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Advanced MNT 1 > Biochemical Assessment > Flashcards

Biochemical Assessment Flashcards

1
Q

Used to
◦Diagnose diseases/illness
◦Evaluate hydration status, organ function
◦Diagnose nutritional deficiencies
◦Monitor effectiveness of nutrition interventions

A

Biochemical Assessment

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2
Q

Biochemical Assessment involves __________

A

Comprehensive Metabolic Panel (CMP)

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3
Q

Comprehensive Metabolic Panel (CMP) includes ??

A

Serum Electrolytes:
◦ Sodium (Na+)
◦ Potassium (K+)
◦ Chloride (Cl-)
◦ C02 (total carbon dioxide; bicarbonate)

Glucose
Blood Urea Nitrogen (BUN)
Creatinine (Cr)
Total Calcium
Albumin
Total Protein

Liver function tests:
◦ ALP
◦ ALT
◦ AST
◦ Bilirubin

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4
Q

Total body water (TBW) comprises _____%
of body weight

  • Comprised of intracellular & extracellular fluid
  • Water moves in & out of the intracellular & extracellular spaces based on osmolarity to obtain equilibrium
A

50-60

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5
Q

Intracellular Fluid (ICF) ~ ______ of TBW
Extracellular fluid (ECF) ~_____ of TBW
Transcellular fluid (GIT secretions, cerebrospinal
fluid, pericardial fluid, etc. ) ~ ____% of TBW

A

2/3
1/3
3

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6
Q

ECF Compartments:
o Interstitial fluid (____ of ECF)
o Intravascular fluid (____ of ECF)

A

3/4
1/4

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7
Q

What is interstitial fluid

A

in between cells and interstitial space
lymphatic system gets it back into cells slowly

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8
Q

what is intravascular

A

lymphatic cells and blood

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9
Q

TBW ________ with age
* Varies depending on amount of body fat & muscle mass, more fat means _____ water

A

decreases
less

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10
Q

Average adult:
- Male: ___% of body wt is water
- Female: _____% of body wt is water

  • Older adult (>60 yo): Male ____%; Female ____%
  • Adult with obesity: Male ____%; Female ____%
A

60
50

52
46

50
45

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11
Q

Large plasma proteins cause an osmotic gradient which promotes movement of water into the ______ space

Decreased serum ______=> decreased _______ pressure=> fluid moves from _________ to the________ space (“__________”) => edema

A

intravascular

albumin
oncotic
intravascular
interstitial
third spacing

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12
Q

Pressure exerted by fluid on the capillary walls is ________

Increased by _____ and _____ retention (CHF, HTN, renal failure)

Increased pressure=> movement of fluid into _______space (“________”)=>edema

A

hydrostatic pressure

Na & water

interstitial
third spacing

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13
Q

Accumulation of fluid within the interstitial space is ______

Problem of fluid distribution
Does not necessarily indicate __________fluid excess

A

edema

total body or intravascular

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14
Q

Causes of edema

A

Decrease in colloidal oncotic pressure
Increase in hydrostatic pressure
Increase in capillary permeability
Lymphatic obstruction

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15
Q

_________ AKA: volume depletion
Excessive fluid loss (water & solutes)
Caused by:
*GIT losses=> diarrhea, vomiting, bleeding
*Excessive urinary losses=> _______ therapy
*Skin losses (e.g., fever, burns, wounds)

A

Hypovolemia

diuretic

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16
Q

Deficit of water only is _______
Caused by:
◦Decreased ______
◦Excessive ________ (watery diarrhea, prolonged fever, hyperglycemia, diabetes insipidus)

A

dehydration

fluid intake
water loss

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17
Q

Symptoms of Dehydration

A

Thirst
Dry inelastic skin
Dry mucus membranes
Rapid weight loss
Decreased urine output; dark urine
Tachycardia (fast ♡ rate)
Orthostatic hypotension (blood not getting to brain fast enough)
Headaches

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18
Q

Biochemical Data Indicating Dehydration

A

Increase in serum Na
Increase in serum osmolality
Increase in serum Blood Urea Nitrogen (BUN)

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19
Q

Volume overload is _________
Excessive gain of fluid (water & solute such as sodium) Caused by:
______

A

Hypervolemia

◦Renal failure
◦Congestive Heart Failure (CHF)
◦Excessive fluid or Na intake

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20
Q

Symptoms of hypervolemia

A

Rapid weight gain
Elevated blood pressure
Jugular venous distention (JVD)
Peripheral edema
Dyspnea

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21
Q

Biochemical Data Indicating Hypervolemia

A

Decreased Na (enough in blood, just so much water)
Decreased Osmolality
Decreased BUN

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22
Q

what is serum osmolality ?

