Metabolic Acidosis Made Easy

 Hello, This is dr Shoukat Memon, working as a consultant Nephrologist in the Indus Hospital and Health Network Karachi.

Email: drshoukatmemon@gamail.com We will discuss following: I have highlighted the following areas in discussion in this video: 1. What is AG, how is it calculated, and its significance? 2. Seeing Anion Gap from a different angle. It is an increase in Anions or a decrease in Cations that both give rise to raised AG. 3. Unmeasured Cations when subtracted from Unmeasured Anions give as same gap. 4. Reviewing the range of AG from a study done on thousands of patients. The currently commonly used range of AG is 8 to 12. 5. Metabolic acidosis with rasied AG and Normal AG. 6. How to Get Corrected Anion Gap. Under normal circumstances, the body is based on neutrality which means whatever number of Aations are there, they are balanced with Anions. Examples of Cations: Na, K, Ca, Mg, Globulin; And Anions: Cl, HCO3, Albumin, So4, Po4 For the sack of understanding to manage patients, Anion Gap (AG) has been devised arbitrarily by Substracting sodium ions minus Cloride+Bicarbonate In other words, we can say, Anion Gap is the Unmeasured Anions minus unmeasured cations. Typically AG value has been set as 8 - 12. When we find raised AG, It suggests some unknown anions have been accumulated. To see this from a different angle, we can say either increase in unmeasured anions or a decrease in unmeasured cations, both can give rise to raised AG. Now from a practical perspective, if we take the example of Renal/Kidney Failure, we find raised AG and that is because of the accumulation of sulfate and phosphate anions. In uncomplicated or simple acid base disorder , we find same amount of accumulated (anions which is raised above 12 ) is the decrease in Bicarbonate from 24. For example if anion is increased 8 from cut-off 12 (AG:20) , Bicarbonate would be 16 (24 - 8). In condition where we find normal AG metabolic acidosis i.e. Diarrhea, Renal tubular acidosis. In these condition decrease in bicarbonate is compensated by accumulation of chloride anions and this keep the AG unchanged but metabolic acidosis is there. We need to see AG always in the setting of serum albumin value as we know AG is mainly contributed by serum albumin. If we find serum serum albumin 1 lower than 4 (s.albumin 3 mg/dl) then we need to add 2.5 in calculated AG of that particular patient.

Proteinurea

 

Asalam-Alaikum My name is dr Shoukat Memon and I am working as a consultant Nephrologist in this Indus Hospital and Health Network Karachi. Today we are going to discuss Proteinuria which means protein in urine. Many people ask the question that Is it normal to have protein in urine? And if this is not normal then how much worrisome it is? does it run in the family? What are the symptoms of this disease? We are going to answer (discuss) all of these questions. Normally a person can produce protein in urine up to the level of 150 mg in a day which includes albumin protein along with other proteins. Once this exceeds 150 mg in 24 hour period the doctor tells you this is not normal and condition known as Proteinuria. If protein in urine is more than 150 mg but less than 1 gram ( or 1000 mg) then it is not as worrisome as we find more than 1 gm in some of the people and usually 2gm or more than 2gm where the doctor (nephrologist) often advise kidney biopsy. Kidney/renal biopsy is a procedure in which the patient is supposed to lie down on the abdomen and the doctor inserts an injection after anesthetizing the back (kidney area). This is done under the guidance of an ultrasound machine in which the doctor keeps looking patient’s kidney in real time while doing a kidney biopsy. The kidney tissue which is removed in this procedure is hair-likeand generally, this procedure is very safe and rarely complication occurs. This condition of significant proteinuria (usually equal to 3 gm in 24 hour period) is also called Nephrotic syndrome. Regarding the manifestation of this disease, patient notices froth in urine, swelling in legs and feet which produce dip on pressure and there is periorbital puffiness around the eyes especially when patient wakes up in the morning. Swelling of body may be seen in other condition too but here we are talking about swelling related to an inflammation of natural filters (glomeruli). If proteinuria is associated with diabetes then kidney biopsy and other medicine are not useful and only the needful is to maintain blood sugar and blood pressures targets as follows: Fasting Blood Sugar <150 mg/dl Random Blood Sugar <200 mg/dl HBA1C <7.5% BP <140/90 mmHg Then if a kidney biopsy is done and certain medicines are advised i.e. deltacortil and anotherconditions immunosuppressive in those patients who are not suffering from diabetic kidney disease and proteinuria is significant with or without renal function (serum creatinine) derangement. The question is often asked how worrisome this disease is? the answer is yes if proteinuria is significant then it may take some time and roughly it responds in 2/3 of cases and the rest of the people may lead to end-stage renal disease which means they would survive on dialysis therapy. Other questions often asked by nephrologists are whether these diseases run in families? The answer is not many; very few run in the family; one of them is familial FSGS, some cystic diseases, etc. The final and take-home message is that one should discuss with the doctor regarding proteinuria if someone is suffering. Discuss with the doctor how much protein is leaking and let the doctor do some more tests and discuss treatment options so that a rational approach can be devised. Thank you very much and take care.

Calcium and Bone Health

 Normally recommended daily calcium intake is between 800 to 1200 mg.

And Vitamin D requirement in a day is around 1000 IU.

The High Calcium containing foods are:  Milk and Milk products (i.e. Curd, Yougurt, Cheese, yogurt etc.)

