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Clinical Nutrition Care Applications > Biochemical Assessments Pt. 1 > Flashcards

Biochemical Assessments Pt. 1 Flashcards

1
Q

what is plasma?

A

the unclotted fluid minus RBC + WBC

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2
Q

what is serum?

A

any fluid left after clotting has occurred

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3
Q

what is sensitivity?

A

the ability of a test to detect a condition when it is present in a patient
high sensitivity = minimal false negative results

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4
Q

what is specificity?

A

the ability of a test to rule out the presence of a disease in someone who does not have it
high specificity = minimal false positive results

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5
Q

what is inter-assay variability?

A

the error you get when you do different measurements

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6
Q

what is a static assay?

A

measures concentration in serum/plasma
i.e. iron, zinc, retinol, folate

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7
Q

what can impact static assay measurements?

A

highly dependent on hydration status
dehydration = artificially high levels
over-hydration = artificially low levels

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8
Q

what is a functional assay?

A

measures biochemical/physiological activity

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9
Q

normal serum albumin level

A

3.5 - 5 g/dL

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10
Q

purpose of albumin

A

maintains colloidal osmotic pressure
carrier for many different substances

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11
Q

shortcomings for PEM assessment with albumin

A
  • half-life of ~20 days
  • large extravascular pool – can return to circulation and buffer loss
  • sensitive to hydration status/edema
  • sometimes infused in hospital patients
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12
Q

negative/positive acute phase protein: albumin

A

negative

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13
Q

transthyretin (pre-albumin) normal range

A

normal range: 16 - 40 mg/dL

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14
Q

negative/positive acute phase protein: transthyretin

A

negative

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15
Q

purpose of transthyretin

A

transport thyroxin and retinol-binding protein in blood

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16
Q

shortcomings for PEM assessment: transthyretin

A
  • zinc deficiency can affect the synthesis
  • increases with chronic renal insufficiency
  • decreases with hyperthyroidism
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17
Q

purpose of transferrin

A

transport iron in bone marrow

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18
Q

shortcomings for PEM assessment: transferrin

A
  • nonspecific (increases when iron stores are low)
  • also increases with estrogen therapy
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19
Q

positive/negative acute phase protein: transferrin

A

negative

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20
Q

purpose of retinol-binding protein

A

binds to retinol in the blood

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21
Q

normal range of retinol-binding protein

A

3-6 mg/dL

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22
Q

shortcomings for PEM assessment: retinol-binding protein

A
  • vitamin A status may complicate use
  • renal patients may have elevated complications
    *may be the best marker, but it is very expensive
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23
Q

positive/negative acute phase protein: retinol-binding protein

A

negative

24
Q

positive/negative acute phase protein: hs C-reactive protein

A

positive

25
Q

what is CRP good for?

A

could be an indicator of when to start nutrition therapy; when CRP subsides, therapy should increase

26
Q

serum enzymes that indicate muscle damage

A

creatine kinase
lactate dehydrogenase

27
Q

serum enzymes that indicate liver damage

A

alanine amino transferase (ALT)
aspartase amino transferase (AST)

28
Q

serum enzymes that indicate pancreatic damage

A

amylase
lipase

29
Q

normal blood glucose levels fasted + post-prandial

A

fasted: 70-100 mg/dL
post-prandial: <140 ~2 hours after meal

30
Q

use of hA1c

A

indicator of average plasma glucose concentration over previous months (60-90 days)

31
Q

normal hA1c levels (average adult, older adult, with DM, at risk for DM)

A

average adult: <5.7%
older adult: <7%
with DM: <7%
at risk for DM: 5.7-6.4%

32
Q

how is bilirubin made?

A

break down of hemoglobin, then released in blood

33
Q

what does elevated unconjugated bilirubin indicate?

A

elevated when liver is unable to conjugate to glucuronic acid
indicative of excessive hemolysis

34
Q

what does elevated conjugated bilirubin indicate

A

elevated when liver is unable to excrete due to obstruction in the bile passage

35
Q

what does BUN relate to?

A

protein intake

36
Q

what does elevated BUN indicate?

A

decreased renal function, dehydration, GI bleeding, CHF, and high protein intake

37
Q

what does low BUN indicate?

A

liver disease, overhydration, malnutrition, anabolic steroid use

38
Q

what is creatinine?

A

an oxidized product of creatinine

39
Q

what is creatinine used for (alongside BUN)?

A

a marker of renal function

40
Q

normal serum sodium levels

A

135 - 145 mE/L

41
Q

sodium is the primary intra/extracellular anion/cation?

A

extracellular cation

42
Q

what does sodium do?

A

helps regulate acid-base balance, osmotic pressure, fluid distribution

43
Q

normal serum potassium levels

A

3.5 - 5 mmol/L

44
Q

potassium is the primary intra/extracellular anion/cation?

A

intracellular cation

45
Q

causes of hypokalemia

A

diuretic use, vomiting, diarrhea, eating disorders, IV administration w/o K
– potentially dangerous

46
Q

causes of hyperkalemia

A

renal failure, severe injury (burns, crushing), hypoaldosteronism, Addison’s dx
– very dangerous

47
Q

causes of hypernatremia

A

dehydration, excessive fluid loss/output

48
Q

causes of hyponatremia

A

excess Na loss from body – vomiting, diarrhea, suctioning, diuretics; H2O/fluid retention; SIADH

49
Q

chloride is the primary intra/extracellular anion/cation?

A

extracellular anion

50
Q

what is the purpose of chloride?

A

helps regulate acid-base balance, osmotic pressure, and fluid distribution

51
Q

what is the purpose of potassium?

A

helps maintain acid-base balance, fluid balance, nerve impulse transmission

52
Q

causes of hypochloremia

A

alkalosis and hypokalemia; bulemia

53
Q

causes of hyperchloremia

A

kidney disease, overactive thyroid, CVD

54
Q

phosphorous is correlated with

A

calcium

55
Q

causes of hyperphosphatemia

A

with renal failure, hypoparathyroidism, hyperthyroidism, increased phosphorus intake, use of phosphate-containing enemas, laxatives

56
Q

causes of hypophosphatemia

A

hyperparathyroidism, rickets, osteomalacia, chronic use of antacids containing alumni hydroxide of calcium carbonate
also with refeeding syndrome

Clinical Nutrition Care Applications (10 decks)

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