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FN 3344 > Lecture 7 > Flashcards

Lecture 7 Flashcards

1
Q

What is the purpose of biochemical lab data?

A
  • Detect clinical and subclinical nutrient deficiencies
  • Collect objective and quantitative data about nutrition status
  • Evaluate tissue stores or function of a nutrient
  • Monitoring response to treatment, including medical nutrition therapy
  • Estimate risk of morbidity or mortality
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2
Q

What are the advantages of biochemical lab data?

A
  • Allow collection of subclinical nutrient deficiencies
  • Collection of objective and quantitative data about nutritional status
  • Only objective data used in assessment which are CONTROLLED FOR VALIDITY of the method of measurement
  • Can be used to test validity of dietary intake measurements
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3
Q

What is a control?

A

Each time samples are taste a specimen of known value is assayed

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4
Q

What are the limitations of biochemical lab data?

A

Altered by nutritional an non nutritional factors such as:

  • Intake of nutrients
  • Intake of non nutrients
  • Fluid status
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5
Q

How does the intake of carbs, saturated fat, alcohol and dehydration affect lab data?

A

Carb intake increase blood glucose

Fat increases blood cholesterol

Alcohol decreased blood glucose

Dehydration increases blood albumin, hemoglobin and urea

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6
Q

How are medical treatment and procedures affect lab data?

A

High dextrose dialysate fluid increases blood glucose

Physical activity decreases blood glucose and can increase or decrease Na

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7
Q

How does medication affect lab data?

A

Thiazide diuretics decrease blood K,MG and P

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8
Q

How does illness and disease affect lab data?

A

Renal failure increase blood creatinine

Infections increase blood glucose

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9
Q

What are the limitations to substances altered by nutrition and nonnutritioall factors?

A

Many factors can confound the interpretation of biochemical lab measurements

  • confounding factors
  • inverse relationship between CRP and albumin

Biochemical Assay methods/techniques vary

Many test are not specific

Reference values difference between labs

Reference values different based on sex, age and physiological state

Technical problems in. sample collection or performing test

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10
Q

What is the best test to measure biochemical lab data?

A

There is no single test, index for group of tests by itself is sufficient to evaluate and monitor nutritional status or more a diagnosis of nutrient deficiency

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11
Q

When using lab data what should you be cautious about using?

A

Single isolated lab test values to make a diagnosis

  • reviewing all lab data is recommended
  • Look at direction and speed of change
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12
Q

what happens if you lab data seems to be off in a value?

A

Retake it immediately

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13
Q

What is a summary of confounding factors for biochemical lab data?

A 
Tight homeostatic regulation
Diurnal variation
Sample Contamination 
Physiological state 
Infection
Hormonal Status
Physical exercise
Age, sex, ethnic group
Accuracy and precision of method
Drugs
Recent Dietary intake
Hemolysis
Disease state
Nutrient interactions
Inflammaroty stress
Weight loss
Sampling and collection procedures
Sensitivity and specificity
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14
Q

In lab data what are the common sources/specimen types?

A 
Whole blood
Urine
Blood Cells/White blood cells
Plasma
Serum
Feces
Hair
Saliva
Breast Milk
Sweat
Nails adipose tissue
Organ biopsy
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15
Q

How is whole blood collected and what are the characteristics of it?

A

With and anticoagulant (EDTA, Heparin)

  • readily accessibly
  • relatively noninvasive
  • easily analyzed
  • affected by acute changes
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16
Q

What is urine used to examine?

A

Excreted minerals
Water soluble vitamins (B&C)
Protein

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17
Q

What are the conditions that need to be met for Urine samples to be used?

A

Requires complete 24hr collection
Renal function normal
Affected by acute changes

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18
Q

How are blood cells obtained?

A

Separated from anti-coagulated whole blood to get erythrocytes

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19
Q

What is the foes-an of erythrocytes?

A

120 days

  • good measure of chronic nutrient status
  • depending on nutrition abc may only contain a small % of the total body nutrient content
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20
Q

What is the lifespan of white blood cells?

A

13-20 days

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21
Q

what are the 3 kinds of leukocytes?

A

Lymphocytes
Monocytes
Neutrophils

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22
Q

How are leukocytes elevated?

A

Infection

Stress response

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23
Q

How is plasma obtained?

A

Uncoagulated fluid that bathes blood cells

Fluid (with EDTA/heparin) collected aft blood cells a have been removed or separated by centrifuge

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24
Q

How is serum obtained?

A

Flui (w/o fibrinogen) remaining after whole blood has coagulated

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25
Q

What do both plasma and serum measure?

A

Acute changes, reflecting recent intake (fasting sample)

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26
Q

What are the confounders for both plasma and serum?

