Minerals - K, Cl, Fe, Zn Flashcards
The main roles of chloride is: A. the maintenance of electrolyte balance B. stomach acid production C. Phagocytosis D. Anion exchange in RBC for bicarbonate E. A and B F. All of the above
F. all of the above
Where is chloride absorbed?
A. large intestine
B. small intestine
C. kidneys
B. Small intestine
Chloride follows sodium absorption. Does it follow the same mechanisms as sodium?
No, chloride is passively absorbed via the sodium-glucose system, whereas sodium is actively absorbed.
True or False. Chloride is the only ion that is actively secreted via cells of the GI tract?
True
Chloride excretion mainly occurs through the kidneys. What other areas of the body excretes chloride? A. Kidneys B. Skin C. GI tract D. All of the above
D. All of the above
True or False. The main sources of dietary chloride comes from sodium chloride?
True.
Food sources of chloride are... A. Eggs, meat, seafood B. Legumes, leafy greens, whole grains C. Nuts and seeds D. All of the above
A. Eggs, meat, seafood
Typical dietary consumption of chloride ranges from: A. 1000-4000mg B. 2000-8000mg C. 2500-5500mg D. None of the Above
B. 2000-8000mg
The AI for chloride is ________ and the TUL is _________?
A. 3000mg, 4500mg
B. 2300mg, 3600mg
C. 1500mg, 3000mg
B. 2300mg, 3600mg
True or False. Chloride deficiency is highly prevalent in today’s society?
False. It is very rare due to sodium chloride in many of the SAD type foods.
What is the best way to assess chloride?
A. Urine
B. Serum
C. Hair
B. Serum chloride (normal)= 101-111 mEq/L
What disease state is correlated with chloride transport dysfunction?
A. Dysphagia
B. Marfan Syndrome (connective tissue disorder)
C. Cystic Fibrosis
D. None of the above
C. Cystic Fibrosis- a dysfunction of chloride transport is prevalent in those with CF due to a mutation in a protein called cystic fibrosis transmembrane conductance regulator. Leading to thicker mucous in the lungs and airways.
Yes or No. Does cooking methods hinder absorption and availability of Chloride?
Yes. Because chloride is found mostly in the form of sodium chloride and salts are usually water soluble, some loss occurs during cooking, such as when vegetables are boiled.
True or False. Sodium does NOT need chloride to regulate hydration or cell membrane potential?
False, Sodium and chloride work together and rely on one another to regulate cell membrane potential and hydration.
What dietary approach would limit chloride consumption for certain disease states?
A. Mediterranean
B. Low-FODMAP
C. DASH
C. DASH, due to increased risk of hypertension from sodium chloride.
Chloride is one of the many components of breast milk in which stage?
A. colostrum
B. transitional milk
C. mature milk
A. colostrum
True or False. Sodium chloride does not have any negative reactions with medications and is typically well tolerated among pharmaceuticals.
False. Sodium chloride can decrease the effects of lithium (mood stabilizer), as well as tolvaptan (used to slow kidney dysfunction/disease) which can cause sodium levels to increase rapidly.
Common causes of deficiency in chloride are: A. Diuretics B. Diarrhea C. Vomiting D. All of the above
D. all of the above
Deficiency in chloride can lead to: A. Metabolic acidosis B. Metabolic alkalosis C. Hypokalemia D. B and C E. All of the above
D. B and C. Metabolic alkalosis and Hypokalemia as depletion can lead to elevated blood pH, and urinary pH change from alkali to acidic ranges, and excessive excretion of potassium.
Potassium is the predominant _________ cation.
a. intracellular
b. extracellular
a. Intracellular - Potassium is the principal cation in the fluid inside of cells, while sodium is the principal cation in the extracellular fluid. Normal body function depends on tight regulation of potassium concentrations both inside and outside of cells.
Hark, p. 78
Fill in the blank:
Potassium is necessary for the contraction of ____, ____ and ____ muscle.
(Hint: the three types of muscle tissue)
Smooth muscle, skeletal muscle and cardiac muscle
95-98% of the potassium in the body is found within _________:
a. intracellular fluid
b. serum
c. bone
d. muscle
a. intracellular fluid
Potassium is necessary for:
a. nerve impulse transmission
b. maintaining pH and electrolyte balance
c. fat metabolism
e. A & B
f. B & C
d. A & B - nerve transmission & maintaining electrolyte and pH balance
Potassium is essential for ____ balance and distribution.
a. carb
b. fat
c. protein
d. water
d. Water
Potassium is needed for the function of certain enzymes, including _____________ in ____ metabolism.
a. pyruvate kinase; carbohydrate metabolism
b. acetyl-coA carboxylase; fat metabolism
c. fructokinase; carbohydrate metabolism
d. fatty acid synthase; fat metabolism
a. pyruvate kinase; carbohydrate metabolism
The concentration differences between potassium and sodium across cell membranes create an electrochemical gradient known as the ______ ______.