A

Concentration of particles in the blood

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23
Q

As the amount of free water in the blood increases or the amount of particles decrease=> osmolality ______

As the amount of free water in the blood decreases or the amount of particles increases=> osmolality ______

A

decreases
increases

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24
Q

Increased levels of Serum Osmolality may be caused by…

A

Dehydration
Hypernatremia
Hyperglycemia
Azotemia (nitrogenous waste products)
Ketosis

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25
Q

Decreased levels of Serum Osmolality may be caused by…

A

Overhydration
Syndrome of Inappropriate Antidiuretic Hormone (SIADH)
Hyponatremia

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26
Q

Increased Serum Osmolality will cause…
* Secretion of __________
◦ _______ water reabsorption
◦ __________ urine

  • _______ thirst
  • Results in _______ fluid volume and_______ serum osmolality
A

antidiuretic hormone (ADH)
- Increased
- Concentrated

Increased
increased
decreased

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27
Q

Decreased Serum Osmolality will…
* Suppress the ________
◦ ________ water reabsorption
◦ Large amounts of _______ urine

  • Results in ________ fluid volume and the serum osmolality will then ______
A

release of ADH
- Decrease
- dilute

decreased
increase

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28
Q

electrolytes consist of _____ and ______

A

cations and anions

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29
Q

examples of cations

A

Na+
K+
Ca2+
Mg2+

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30
Q

examples of anions

A

Chloride Cl-
Phosphate PO4 3-

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31
Q

Principle cation in the ECF space is _____ ; therefore, is
a major determinant of serum osmolality and regulator of water balance

Serum level is the result of a balance between ______ intake and ________

  • Regulated by=> ________ ; _____ function

Normal serum level: 136-145 mEq/L

A

Na

dietary Na
renal excretion

aldosterone(keep Na)
renal

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32
Q

Clinical Manifestations of Hyponatremia

A

N/V
Headache
Lethargy
Muscle cramps
Confusion
Severe: Seizures; Coma

33
Q

Causes of Hyponatremia

________ or ________

Syndrome ______________

Increased loss of sodium=> diarrhea, vomiting, NG suction Medications: diuretics

Third-space losses=> peripheral edema, _____ (fluid in tummy)

Decreased sodium intake
- Deficient content in _____
- Deficient dietary intake - rare

A

Hypervolemia
overhydration

of Inappropriate Antidiuretic Hormone (SIADH)

ascites

IVF

34
Q

Clinical Manifestations of Hypernatremia

A

Dry mucous membranes
Thirst
Headache
Dizziness
Confusion
Severe=> seizures; coma

35
Q

Causes of Hypernatremia

Excessive free body water loss (GI, renal)

Decreased sodium loss: ________(make too much cortisol which retains sodium); _____________

Medications: __________

Increased sodium intake
- Excessive content in _____
- Excessive dietary intake is rarely the cause

A

Cushing syndrome
Hyperaldosteronism

corticosteroids

IVF

36
Q

Major intracellular cation is ______

Normal serum K +: 3.5 – 5.0 mEq/L

Functions:
◦ Conduction of ________
◦ Muscle _________
◦ Cell _______

Regulation of serum K+=> balance of intake and
output (renal; _________ increases urinary excretion)

A

Serum Potassium (K+)

nerve impulses
contraction
metabolism

aldosterone

37
Q

Clinical Manifestations of Hypokalemia

A

Skeletal muscle weakness
Lethargy
GI: Constipation; N/V; Ileus (lack of peristalsis)
Severe: paralysis, cardiac dysrhythmias, & death (less than 2.5)

38
Q

Causes of Hypokalemia

Excessive ____ loss
◦ GI=> diarrhea, vomiting, gastric drainage
◦ Urinary losses

Drugs: _____________

Shift to intracellular space
◦ Insulin
◦ ______ syndrome
◦ Metabolic ______

Inadequate dietary intake

A

K+

diuretics, insulin, amphotericin B

Refeeding
alkalosis

39
Q

Clinical Manifestations of Hyperkalemia

A

Muscle twitching, cramping, weakness
Irritability; restlessness
Diarrhea, intestinal cramping
Severe=>paralysis; cardiac dysrhythmias

40
Q

Causes of Hyperkalemia

Decreased K+ excretion=> ________

Meds: ____________

Shift from intracellular to intravascular space
o Tissue destruction
o Hemolysis
o Metabolic acidosis

Dehydration

Excessive K+ intake - rare (common in _____)

A

kidney failure

K +-sparing diuretics (e.g., spironolactone)
ACE-inhibitors (e.g., lisinopril)

salt substitutes made with potassium (nusalt, mortin salt)

41
Q

Serum Calcium (Ca2+)
Serum calcium: (only __ % in the blood)
◦ ____% ionized/free Ca2+
◦ ____% bound to albumin
◦ _____% complexed with phosphate, bicarbonate, etc.

