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NUTR 425 > Biochem assessment > Flashcards

Biochem assessment Flashcards

1
Q

purpose of lab testing:

A

diagnose disease/illness, support nutr diagnoses, evaluate med effectiveness, evaluate NCP interventions/response to med nutrition therapy, reflect acute or chronic change depending on situation

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2
Q

most common biochem tests

A

blood, tissue, urine, stool/fecal

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3
Q

less common biochem tests

A

saliva, sweat, breath tests, hair and nails

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4
Q

plasma without clotting factors

A

serum

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5
Q

main component of blood that consists of water, proteins, electrolytes, ions, clotting factors

A

plasma

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6
Q

these cells carry O2 and CO2

A

RBC

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7
Q

small blood cells that assist in blood clotting by forming a plug/clot at site of damage

A

platelets

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8
Q

part of the immune system and function in immune response, includes neutrophils/eosinophils/basophils/lymphocytes/monocytes

A

white blood cells

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9
Q

____ is liquid and cell free part of blood that has been treated with anticoagulants; ___ is liquid part of blood after coagulation

A

plasma; serum

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10
Q

serum = plasma - ____

A

fibrinogen

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11
Q

limitations of blood analysis

A

only reflects nutrient lvl of fluid or tissue sampled and may not reflect overall nutr status (ie. calcium)

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12
Q

two compartments of body’s metabolically available protein:

A

somatic (75%), visceral (25%)

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13
Q

what is somatic protein?

A

located within skeletal muscle, homogenous protein pool

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14
Q

what is visceral protein?

A

located in body’s organs, blood cells, serum proteins; composed of hundreds of diff proteins serving structural and functional roles

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15
Q

somatic + visceral proteins = ___% of total body protein

A

30-50

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16
Q

where is remaining protein (not metabolically active)?

A

skin, connective tissue

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17
Q

how is assesment of protein status nutr relevant?

A

help diff between malnutrition related to disease related inflammation vs starvation (chronic low intake), central to diagnosis of PEM

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18
Q

traditional/classical way of classifying nutritional status:

A

kwashiorkor, marasmus, marasmic kwashiorkor

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19
Q

PEM that is principally protein deficiency

A

kwashiorkor

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20
Q

PEM that is predominantly energy deficiency

A

marasmus

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21
Q

combo of chronic energy and protein deficits

A

marasmic kwashiorkor

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22
Q

nitrogenous by-product of muscle creatine phosphate for energy metabolism and skeletal muscle contraction, excreted in urine, only abnormally low lvls true indicator of muscle stores

A

creatinine

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23
Q

how to calculate Creatinine Height Index?

A

(24h urine creatinine (mg) x 100) / expected 24 urine creatinine

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24
Q

what is nitrogen balance?

A

muscle protein synth = muscle protein breakdown

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25
Q

factors promoting muscle protein synthesis

A

substrate (protein, leucine, kcal), activity stimulus, hormones (insulin, growth factors)

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26
Q

factors promoting muscle protein breakdown

A

inflammation, acute/chronic illness, immobilization/inactivity, low nutrient availability, meds

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27
Q

N2 Balance =

A

protein intake (g/24h) / 6.25 - urinary urea nitrogen (g/24h) - 4

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28
Q

assumptions of N2 balance calculation:

A

protein = 16% N, general estimate of N2 losses from skin and stool is 4 g

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29
Q

primary serum proteins

A

albumin, transferrin, prealbumin, retinol-binding protein

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30
Q

primary serum proteins also called:

A

negative acute phase reactants (aka not in time of stress/inflammation)

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31
Q

why measure serum proteins?

A

assessing protein and nutr status, determining patient risk for developing med complications, evaluating response to nutr support

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32
Q

when a.a. supply low, liver serum protein synthesis ___

A

decreases (so v serum markers = indirect measure of nutr status)

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33
Q

caveat in serum protein measures?

A

in inflammation, priority shift to synth acute phase reactance proteins to support inflamm response, synth of neg acute phase proteins is decreased –>slow serum proteins like albumin not a good indicator of nutr status but rather a reflection of disease

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34
Q

what is sensitivity?

A

true positive rate, measurement of proportion of actual positives that are correctly identified as such

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35
Q

what is specificity?

A

true negative rate, measurement of proportion of actual negatives that are correctly identified as such

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36
Q

most familiar and most abundant serum protein

A

albumin

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37
Q

part of the extracellular fluid between cells

A

interstitial fluid

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38
Q

other component of ECF that isn’t IF?

