillary O'Brien, Issac Schwantes, and Jason Lewis discuss Finland's contribution to parenting, the cardboard box in which babies sleep. This year, hundreds of thousands of boxes will be given to new parents by US states in an attempt to improve infant mortality rates. Is that at all helpful, or are we ignoring other causes of death among infants? You know things are weird in healthcare when baking soda is in such short supply that hospitals start cutting back on open-heart surgery. And thanks to a certain 19th neuroanatomist's ideas about the relative sizes of the frontal lobe and the olfactory bulb, we decided that humans have crappy senses of smell...a 'fact' that turns out was never tested and is probably not at all true! We also heard from listener Mike, who we offended 70 episodes ago. We're not entirely sure what we said, exactly, that made Mike give us up after listening to roughly 80 hours of our half-baked opinions, but we always count ourselves fortunate to hear specific negative feedback (and hey, positive feedback is nice, too). Call us at 347-SHORTCT any time, and email theshortcoats@gmail.com.

Bicarbonate, the chemical that transports CO2 through the blood, increases the "refresh rate" of rod cells in lab tests--which could mean better motion detection. Christopher Intagliata reports

Bicarbonate, the chemical that transports CO2 through the blood, increases the "refresh rate" of rod cells in lab tests--which could mean better motion detection. Christopher Intagliata reports

In this show we explore some of the most prevalent digestive conditions such as Irritable Bowel Syndrome (IBS), Food Sensitivities, Crohn’s, Ulcerative Colitis (IBD), Coeliacs and more, identifying underlying causes which may be responsible for the onset of the condition along with natural ways you can begin to truly heal your gut from the inside out.    Show notes and resources: - Headspace - Mindfulness App - 10 mins a day for 10 days that can change your life. This app is free and Angela recommends this to her clients as a great way to slow your mind, reduce stress and practice mindfulness. - Chemical Free Cleaner Recipe: 1tsp Bicarb, 10-20 drops Eucalyptus oil, splash of white vinegar + water in a 500ml - 1l container.    3 Take Away Keys 1. Work with a trustworthy Practitioner / Naturopath 2. Repopulating the gut with good bacteria, especially after antibiotic use to re-establish a balance.  3. Use gut healing nutrients: Vitamin A, Slippery Elm, Glutamine, Marshmallow Root, Licorice Root (if you don’t have high blood pressure), Chamomile,    Thanks for listening. If you enjoyed this episode the best compliment you can give is a referral, so please share this with your friends and remember to subscribe on iTunes or Stitcher and write us a review!   This show is about you, the listener, so get involved and send us your feedback, questions and topic suggestions to busbynaturopathics.com/podcast -  email us at podcast@busbynaturopathics.com.au or give us a call 0416-775-530 (for int. 0011 61-416-775-530)   If you would like to book a Skype or in-clinic appointment with Angela Click Here   Join us in the health journey by following us on: - Facebook - Instagram   - Youtube

More on Bicarb in the Critically Ill and a discussion with John Kellum, MD

In this bonus episode, our second installment of the highlights from Whistler's Update in Emergency Medicine Conference 2012, we have Dr. David Carr updating us on infectious diseases, Dr. Dennis Scolnick giving us the low down on pediatric urological emergencies, Dr. Anil Chopra reviewing the pearls and pitfalls of managing shock states, and much more. In these conference highlights our experts answer such questions as: Which oral antibiotics can replace IV antibiotics in the majority of bacterial infections? What are the most recent recommendations for pelvic inflammatory disease management? Which patients with mammalian bites require antibiotics? How can we best counsel our patients with potential exposure to HIV? Does every child with a painful scrotum require an ultrasound? What is the role of treatment with Bicarb in shock? What are the best antibiotic choices in patients suspected of septic shock? When are steroids indicated for patients in shock? How should you decide between the different vasopressors for shock? and many more....... The post Episode 22b: Whistler Update in Emergency Medicine Conference 2012 appeared first on Emergency Medicine Cases.

In Part 2 of this episode on ACLS Guidelines - Atropine, Adenosine & Therapeutic Hypothermia, Dr. Steven Brooks and Dr. Michael Feldman discuss the removal of Atropine from the PEA/Asystole algorithm, the indications and dangers of Adenosine in wide-complex tachycardias, pressors as a bridge to transvenous pacing in unstable bradycardias, and the key elements of post cardiac arrest care including therapeutic hypothermia and PCI. They answer questions such as: In which arrhythmias can Amiodarone cause more harm than good? Is there any role for transcutaneous pacing for asystole? When should Bicarb be given in the arrest situation? In what situations is Atropine contra-indicated or the dosage need to be adjusted? How has the widespread use of therapeutic hypothermia currently effected our ability to prognosticate post-arrest patients? What are the indications for PCI and thrombolysis in the cardiac arrest patient? Should we be using therapeutic hypothermia in the non-Vfib arrest patient? What is the best method for achieving the target temperature for the patient undergoing therapeutic hypothermia? and many more......

In Part 2 of this episode on ACLS Guidelines - Atropine, Adenosine & Therapeutic Hypothermia, Dr. Steven Brooks and Dr. Michael Feldman discuss the removal of Atropine from the PEA/Asystole algorithm, the indications and dangers of Adenosine in wide-complex tachycardias, pressors as a bridge to transvenous pacing in unstable bradycardias, and the key elements of post cardiac arrest care including therapeutic hypothermia and PCI. They answer questions such as: In which arrhythmias can Amiodarone cause more harm than good? Is there any role for transcutaneous pacing for asystole? When should Bicarb be given in the arrest situation? In what situations is Atropine contra-indicated or the dosage need to be adjusted? How has the widespread use of therapeutic hypothermia currently effected our ability to prognosticate post-arrest patients? What are the indications for PCI and thrombolysis in the cardiac arrest patient? Should we be using therapeutic hypothermia in the non-Vfib arrest patient? What is the best method for achieving the target temperature for the patient undergoing therapeutic hypothermia? and many more...... The post Episode 12 Part 2: ACLS Guidelines – Atropine, Adenosine & Therapeutic Hypothermia appeared first on Emergency Medicine Cases.