Membrane potential
Membrane potential refers to the difference in charge between the inside and outside of a neuron, which is created due to the unequal distribution of ions on both sides of the cell (NOT to be confused with action potential, which is the electrical signaling that occurs within neurons).
Small changes in the level of potassium that is present outside the cells can have severe effects on the:
a. heart, nerves, muscles
b. lungs, intestines, liver
c. heart, liver, gallbladder
a. heart, nerves, muscles
Potassium is largely regulated by the ______ (organ) via the _____-_____-_____ system.
Kidneys via the renin-angiotensin-aldosterone system (RAAS). Regulation of potassium is same as sodium, just in opposite direction.
What two key hormones lead to potassium excretion?
a. anti-diuretic hormone; aldosterone
b. angiotensin I; aldosterone
c. angiotensinogen; ACE
d. ACE; angiotensin I
a. anti-diuretic hormone; aldosterone
High levels of potassium can cause release of aldosterone (by adrenals), leading to increased potassium excretion by the kidneys.
Anti-diuretic hormone (ADH) causes water, sodium and chloride reabsorption and potassium excretion.
The AI for potassium in adults 19 years old and above is:
a. 2,400 mg for men; 1,500 mg for women
b. 3,400 mg for men; 2,600 mg for women
c. 4,300 mg for men; 3,500 mg for women
d. the same for men and women
b. 3,400 mg for men; 2,600 mg for women
Hypokalemia is more commonly a result of:
a. inadequate intake
b. excess potassium losses
b. excess potassium losses - These losses can occur from vomiting, diarrhea, kidney disease, or metabolic disturbances, as well as sweat-producing exercise where potassium and electrolytes are not replenished.
(Hark, p. 78)
Rich food sources (at least 20% of DV) of potassium include:
a. Higher in animal foods - organ meats, shellfish, fish, red meat, poultry, eggs, dairy
b. Higher in plant foods - avocados, bananas, cantaloupe, honeydew melon, mango, papaya, winter squash, leafy greens, yams, prune juice
b. Higher in plant foods - avocados, bananas, cantaloupe, honeydew melon, mango, papaya, winter squash, leafy greens, yams, prune juice
Other good sources include: legumes, nuts, seeds, peanut/nut butter
Potassium decreases the urinary excretion of:
a. magnesium
b. sodium
c. calcium
d. chloride
c. calcium
True or false: Potassium toxicity is unlikely, except in patients with poor renal function or excessive supplementation.
True
Which is a sign of hypokalemia?
a. high blood pressure
b. low blood pressure
a. high blood pressure
Which medications can cause hypokalemia?
a. Thiazide diuretics and excessive laxative use
b. statins and SSRIs
c. NSAIDs and tricyclic antidepressants
a. Thiazide diuretics and excessive laxative use
Zinc balance is determined by absorption in the _____ and secretion of _______.
a. jejunum, endogenous reserves
b. jejunum, HCL
c. duodenum, pepsin
d. jejunum, pepsin
a. jejunum, endogenous reserves.
* Zinc depletion increases the efficiency of its absorption.
Zinc absorption is reduced in the presence of _______
a. copper and iron
b. oxalate
c. calcium
d. phytate and fiber
e. all of the above
e. all of the above
Zinc is distributed throughout the body, with highest levels found in the ______.
a. prostate
b. skin and brain
c. liver and pancreas
d. bone and blood
e. all of the above
e. all of the above
True or false: Zinc is a cofactor for over 100 enzymes in carbohydrate, fat, and protein metabolism?
True.
True or false: Proper wound healing, skin integrity, and immune function require zinc?
True.
Zinc is involved in:
a. Normal taste and smell
b. Sexual maturation, fertility, and reproduction
c. Cell division, growth, and repair
d. DNA and RNA synthesis, and gene regulation
e. All of the above
e. All of the above
Poor appetite, taste perception changes, anosmia (loss of smell), hair loss, skin problems, pour wound healing, impaired cell-mediated immunity, and growth retardation are all symptoms of ________ deficiency.
zinc
**The cornea (which has a high zinc concentration) can also develop edema and opacification).
Zinc toxicity, though rare, can cause:
a. Diarrhea, vomiting, dizziness, joint pain
b. diarrhea, nausea, vomiting, headache
c. nausea, joint pain, constipation
b. diarrhea, nausea, vomiting, headache
* Chronic toxicity can impair copper status and may depress immune function.