A

blood plasma

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39
Q

most of the water in body is ___

A

intracellular fluid

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40
Q

primary functions of albumin:

A

maintain colloidal osmotic pressure, transport molecule for enzymes, f.a., hormones, bilirubin

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41
Q

serum albumin is altered by:

A

acute inflamm, disease staets/clinical conditions, leakage from intravasc to extravasc spaces, blood loss, fluid resuscitation, shock state

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42
Q

albumin is ___ indicator of morbidity, mortality, severity of illness

A

prognostic (hypoalbuminemia –> ^ LOS, morbidity, mortality)

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43
Q

transferrin is primarily found in ____ and its function is to :

A

intravascular body pool; binds and transports iron in plasma (synth of transferrin inversely related with body’s iron stores, ^ transferrin means early iron deficiency, last lab value return normal when iron deficiency corrected)

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44
Q

when unable measure transferrin directly, can be measured indirectly via:

A

total iron binding capacity (TIBC) , which is an equation based measurement to predict transferrin

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45
Q

transport protein for thyroxine (T4) and carrier for retinol-binding protein with a short half life and small body pool

A

prealbumin

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46
Q

is prealbumin more or less sensitive indicator of nutr status than albumin?

A

more

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47
Q

when complexed with prealbumin, acts as a carrier to retinol and responds quickly to protein energy deprivation

A

retinol-binding protein

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48
Q

transferrin levels increase in ____ and decrease in ____

A

pregnancy, estrogen therapy, acute hepatitis; protein losing enteropathy and nephropathy, chronic infection, uremia, acute catabolic states

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49
Q

prealbumin levels increase in _____ and decrease in ____

A

CKD on dialysis; acute catabolic states, after surgery, hyperthyroidism, protein-losing enteropathy

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50
Q

RBP is increased in ___ and decreased in ___

A

renal disease; vitamin A deficiency, acute catabolic states, after surgery, hyperthyroidism

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51
Q

what is CBC?

A

complete blood count

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52
Q

what is incorporated in CBC?

A

red blood cells, white blood cells, platelets

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53
Q

in CBC lab chart, top value is ___ right value is ___ bottom value is ___ and left value is ___

A

Hgb; Plt; Hct; WBC

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54
Q

possible etiology of v RBC

A

hemorrhage, hemolysis, diet deficiency, genetic aberrations, marrow failure, chronic illness, organ failure

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55
Q

low values of Hb is < ___ in males and < ___ in females

A

130g/L; 120 g/L

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56
Q

causes of low hemoglobin

A

anemia, hemorrhage, hemolysis, cancer, nutr deficiencies, lymphoma, systemic lupus, sarcoidosis, kidney disease, sickle cell anemia

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57
Q

causes of high hemoglobin

A

congenital heart disease, polycythemia vera, hemoconcentration of blood, COPD, CHF, severe burns, dehydration

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58
Q

measure of the % of total blood volume that is made up by the RBCs

A

hematocrit

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59
Q

how to test hematocrit

A

ht of RBC column measured after centrifugation, ratio of height of RBC column compared to total blood column

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60
Q

what causes decreased Hct?

A

anemia, hyperthyroidism, cirrhosis, hemolytic reaction, hemorrhage, diet deficiency, malnutrition, bone marrow failure, pregnancy, rheumatoid arthritis, multiple myeloma

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61
Q

what causes incrased Hct (polycythemia)?

A

congenital heart disease, polycythemia vera, erythrocytosis, severe diarrhea, burns, dehydration, COPD, eclampsia

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62
Q

rbc indices provide info about _____ of RBCs

A

size, weight, Hgb concentration

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63
Q

what are the RBC indices?

A

mean corpuscular volume, mean corpuscular hemoglobin, mean corpuscular Hgb concentration, red blood cell distribution width

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64
Q

measure of the average volume (size) of a single RBC, used in classifying anemias

A

mean corpuscular volume

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65
Q

examples of microcytic

A

iron deficiency anemia and thalassemia

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66
Q

examples of macrocytic

A

vitamin B12, folate deficiencies

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67
Q

indication of variation in RBC size, calculated using MCV and RBC values, variations in this may be helpful in classifying certain types of anemias, indicator of anisocytosis, blood condition characterized by RBC’s of variable and abnormal size

A

red blood cell distribution width

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68
Q

most common cause of anemia worldwide

A

iron deficiency

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69
Q

iron deficiency occurs when:

A

ingestion/absorption of dietary iron is inadequate to meet losses (aspirin, menstruation, blood donations); unable meet requirements (rapid growth)

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70
Q

biochem indicators of iron status

A

serum iron, ferritin, sluble transferrin receptor, TIBC and transferrin, erythrocyte protoporphyrin

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71
Q

primary intracellular iron storage protein, most sensitive indicator of early iron deficiency, acute phase protein ^ during inflammation

A

ferritin

72
Q

serum concentration of ___ directly proportional to body’s requirement for iron, esp in the erythrocyte producing cells of bone marrow

A

sTfR (soluble transferrin receptor)

73
Q

serum sTfR ^ in ____

A

early iron deficiency before anemia develops

74
Q

synth of tranferrin is ____ correlated with body’s iron stores

A

inversely

75
Q

precursor of heme

A

protoporphyrin (accumulates in RBC when iron not available)

76
Q

first stage of iron deficiency:

A

depleted iron stores, decreased serum ferritin

77
Q

second stage of iron deficiency

A

early functional iron deficiency without anemia, decreased serum transferrin, ^ protoporphyrin, ^ sTfR, low end of normal Hgb

78
Q

third stage of iron deficiency

A

iron deficiency anemia, v Hgb/ferritin/transferrin/MCV, ^ protoporphyrin/TIBC/sTfR, microcytic hypochromic anemia

79
Q

what is anemia of chronic disease? (ACD)

A

during acute phase response, iron studies are altered (must differentiate this from IDA)

80
Q

in IDA, serum ferritin is ___ while ACD it is ___

A

v ; ^ or normal

81
Q

in IDA, TIBC is ___ and ACD it is ____

A

^ ; v or normal

82
Q

transferrin saturation (extent to which transferrin is saturated with Fe) is more significant in decrease for IDA or ACD?

A

IDA

83
Q

serum iron is affected by:

A

significant diurnal variation

84
Q

RDW is ___ in IDA and ___ in ACD

A

^; normal (rises early in IDA)

85
Q

MCV in IDA is ___ and in ACD is ____

A

v ; normal usually

86
Q

sTfR is __ in IDA and __ in ACD

A

^ ; normal (sensitive test)

87
Q

accumulation of excess iron in body tissues:

A

iron overload

88
Q

iron overload usually result of :

A

hemochromatosis (group of genetic diseases characterized by excessive intestinal iron absorption and deposition of excessive iron in parenchymal cells with eventual tissue damage)

89
Q

what are parenchymal cells?

A

essential to framework of tissue of organ

90
Q

other cause of iron overload

A

multiple blood transfusions, excessive intake of iron fortified foods and supplements

91
Q

two components of wbc count:

A

WBC count and differential count

92
Q

what is diff. count?

A

measures percentage of each type of leukocyte present in the same specimen

93
Q

v WBC (leukopenia) found cuz;

A

drug toxicity, bone marrow failure, infections, diet deficiency, autoimmune disease, bone marrow infiltration, congenital marrow aplasia

94
Q

^ WBC (leukocytosis) found cuz:

A

infection, inflammation, trauma, stress, leukemia neoplasia, tissue necrosis

95
Q

essential for blood clotting

A

platelets

96
Q

reasons for v Plts:

A

hypersplenism, hemorrhage, immune thrombocytopenia, leukemia, inherited thrombocytopenia, disseminated intravascular coagulation, systemic lupus, pernicious anemia, hemolytic anemia, cancer chemo, infection

97
Q

^ platelets (thrombocytosis) cuz:

A

malignant disorder, polycythemia vera, post-splenectomy syndrome, rheumatoid arthritis, iron deficiency anemia

98
Q

chem blood tests are used in the detection of:

A

electrolyte balance, organ status, disease diagnosis and management

99
Q

basic metabolic panel consists of these 8 test:

A

sodium, potassium, CO2 (bicarbonate), chloride, calcium, blood urea nitrogen, creatinine, glucose

100
Q

basic metabolic panel provides info about:

A

kidney function, resp status, electrolyte balance, acid base balance, blood glucose

101
Q

typical lab charting format for basic chem panel:

A

Na (top left) Cl (top mid) BUN (top right) Glc (right) K (bottom left) CO2 (bottom mid) Cr (bottom right)

102
Q

comprehensive metabolic panel also has:

A

albumin, total protein, alkaline phosphatase, alanine amino transferase, aspartate amino transferase, bilirubin

103
Q

electrolyte panel:

A

Na, K, Cl, Co2

104
Q

renal panel

A

basic metabolic, Ca, Mg, glc, alb, total protein, P, creatinine clearance, eGFR

105
Q

liver panel

A

liver enzymes (ALP, ALT, ASP, GGT), bilirubin, albumin, total protein, prothrombin time

106
Q

lipid profile:

A

total cholesterol, HDL, LDL, TG

107
Q

thyroid function:

A

TSH, free T4, free T3

108
Q

minerals with electric charges that dissociate into solution into positively or negatively charged ions

A

electrolytes

109
Q

electrolytes essential for:

A

maintain physiologic body functions, cell metabolism, neuromuscular, osmotic equilibrium

110
Q

extracellular cations:

A

sodium and calcium

111
Q

intracellular cations

A

K and Mg

112
Q

extracellular anions:

A

CO2, Cl

113
Q

intracellular anion

A

P

114
Q

in Na/K ATPase, ___ Na is exchanged with ___ K

A

3; 2

115
Q

most sodium is lost from ____

A

urine

116
Q

balance of Na is maintained thru ____ from ____

A

aldosterone ; adrenal cortex

117
Q

S/S of hyponatremia

A

headache, lethargy, restlessness, decreased reflexes, seizures, coma (found in 25% of hospitalized pt)

118
Q

3 basic causes of hyponatremia

A

hypertonic hyponatremia, isovolemic hyponatremia, hypervolemic hypotonic hyponatremia

119
Q

S/S for hypernatremia:

A

lethargy, thirst, hyperreflexia, seizures, coma, death

120
Q

potential cauuses for hypernatremia

A

^ Na intake, v Na losses, excessive free body water loss

121
Q

S/S for hypokalemia:

A

muscular and generalized weakness, cramping in extremities, vomiting, arrhythmias, cardiac arrest

122
Q

potential causes of hypokalemia

A

large vol losses, refeeding syndrome, insulin delivery, excessive losses thru urine (med related), diabetic ketoacidosis, deficient intake

123
Q

S/S of hyperkalemia:

A

muscle weakness, paralysis, resp failure, arrhythmias, cardiac arrest

124
Q

potential causes hyperkalemia:

A

acute/chronic renal failure, excessive intake, aldosterone inhibiting diuretics, crush/cell damage injuries, hemolysis, acidosis, dehydration

125
Q

primary functions fo calcium not in bone:

A

electroconductivity of cell, bone metabolism, BP, blood clotting

126
Q

about half of Ca in intravascular compartment is bound to ___

A

albumin

127
Q

what is equation for corrected Ca?

A

serum Ca + 0.8 (4-serum albumin)

128
Q

S/S for hypocalcemia:

A

numbness, tingling, hyperactive reflexes, tetany, lethargy, muscle weakness, confusion, seizure

129
Q

potential cause for hypocalcemia:

A

hypoparathyroidism, renal failure, hyperphosphatemia 2ndary to renal failure, vit D deficient, osteomalacia, malabsorption, alkalosis

130
Q

S/S of hypercalcemia:

A

lethargy, nausea, vomiting, muscle weakness, depression

131
Q

potential causes of hypercalcemia:

A

hyperparathyroidism, cancer with PTH producing tumours, excessive intake vit D/milk/antacids, Addison disease, granulomatous infections

132
Q

second most prevalent intracellular cation, 70% free/ionized in serum

A

Magnesium

133
Q

primary functions of Mg

A

cofactor in enzyme reactions, important in bone, CNA, cardiovasc

134
Q

___% Mg absorbed in small intestine, regulated by ______

A

30-50; intestine, kidney, bone

135
Q

S/S of hypomagnesemia

A

muscle weakness, tetany, ataxia, nystagmus, ventricular arrhythmia

136
Q

potential causes of hypomagnesemia:

A

malnutrition/malabsoprtion, refeeding, hypoparathyroidism, alcoholism, chronic renal tubular disease, diabetic acidosis, excess loss from fluids, cirrhosis

137
Q

S/S of hypermagnesemia

A

nausea, vomiting, muscle weakness, reduced resp, hypotension, decreased heart rates, cardiac arrest

138
Q

potential causes of hypermagnesemia

A

renal insufficiency, addison disease, hypothyroidism, dehydration, use of Mg containing antacids or salts

139
Q

S/s of hypophosphatemia

A

impaired cardiac fxn, reduced diaphragm contractions, confusion, decreased tissue o2 delivery, coma, death