A 
Recent meal
Diurnal variation
Homeostatic regulation
Medications
Infection 
Inflammation
Stress
Sample Contamination
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27
Q

What do we look at when collecting a fece sample?

A

Fecal fat test for fat soluble vitamins
Colour
Frequency
Constipation vs diarrhea

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28
Q

What is Steatorrhea?

A

Risk of fat soluble vitamin deficiencies

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29
Q

What are the different colours a fecal sample can be?

A

Bloody Red/ Black= GI bleed or fe deficiency

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30
Q

Why is hair used as a specimen?

A

Used for screening population groups and individuals for trace element deficiencies and exposure to heavy metals

Retrospective (chronic index of trace element status during period of hair growth)

Non invasive

Trace elements are more concentrated and stable in hair

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31
Q

How are hair specimens confounded?

A

Exogenous contaminants such as:

  • Atmospheric pollutants
  • Water
  • Sweat
  • Beauty treatments
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32
Q

What are the 2 main types of test available for assessing nutritional status?

A

Static

Functional

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33
Q

What is a static test?

A

Based on measurement of nutrient or its metal elite in blood, urine, or body tissue

  • Serum [Albumin]
  • readily available
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34
Q

What is the downfall of the static test?

A

Often fail to reflect overall nutrient statues of individual or whether the body as a whole is in a s Tate of nutrient depletion or excess
-serum [Ca]

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35
Q

What is a functional test?

A

Measure of body function based on the idea that the. final outcome of a nutrient deficiency and its biological importance are due to failure of one ore more physiological processes relying on that nutrient for optimal performance

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36
Q

What are examples of functional tests?

A

Enzyme activity measurement

Impairment of immune status due to PEM and nutrient deficiencies

Measurement of Abnormal metabolite excreted in urine

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37
Q

What are the limitations of functional tests?

A

Some are non specific
Not used as much as static

May indicate general nutritional status but not allow identification of specific nutrient deficiencies

  • Ex: Hb=function measure of Fe status
  • Hb=anemia but altered b12 and Folate can also lead to decrease Hb
  • Functional marker but not specific
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38
Q

How do you assess protein status?

A

Uses a 2 compartment model which counsitis of the metabolically available protein
-Somatic and Visceral Protein

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39
Q

What is Somatic protein?

A

75% of the body cell mass

Found in Skeletal muscle

Serum creatinine reflective of NMM (for normal renal function

Homogeneous

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40
Q

What is Visceral Protein?

A

25% of the body cell mass

Found within organs of viscera of the body liver, the RBS and WBCs and serum proteins

Heterogenous (100’s of different proteins)

Increase Createnin, increased BUN (blood urine nitrogen) and decreased u/o= Renal failure

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41
Q

How do you assess Somatic protein status?

A

24hr urinary creatinine excretion

  • Urinary creatinine is a product of skeletal muscle
  • excreted in a fairly constant proportion to the muscle mass in the body
  • Readily measured in the clinical lab
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42
Q

What is the excretion when measuring somatic protein status?

A

Each gram of creatinine exerted represents 18-20kg of LMM (not controlled for age, sex, physical training, metabolic state, recent diet)

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43
Q

What should be eliminated from the diet when doing a 24hr urine sample?

A

Meat because not will imact the accuracy of urinary creatinine

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44
Q

Whatare factors that affect daily creatinine excretion?

A

Diurnal and day to day variation (4-8%)
Strenuous exercise (increase 5-10%)
Dietary intakes of creatinine (increase with meat and other protein sources)
Age (decreases as you get older)
Infection/fever/trauma( increase excretion with stress response)
Chronic renal failure (decrease due to inadequate clearance)

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45
Q

What is the equation for estimation of protein status

A

24hr urine creatinine(mg)x100/(expected 24hr urine creatinine (mg)

46
Q

How do you interpret the results of the estimation of protein status?

A

60-80%- mild protein depletion

40-60%- Moderate protein depletion

Less than 40%- Severe protein depletion

47
Q

What is the equation for estimating protein status: Nitrogen Balance?

A

[Protein intake (g/24hr)/6.25gN/gprotein]-[Urinary Urea Nitrogen(g/24hrs)+4]

48
Q

In the nitrogen balance equation what does the 4 stand for?

A

Accounts for losses in dermal and fecal Nitrogen losses and non-urea Nitrogen components of urine

  • which are ammonia, uric acid, creatinine
  • normal renal and hepatic function (need this to do test)
49
Q

How do you interpret the results from the nitrogen equation?

A

Intake>loss=Anabolism
-+Nbalance

Intake

50
Q

When do we see a +NBalance?