High doses of zinc have been associated with:
a. UTI
b. decreased copper absorption
c. decreased iron absorption
d. all of the above
d. all of the above
The TUL for zinc has been established at _____.
a. 100mg/day
b. 60mg/day
c. 40mg/day
d. 15mg/day
c. 40mg/day
(the RDA for men is 11mg/day, and for women is 8mg/day) .
Conditions when zinc should be supplemented:
- Malabsorption, diarrhea
- vegetarians (lower zinc absorption from plants)
- alcoholics (alcohol reduces absorption and increases excretion)
- lactating women
- chronic skin ulcers/bed sores
- children who have growth failure due to zn deficiency.
- heavy cigarette smokers
Supplementation with doses of zinc in excess of the UL is effective to reduce the duration of common cold symptoms. The use of zinc at daily doses of 50 to 180 mg for one to two weeks has not resulted in serious side effects. (More information) - NIH.
Zinc supplements should not be taken simultaneously with _____ and/or ______ supplements on an empty stomach, as these interfere with zinc absorption.
a. magnesium, iron
b. magnesium, copper
c. calcium, magnesium
d. calcium, iron
d. calcium, iron
Long term high doses of zinc can cause white patches on brittle nails, anemia, and a weakened immune system, which are all symptoms of __________ deficiency.
copper.
Long term high dose zinc can deplete copper. Doses exceeding 40mg/day may interfere with WBC function.
Zinc supplementation has been shown to significantly reduce the frequency and severity of ______ and ______ in children.
a. diarrhea, constipation
b. diarrhea, respiratory illness
c. rashes, diarrhea
b. diarrhea, respiratory illness
* Can take Zn with copper to prevent copper depletion
A combination of trace mineral supplements (zinc, copper, manganese) have been shown to be important in the maintenance of bone mass in _________ women.
a. menstruating
b. post-menopausal
c. pre-menopausal
d. menopausal
b. post-menopausal
* zinc + antioxidant support has also shown benefit for age-related macular degeneration.
True or false?
Zinc bioavailability is high in meat, eggs, and seafood, and less bioavailable from whole grains and legumes?
True. Whole grains and legumes contain phytates that inhibit absorption.
*Other food sources: oysters, wheat germ, liver, dark chocolate, roasted pumpkin seeds.
True or false? In older adults, zinc deficiency has been linked to reduced effectiveness of vaccinations?
True.
True or false?
Zinc is transported around the body bound to albumin.
True.
*Zn transporter proteins are responsible for zinc transport through cell membranes.
True or false? Zinc is likely effective for Wilson’s disease, a genetic disorder that causes copper poisoning in the body.
True.
*zinc is also helpful for: acne age-related macular degeneration anemia anorexia nervosa ADHD burns common cold dandruff depression diabetic foot ulcers diaper rash halitosis (chronic bad breath) gingivitis herpes simplex virus muscle cramps osteoporosis pressure ulcers
_______ is critical in wound healing due to its role in collagen synthesis and cell proliferation.
Zinc
In a Nutrition Focused Physical Exam the following may suggest a deficiency in what mineral?
White spots under nails (if injury has been ruled out), loss of appetite, anorexia nervosa, loss of normal taste sensation, alopecia, hyperkeratinization of the skin dermatitis, and reproductive abnormalities.
Zinc
True or false? Zinc affects DNA.
True.
Zinc is an essential component of numerous proteins involved in the defense against oxidative stress and DNA damage repair. Studies in vitro have shown that zinc depletion causes DNA damage.
Medications to watch for interactions with zinc:
a. HIV integrase inhibitors
b. Quinolone & Tetracycline antibiotics
c. H2 Blockers and PPI’s
d. Loop diuretics
e. all of the above
e. all of the above
a. Decrease zinc absorption
b. Decrease antibiotic absorption.
c. Decrease zinc absorption
d. Decrease zinc
This vitamin enhances absorption of Iron A. Vitamin B3 B. Vitamin C C. Vitamin A D. Vitamin D
b. Vitamin C
\_\_\_ and \_\_\_\_ reduce non-heme iron absorption. A. Herbs and spices B. Calcium and Vitamin C C. Phytates and Oxalates D. All of the above
C. Phytates and Oxalates
True or False:
Iron deficiency is the most common nutrient deficiency in the US and in the world
True
True or False:
Polyphenols – in tea, coffee, wine, fruits, vegetables, and spices. Tea and coffee can reduce absorption of dietary iron by 40 to 60 percent.