140
Q

potential causes of hypophosphatemia:

A

malnutrition, refeeding, hyperparathyroidism, hypercalcemia, hyperinsulinemia, IV clucose administration, chronic alcoholism, NG suction, vomiting

141
Q

S/S hyperphosphatemia

A

muscle cramps , tetany, numbness/tingling, bone/joint pain, pruritus, rash

142
Q

potential causes of hyperphosphatemia

A

renal failure, hypoparathyroidism, acromegaly, addison, bone metastases, sarcoidosis, hypocalcemia, rhabdomyolysis, healing fractures, hypervitaminosis D

143
Q

functions of water

A

transport nutrients, transport and excrete metabolic waste, support cell shape/structure, lubricate, sustain body temp

144
Q

TBW makes up ____% of body wt in healthy, lean adults and is influenced by:

A

50-70; sex (less in f), fat/lean mass (less in fat)

145
Q

3 types of ECF

A

interstitial, intravascular, transcellular

146
Q

third spaces?

A

peritoneal, pericardial, thoracic cavities, joints and bursae

147
Q

fluid move between compartments via:

A

osmosis (mvmt water only) and filtration (water and solutes)

148
Q

what is osmosis?

A

mvmt of fluid across semipermeable mem from area low concentration of solute to area of high concentration

149
Q

what is osmotic pressure?

A

force that pulls water across mem; based on # solute particles in solution

150
Q

solutes that do not disperse in fluid

A

colloids

151
Q

_____ exerts greatest effect on colloidal oncotic pressure

A

serum albumin

152
Q

pressure exerted by fluid on membrane

A

hydrostatic

153
Q

when hydrostatic pressure differs on 2 sides of me, fluid goes from area of ____ pressure to place of ___ pressure

A

high; low

154
Q

osmotic pressure can be expressed as either ____ or ____

A

osmolarity (number of osmols per L of solution) and osmolality (number of osmols per kg/solvent)

155
Q

fluids with osmolality equal to blood - ___

A

isotonic

156
Q

osmolality estimated using serum concentrations fo ____

A

Na, K, glc, urea

157
Q

sensible losses of fluid thru ___ and insensible thru ____

A

urine, sweat, feces; lungs, evaporation

158
Q

average healthy adult fluid requirement:

A

30-35ml/kg

159
Q

sample calcs for est fluid requirements;

A

1 mL of fluid per kcal, 30-35ml/kg, 1 mL/kcal + 100 mL/g N, 1500 mL/m^2

160
Q

how to calc BSA:

A

square root of htxwt, / by 3600

161
Q

3 categories of altered fluid balance:

A

changes in fluid volume, changes in fluid concentration, changes in fluid composition

162
Q

what is hypovolemia?

A

extracell fluid deficit, usually renal/extrarenal fluid loss

163
Q

treat hypovolemia?

A

replete w/ fluid and Na slowly

164
Q

Na concentration is used to determine ____

A

ECF osmolality

165
Q

fluid deficit equation:

A

(%age of body water x wt) x (serum Na - 140) / serum Na

166
Q

hypervolemia means ____ and in this setting, fluid shifts into ____

A

excess ECF; interstitial spaces

167
Q

shift of fluid into interstitial spaces is called:

A

edema

168
Q

hypervolemia is caused by:

A

decrased urine output, excess IV fluids. excess vasopressin secretion

169
Q

most common alterations in osmolality:

A

Na or hyperglycemia (shift of water without shift in solute)

170
Q

hyponatremia usually caused by:

A

Na restriction and diuretic use (hypervolemic hyponatremia, hypovolemic hypotonic hyponatremia, hypertonic hyponatremia)

171
Q

this type of hyponatremia caused by excess total body water without increase in Na, mostly treated by water restriction

A

hypervolemic hyponatremia

172
Q

this type of hyponatremia is characterized by a deficits in total body water and Na, primary treat by calculating fluid deficit and replacing half fluid deficit in first 24 hr and correct Na slowly

A

hypovolemic hypotonic

173
Q

fluid and Na loss can occur in:

A

excess sweating, GI loss, wound drainage/burns, excess diuretics, stomach resections

174
Q

why need to slowly Na correct in hypovolemic hypotonic?

A

cuz prevent osmotic demyelinating syndrome

175
Q

this type of hyponatremia is found in setting of increased plasma solute (usually hyperglycemia)–>^ in gluc cause water from ICF to ECF and Na is diluted

A

hypertonic hyponatremia

NUTR 425 (15 decks)

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