Regulated by=> __________

  • Normal Total Calcium: 9-10.5 mg/dL
  • Normal Ionized Calcium: 4.5-5.6 mg/dL
    which one is better to look at ?
A

1%

47 (active calcium)
40 (albumin in transfer protein)
13 (bound = not active) (usually permanently bound)

intestine, vitamin D, kidneys,
parathyroid hormone(raises calcium from bones) , calcitonin(send ca back to bone)

ionized

42
Q

Symptoms of Hypocalcemia

A

Irritability
Paresthesia
Muscle cramps; Tetany
Intestinal cramping & diarrhea
Cardiac dysrhythmias
Seizures

43
Q

Causes of Hypocalcemia

Decreased Ca2+ ________
________________ (dont make enough parathyroid)
________________ (high phosphate)
________ failure (vit D won’t work)
Medications: ________________

A

absorption
Hypoparathyroidism
Hyperphosphatemia
Kidney
corticosteroids, Dilantin, cisplatin

44
Q

____________ decreases total serum Ca2+ by decreasing the amount of bound Ca2+
- Causes a false____ serum total calcium

Correction of total serum Ca2+: ([4 – albumin(g/dL)] x 0.8) + Total Ca2+(mg/dL)

Alternative=> request an ____________

A

Hypoalbuminemia
low

ionized serum Ca2+

45
Q

Correction of total serum Ca2+:

A

([4 – albumin(g/dL)] x 0.8) + Total Ca2+(mg/dL)

46
Q

Symptoms of Hypercalcemia

A

Fatigue, muscle weakness
N/V, constipation
Anorexia
Confusion
Bone pain; pathologic fractures
Cardiac dysrhythmias
Impaired renal function; kidney stones

47
Q

Causes of Hypercalcemia

_______________ (more this hormone)
______ cancer or _______
Prolonged ______________
Excessive intake of _____ or _____ supplements

A

Hyperparathyroidism
Bone … metastases
immobilization
Ca or vitamin D

48
Q

what is positive acute phase reactants
markers of ?
produced by _______

A

Serum levels increase with inflammation
o Considered markers of inflammation
liver

49
Q

examples of positive acute phase reactants

A

C-reactive protein (CRP)
Fibrinogen
Ferritin (storage form of iron) (will make more from inflammation and hide iron deficiency so be careful)

50
Q

Negative Acute-Phase Reactants

Serum levels ______ with _______
Produced by the _____

Examples:
◦Albumin
◦Prealbumin
◦Retinol-Binding Protein
◦Transferrin

A

decrease
inflammation
liver

51
Q

Examples of negative acute phase reactants

A

◦Albumin
◦Prealbumin
◦Retinol-Binding Protein
◦Transferrin (carries iron)

52
Q

serum albumin maintains ______
transport protein for many smaller molecules like ______
half life _____

A

colloidal oncotic pressure
calcium, medications
18 days (doesn’t change fast)

53
Q

serum albumin is a Good indicator of _______ and _________-

A

inflammatory response and severity of illness

54
Q

Factors that Affect Serum Albumin Concentrations:

Levels decreased by:
◦__________ disease
◦____________
◦_________ disease
◦ Hyper_________and________

Malnutrition Levels increased by=> _______

A

Inflammatory disease
Metabolic stress response
Liver
Hypervolemia & overhydration

dehydration

55
Q

Serum Prealbumin Function:

___________=> e.g., thyroid hormones
Normal Value: 15-36 mg/dL
Half-life: ______

A

Transport protein

2 days (changes faster)

56
Q

Factors that Affect Serum Prealbumin
Levels decreased by:

A

◦Inflammation
◦Metabolic stress
◦Liver disease
◦Zinc deficiency
◦Malnutrition

many many things

57
Q

Blood Urea Nitrogen (BUN)
- Measures amount of _____ in the ____

path of urea

Used to assess excretory function of the _____ and metabolic function of the _____