A

During growth
Late pregnancy
recovery from illness
In athletic training

51
Q

When do we see -Nbalance?

A

Inadequate protein and or energy intake
Imbalance in EAA:NEAA
Catabolic states (trauma, infection, sepsis burns)
Excessive protein loss burns. excessive diarrhea)

52
Q

In terms of N, what should we do to monitor the effectiveness of nutritional therapy?

A

An estimate of the change in N balance rather than a single measurement is preferred

53
Q

How do you measure visceral protein status?

A

serum proteins

  • measure is considered simple and accurate
  • Liver site of synthesis (liver failure=decreased albumin)
  • Many confounding factors
  • Low sensitivity and specificity
54
Q

When measuring visceral protein status, which marker can we use?

A

Serum albumin (main protein in serum)

  • Made by liver
  • poor prognostic associated with [low]
55
Q

What are the interpretation ranges for Sarum albumin?

A

30-35g/l= Mild deficit
24-29g/l= Moderate deficit
Less than 24= Severe deficit

56
Q

What is the half life of serum albumin?

A

14-20 days

-not sensitive to acute nutritional changes

57
Q

What kind of body pool does serum albumin has?

A

Large 3-5g/kgBW

58
Q

What does serum albumin reflect in the body?

A

Changes in intra-vascular space, however ext5ra vascular space will supply to intra scalar space during deficiency
-Serum Albumin may increase ins semi starvation (Anorexia)

59
Q

What will serum albumin increase with?

A

Dehydration

60
Q

What will swum albumin decrease with?

A 
Low protein intake
Over hydration
Malabsorption
Acute catabolic states/infection
Chronic losses
Agining
Edema
Disease
Poor synthesis
-overall poor specificity to nutritional status
61
Q

What is serum transferrin used for?

A

Biochemical measure of visceral protein status

62
Q

What does serum transferrin do?

A

Binds and transports Fe (concentration increases in Fe deficiency)
-made by liver

63
Q

What is the half life of serum transferrin?

A

8-10 days

-better sensitivity than serum albumin

64
Q

Serum transferrin is bacteriostatic, what does that mean?

A

Prevents bacteria from reproducing

-Renders Fe unavailable to bacteria

65
Q

What kind of body pool does serum transferrin have?

A

Small body pool

Less than 100mg/kgBW

66
Q

What does serum transferrin increase with?

A

Fe deficiency
Pregnancy
Estrogen Tx

67
Q

What does serum transferrin decrease with?

A 
Acute catabolic states
Chronic infection
PEM
Some disease states:
-diseases of liver decreases synthesis
-diseases of kidney, heart and GI
68
Q

How can we assess health status off serum transferrin? (ranges)

A

1.5-2g/l= Mild deficit
1-1.5g/l= Moderates deficit
Less than 1 g/l= Severe deficit

69
Q

What is thyroxine binding prealbumin used to measure?

A

Biochemical measure of visceral protein status

  • thyroxine transport protein
  • retinol binding protein (carrier protein)
70
Q

What is the half life of thyroxine binding prealbumin?

A

2-3 days

-more sensitive to acute nutritional changes than albumin

71
Q

What is the other name for thyroxine binding prealbumin?

A

Transthyretin

-not a precursor to albumin

72
Q

Where is thyroxine binding prealbumin made and what is the body pool?

A

Liver

Small pool 10mg/kgBW

73
Q

What re the ranges for interpreting thyroxine binding prealbumin levels?

A

1-1.5g/l= Mild deficit
0.5-1g/l= Moderate
Less than 0.5= severe deficit

74
Q

What does thyroxine binding prealbumin increase with?

A

Renal disease (chronic kidney disease)

Hodgkins disease

75
Q

What does thyroxine binding prealbumin decrease with?

A 
Liver disease/damage decreases synthesis
Malabsorption/malnutriiton
Chronic losses
Hyperthyroidism
Acute catabolic states
76
Q

What is C-reactive protein?

A

Produced by liver in repose to inflammation

-inflammartory cytokines (interleukin-6)

77
Q

When do we see increased serum [C-reactive protein]?

A

In acute or chronic clinical stress

  • abdominal obesity, atherosclerosis
  • Acute pancreatitis
  • Cancer
  • Sepsi
78
Q

What is BUN?

A

Urea is the end product of protein metabolism and the primary method of N excretion
-ammonia converted to urea by liver and excreted by kidney in urine

79
Q

When do we see a decrease in BUN?

A

PEM
Liver disease
Overhydration
Anabolic Steroid use

80
Q

When do we see increases in BUN?

A

Renal failure
Dehydration
GI bleed
High protein intake

81
Q

What is Azotemia?

A

When you have elevated Urea

82
Q

What is renal failure the result of?