Other foods with adequate calcium are  Dark Leafy vegetables (i.e. Collard ),   Almonds.

The biggest source of vitamin D is sun light. Aproximatelly suggested amount of sun bath is half an hour a day at least with exposure of 25% of the sunlight body approximately. Dark-skinnedApproximately people may require bit more. 

Fish is good source of vitamin D or other fortified vitamin D foods.

It is not the way one takes adequate calcium and vitamin D in diet and thinks that he/she has done well for bone health. Bone health needs some endurance exercises, where there is some exertion.

No matter how weak the bones are ( i.e. Osteoporosisthe ) , serucm calcium level if tested would come normal. This is because the feedback mechanism of body has been designed in such a way that whenever the Nobody senses decreased calcium intake of more need of calcium, it draws it from bone and keeps the level ok in the blood/serum. 

The best test to know weak bones (Osteoporosis) is Dexa-Scan which tells the degree of bone weakness.

Shoukat Memon

Nephrologist ( Kidney Physician )

ہائی کیلشیم والی غذائیں یہ ہیں: دودھ اور دودھ کی مصنوعات (یعنی دہی، یوگرٹ، پنیر، دہی وغیرہ)

مناسب کیلشیم کے ساتھ دیگر غذائیں سیاہ پتوں والی سبزیاں (یعنی کولارڈ)، بادام ہیں۔

وٹامن ڈی کا سب سے بڑا ذریعہ سورج کی روشنی ہے۔ سورج غسل کی تقریباً تجویز کردہ مقدار دن میں آدھا گھنٹہ ہے کم از کم سورج کی روشنی کے جسم کے تقریباً 25 فیصد کی نمائش کے ساتھ۔ سیاہ جلد والے تقریباً لوگوں کو تھوڑی زیادہ ضرورت پڑ سکتی ہے۔

مچھلی وٹامن ڈی یا دیگر مضبوط وٹامن ڈی کھانے کا ایک اچھا ذریعہ ہے۔

ایسا نہیں ہے کہ کوئی شخص خوراک میں مناسب کیلشیم اور وٹامن ڈی لے اور یہ سمجھے کہ اس نے ہڈیوں کی صحت کے لیے اچھا کام کیا ہے۔ ہڈیوں کی صحت کو برداشت کی کچھ مشقوں کی ضرورت ہوتی ہے، جہاں کچھ مشقت ہوتی ہے۔

اس سے کوئی فرق نہیں پڑتا ہے کہ ہڈیاں کتنی ہی کمزور ہوں (یعنی اوسٹیوپوروسستھ)، اگر ٹیسٹ کیا جائے تو سیرکم کیلشیم کی سطح معمول پر آجائے گی۔ اس کی وجہ یہ ہے کہ جسم کے فیڈ بیک میکانزم کو اس طرح سے ڈیزائن کیا گیا ہے کہ جب بھی کسی کو کیلشیم کی زیادہ ضرورت کے کیلشیم کی مقدار میں کمی کا احساس ہوتا ہے تو وہ اسے ہڈی سے کھینچ کر خون/سیرم میں لیول کو ٹھیک رکھتا ہے۔

کمزور ہڈیوں (آسٹیوپوروسس) کو جاننے کے لیے بہترین ٹیسٹ Dexa-Scan ہے جو ہڈیوں کی کمزوری کی ڈگری بتاتا ہے۔



شوکت میمن

ماہر امراض گردہ (گردے کا معالج)

End Stage Kidney Disease

 

 Asalamalaikum

My Name is Dr Shoukat Memon consultant Nephrologist at Indus Hospital and Health Network Karachi.

In this video I have described the following:

To many extent, we can say that kidney disease is asymptomatic. A significant number of people come to know “End Stage Kidney Disease” when they see a doctor first time for the symptoms i.e generalized weakness, nausea with intermittent vomiting, and breathlessness while walking.

These symptoms with very low intensity are usually not noticed especially when the age is younger.

In many people, high blood pressure is the first sign which is checked incidentally and that person is found to have kidney disease when further investigated.

بہت سے لوگوں تک، ہم کہہ سکتے ہیں کہ گردے کی بیماری غیر علامتی ہے۔ لوگوں کی ایک بڑی تعداد "گردوں کی بیماری کے اختتامی مرحلے" کے بارے میں اس وقت جانتی ہے جب وہ پہلی بار ڈاکٹر کو علامات کے لیے دیکھتے ہیں یعنی عام کمزوری، متلی کے ساتھ وقفے وقفے سے الٹی آنا اور چلتے وقت سانس پھولنا۔

بہت کم شدت کے ساتھ یہ علامات عام طور پر نظر نہیں آتی ہیں خاص طور پر جب عمر کم ہو۔

بہت سے لوگوں میں ہائی بلڈ پریشر پہلی علامت ہوتی ہے جسے اتفاق سے چیک کیا جاتا ہے اور مزید تفتیش کرنے پر اس شخص کو گردے کی بیماری پائی جاتی ہے۔

 in Youtube video:

Nephrolithiasis (Kidney Stones)

 A significant number of people we come across have kidney disease secondary to stones. This makes me surprise too like those people who are not in the medical field how come stone forms in the body which look the same and feel hard we see the outside body in the environment.

If we see the chemical composition of any organic thing we find same elements but in different proportions. A poet said: 

I am sharing the link to my you tube video regarding kidney stones: https://youtu.be/xvNR-ab2QYA