Also varies with the state of ______

A

urea in the blood

Amino acids=> ammonia=> urea=> bloodstream=>kidneys for excretion

kidneys
liver

hydration

58
Q

Normal Findings
Adult: 10-20 mg/dL
Elderly: May be slightly higher

CRITICAL VALUE: >______ mg/dL indicates
serious impairment of _____ function

A

100
renal

59
Q

Causes of Increased BUN

______ disease
_________
GI _______
Excessive ___________
_________ obstruction
Excessive ______________

A

Kidney disease
Dehydration
GI bleeding
excessive protein catabolism
Urinary tract obstruction
protein ingestion

60
Q

Causes of Decreased BUN

A

Overhydration
Liver failure
Negative nitrogen balance

61
Q

Serum Creatinine (Cr)
- Daily production depends on ________
- Excreted entirely by the ________
- Used to assess ___________ function

A

muscle mass
kidneys
renal excretory

62
Q

Serum Creatinine (Cr)
Normal Findings
◦Adult male: 0.6-1.2 mg/dL
◦Adult female: 0.5-1.1 mg/dL
◦Elderly: may have decreased values
◦Critical Values: >_______ mg/dL indicates serious
impairment in renal function

A

4

63
Q

Causes of Increased Serum Creatinine

_______ failure

________: glomerulonephritis, acute tubular necrosis, diabetic nephropathy

Reduced _____________

___________ obstruction

Meds: _____________

A

Renal
Kidney disease
Reduced renal blood flow
Urinary tract obstruction
gentamicin, cisplatin

64
Q

Decreased Serum Creatinine

A

Decreased muscle mass

65
Q

Fasting Plasma Glucose (FPG)
AKA: Fasting Blood Sugar (FBS) or Fasting Blood Glucose (FBG)

Used to diagnose and evaluate _____ and other causes of ____________

Controlled by _______ and _______

A

DM
hyperglycemia

insulin & glucagon

66
Q

Fasting Plasma Glucose (FPG)
* Normal Findings: 70-110 mg/dL
* Fasting=> no caloric intake for at least ____ hrs
* Note: serum glucose levels must be evaluated according to _______________

A

8

the time of day (meal status)

67
Q

Causes of Hyperglycemia

____________
Metabolic response to _______
Meds: _____________
__________ syndrome

A

Diabetes mellitus
stress (physical)
corticosteroids, diuretics
Cushing’s (too much cortisol)

68
Q

Causes of Hypoglycemia

Excessive ____________ administration
Extensive______ disease
__________
__________ disease

A

insulin
liver
Starvation
Addison’s (deficiency of cortisol)

69
Q

Hemoglobin (Hgb)

An index of the blood’s _________ capacity
Used to diagnose _______

Normal levels:
◦ Men: 14-18 g/dL ◦ Women: 12-16 g/dL

A

oxygen carrying
anemia

70
Q

Causes of Decreased Hgb levels
*______ due to
◦Hemorrhage
◦Hemolysis
◦Nutritional deficiencies
◦Kidney disease (make erythropoietin that tells to make RBC)
◦Meds: ____________
◦Genetic disorders (e.g., _____________)

A

Anemia

antineoplastic drugs

thalassemia, sickle cell anemia

71
Q

Causes of Elevated Hgb levels

A

Dehydration
CHF
COPD
Polycythemia vera

72
Q

Hematocrit (Hct)

___________________

Normal levels:
◦ Men: 42-52%
◦ Females: 37-47%

A

Percentage of the total blood volume that is made up by RBC

73
Q

Causes of Decreased Hct levels
* _______ caused by
Hemorrhage
Hemolysis
Nutritional deficiency
Bone marrow failure
Genetic disorders
Leukemia
Hypervolemia

A

Anemia

74
Q

Causes of Elevated Hct levels

A

Dehydration
COPD
Polycythemia vera

75
Q

Mean Corpuscular Volume (MCV) is
________________________

Normal values: 80-95 fL

A

A measure of the average volume or size of a RBC

76
Q

Decreased MCV=> small RBC=> _____________
◦_________________, thalassemia, copper
deficiency can cause it

  • Increased MCV=> large RBC=> __________
    ◦_________________, _______________,
    cytotoxic chemotherapy can cause it
A

microcytic anemia
iron deficiency

macrocytic anemia
B12, folate

77
Q

Decreased Hgb & Hct=> anemia

Then check ______:

If decreased=> microcytic anemia=> possible ____

If increased=> macrocytic anemia=> possible ___________ deficiency anemia

If nutritional anemia suggested by MCV=>
check micronutrient levels to confirm deficiency
deficiency anemia

A

MCV

iron
vitamin
B12 or folate

78
Q
A

Advanced MNT 1 (20 decks)

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