A

Serum creatinine increases (low urine creatinine)

Serum urea increases (low urine urea)

83
Q

In renal failure what happens the ruin output decreases, retaining or remains adequate?

A

Decreases

  • anuric= no ruin or oliguric=~500ml
  • would need to increase K,Mg, P

Retaining
-decrease in serum Na (due to fluid overload)

Remains adequate

  • K,Mg,P and Na may remain low
  • Creatinine and Urea remain elevated
84
Q

What does renal failure cause when looking at the skin?

A

Pedal pitting edema

  • due to loss of electrolytes through urine via kidney
  • don’t have u/o (anuric)
  • increase in K, Mg and PO4
85
Q

Whats phosphors’s role in the body?

A 
Structural components 
Enzyme cofactor
Energy metabolism
Component of cell membranes
-controlled by parathyroid
86
Q

Where do we find Phosphorus in the body?

A

Bones 80-85%
Muscles 14%
Extracellular Fluids 1%

87
Q

What is the serum concretion of phosphorus?

A

Inorganic phosphorus
Does not reflect total body status
Closely related to serum [Ca]

88
Q

What does Phosphorus increase with?

A 
Hypoparathyroidism
Hyperthryroidism
Acidosis
Hypocalcemia
Renal failure
Excess use of laxatives and enemas containing phosphate

-Ca binds P in the GI

89
Q

What does Phosphorus decrease with?

A 
Alcoholism
Hypokalemia
Hemodialysis
Hyperparathyroidism
Rickets
Osteomalacia
Refeeding Synfrome 
Excess use of antacids

-binds P in GI and decreases absorption

90
Q

Whats Magnesiums role in thee body?

A

Catalyst in metabolic pathways

91
Q

Where do you find magnesium in the body?

A

Bones 60%
Muscles 25%
Extracellular fluids less than 1%
Other tissues 10%

92
Q

What does magnesium increase with?

A

Some renal disease
Dehydration
Hypothyroidism

-High GI losses decreased K, Mg PO4 Na

93
Q

What does Magnesium decrease with?

A 
Malabsorption
Alcoholism
Burns
Emesis
antibiotics
Diuretics
POancreatitis
Some renal Disease
Liver disease
94
Q

What is potassiums role in the body?

A

Major intracellular cation
Acid base balance
Body fluid Balance
Nerve impuse transmission

95
Q

Where do you find potassium in the body?

A

Muscles 80%

Extracellular fluids 10-20%

96
Q

What happens when you have an increase in potassium?

A

results in hyperkalemia

-danger of heart problems because too much K in blood

97
Q

What increases potassium?

A 
Acidosis
Renal failure
Hemolysis
Addisons disease
Severe burns
Crushing injuries
Some Meds
98
Q

What does potassium decrease with?

A 
Diarrhea
Vomiting
Diuretics
Alcoholism
Alkalosis (increase blood pH)
Bulimia
Some meds
99
Q

What is sodiums role in the body?

A

MAJOR extracellular cation

Maintenance of fluid balance and acid base rxns

100
Q

Where is sodium found int he body?

A

Extracellular fluids 80%

Bones 20%

101
Q

What is Serum [Na] sensitive too?

A

Na intake
Na excretion
Fkuid metabolism

102
Q

What happens when you have an increase in Na?

A

Hypernatremia

-increase Na in the blood

103
Q

What increases Na?

A

Dehydration
renal disease
Aldostreonism
-increase Na reabsorption in the distal renal tubule

104
Q

What does Na decrease with?

A 
Diarrhea
Vomitting
Diuretics Gastric Suctioning
Congestive heart failure
Edema
105
Q

What does hepatic failure increase in?

A

Liver function tests

  • AST aspartate transaminase
  • ALT alanine tranaminase
  • Alk Phos
  • GGT
  • Bilirubin

Clotting factors

  • INR
  • PPT

Ammonia

106
Q

What does hepatic failure decrease in?

A

Albumin

Transferring

107
Q

What is Hepatic encephalopathy?

A

Confusion with an altered level of consciousness and possibly leading to coma and death
-accumulation of took substances (ammonia) in blood which is normally removed by the liver

108
Q

What is ascites?

A

Accumulation of protein containing fluid in the peritoneal cavity seen in liver failure

109
Q

What is muscle wasting?

A

Loss of protein synthesis (somatic proteins)

110
Q

When you have hepatic failure what side effects fo you usually see in the later stages of liver disease?

A

GI bleeds
-Coagulopathic (high PPT) due to decreased clotting factors made by liver

Jaundice
-Conjunctival membranes over sclera caused by hyperbilirubinemia

FN 3344 (13 decks)

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