Micronutrients Flashcards
What micronutrient should you consider supplementing?
- Recurrent or prolonged N/V (>2 weeks),
- rapid weight loss (>1#/day),
- and/or prolonged poor PO intake
Supplement thiamin
(Ideally, 100-250mg via IV)
Check the following labs: Cheilosis, stomatitis, glossitis
- Vitamin B12
- Vitamin C
- Vitamin B2 (riboflavin)
- Vitamin B6
- Zinc
Check the following labs: Skin disorders/dermatitis/rashes
- Niacin
- Vitamin A
- Vitamin B2 (riboflavin)
- Vitamin B6
- Zinc
Check the following labs: Neuropathy, myelopathy, gait disturbance
- Copper
- Vitamin E
- Vitamin B1 (thiamin)
- Vitamin B12
- Vitamin B6
- Niacin
Check the following labs: Vision changes
- Vitamin A
- Vitamin E
- Copper
- Thiamin
Commonly affected nutrients in IBD
Vit A
Vit C
Vit D
Vit B12 (terminal ileum resection)
Calcium, magnesium, iron
Zinc & selenium - significant diarrhea
Vitamin C deficiency sx
Arthritis
Fatigue
Skin findings (rash, hyperpigmentation)
Easy bruising
Poor wound healing
Gingivitis
Perifollicular findings (hemorrhage, folliculitis)
Alopecia
Mechanisms of malabsorption in SBS
1- acid hypersecretion, which inactivates panc enzymes = maldigestion & malabsorption
2- rapid intestinal transit
3- loss of SB surface area (magnesium absorbed in ileum, difficult to maintain)
4- bacterial overgrowth (loss of ileocecal valve, decreased pH, sluggish peristalsis)
5- bile acid wasting (absorbed in terminal ileum)
Acute pancreatitis – NG vs NI feeds
Trial gastric feeds before going to SB feeds
Nutrients affected by chronic pancreatitis
Vit B12
Fat soluble vitamins (ADEK) – malabs
Vit A, Vit E, selenium, lycopene, xanthine, beta carotene – lower levels of antioxidants
What mineral to monitor closely in acute pancreatitis
Calcium – esp in ICU
MN affected by alcoholism
- Thiamine
- Folate
- Niacin
- Magnesium
- Zinc
- Selenium
- Vitamin B6
- Vitamin B12
- Vitamin A
Severe liver disease & pancreatic and/or SB involvement
Steatorrhea
Impaired abs of ADEK
Impaired hepatic metabolism/storage
- AA
- CHO
- Fats
- Folate
- Vit D
- Vit B6
- Vit B12
Vitamin A deficiency symptoms
Night blindness
Acne
Vitamin D deficiency symptoms
Fatigue
Muscle pain
Lower extremity muscle weakness
Vitamin B12 deficiency symptoms
LE numbness
Sensory loss
Loss of taste
Glossitis
Zinc deficiency symptoms
Frontal hair loss
Dermatitis
Altered taste
Bile drainage results in what nutrient alteration?
Copper loss increased
Fat-soluble vitamins may be malabsorbed
Why are Vitamin D and Vitamin K impacted by liver failure?
Ability to activate Vitamin D is decreased
Vitamin K level decreased
Ostomy loss / diarrhea
Zinc loss increased
What nutrients are affected in Renal failure?
Altered metabolism - Vit D, phosphorous, calcium
Decreased - iron d/t depressed erythropoietin
Increased - Vitamin A
Decreased excretion - magnesium, zinc
Decreased zinc level in dialysis pts
Steatorrhea
ADEK decreased
Calcium level decreased
When is fluid restriction indicated?
When hyponatremia and fluid overload are present
When is sodium restriction indicated?
When fluid retention is severe
When should you switch to a cyclic TF schedule?
PO intakes meet 50% of pt’s EEN
Acute thiamin deficiency
Lactic acidosis with urinary electrolyte losses
May be clinically recognized by:
- hypotension
- AMS
- kussmaul’s respiration
What should be carefully evaluated in patients receiving thiazide diuretics?
Calcium supplementation
Reduces renal calcium excretion, which leaves soft tissues and blood vessel walls as alternate sites for deposition
Which bronchodilator decreases serum thiamin?
Theophylline