True
True or False:
Iron deficiency anemia leads to the production of smaller (microcytic) and lighter color (hypochromic) red blood cells
True: Insufficient iron for red blood cell formation leads to the production of smaller (microcytic) and lighter color (hypochromic) red blood cells (note/recall that heme is a pigmented compound). Signs and symptoms of insufficient oxygen delivery appear here and a number of lab values will be abnormal (red blood cell count, hemoglobin, hematocrit, and others).
The most absorbable form of iron is: A. Ferrous sulfate B. Ferrous gluconate C. Ferrous fumarate D. Ferrous bisglycinate
D. Ferrous bisglycinate
Medications that decrease stomach acid: A. Increase iron absorption B. Decrease iron absorption C. Has no effect on iron absorption D. Completely inhibits iron absorption
B. Any medication that decreases stomach acid (antacids, histamine H2 receptor antagonists, proton pump inhibitors) can impair iron absorption.
True or False:
Iron supplements should not be taken with allopurinol (for gout) as this medication may increase iron storage in the liver.
True
The current RDA for women 19+ is: A. 8mg B. 12mg C. 18mg D. 27mg
C. 18mg
The current RDA for men 19+ A. 8mg B. 10mg C. 15 mg D. 18mg
A. 8mg
The current RDA for pregnancy is: A. 18mg B. 20mg C. 25mg D. 27mg
D. 27mg
True or False:
Accidental overdose of iron is the leading cause of fatalities due to poisoning in children under six years of age.
True :(
Symptoms of overdose appear in four stages starting with nausea, vomiting, pain, lethargy, weak and rapid pulse, decreased blood pressure, difficulty breathing, and coma within one to six hours of ingestion with single or multi-organ system failure, damage to the central nervous system, liver, and stomach following in twelve hours to up to six weeks after the overdose.
True or False:
High doses of iron improves zinc absorption
False: high doses of iron with supplemental zinc can inhibit the absorption of zinc
It is advised to supplement \_\_\_\_ away from iron because it interferes with absorption A. Calcium & Vitamin E B. Vitamin C & Vitamin A C. Vitamin B1 & B3 D. None of the above
A. Calcium & Vitamin E
Calcium —decreases the absorption of both heme and non-heme iron, so supplementation of calcium is advised away from iron supplementation
Vitamin E—iron interferes with the absorption of vitamin E and its actions so it is advised to take these two nutrients separately.
There is an increased likelihood of iron deficiency when there is: A. excess energy intake B. insufficient energy intake C. Adequate energy intake D. All of the above
B. insufficient energy intake
Signs of iron deficiency include: A. Glossitis (sore tongue) B. Angular Chelitis (sores at corner of mouth) C. Spoon shaped nails D. Pica E. None of the above F. All of the above
F. All of the above
The TUL limit for iron is: A. 30mg B. 32mg C. 40mg D. 45mg
D. 45mg
True or False: Iron deficiency anemia is marked by low hemoglobin in the blood, transferrin saturation of <20, and serum ferritin of <30- all in the absence of inflammation.
True
In the case of suspected inflammation it is suggested to use high sensitivity \_\_\_\_ to help assess iron status: A. Fasting Glucose B. HgA1c C. High sensitivity C-reactive protein. D. TSH
C. High sensitivity C-reactive protein
When someone switches to a gluten-free diet, they are at a higher risk for loss dietary intake of iron, why?
While a number of whole grain products (cereal, pasta, etc.) are fortified with iron, many gluten-free grain products are not fortified with iron and this may lead to a significant loss of dietary iron intake when an individual previously relying on fortified grains for iron switches to a gluten-free diet.
Some of the best sources of iron rich foods are:
A. fortified cereals, oysters, white beans, lentils, spinach, chocolate, liver
B. Dairy, eggs, potatoes, apples, shrimp
C. Yogurt, tofu, carrots, pasta, pork
D. Onions, leeks, cashews, chicken, artichokes
A. fortified cereals, oysters, white beans, lentils, spinach, chocolate, liver
During pregnancy, ________ and red cell mass expand due to dramatic ______ in maternal red blood cell production.
A. mitochondria, decreases
B. plasma volume, increases
C. iron, increases
D. plasma volume, decreases
B. plasma volume, increases
During pregnancy, plasma volume and red cell mass expand due to dramatic increases in maternal red blood cell production [2]. As a result of this expansion and to meet the needs of the fetus and placenta, the amount of iron that women need increases during pregnancy. Iron deficiency during pregnancy increases the risk of maternal and infant mortality, premature birth, and low birthweight
https://ods.od.nih.gov/factsheets/Iron-HealthProfessional/
Full-term infants usually have sufficient iron stores and need little if any iron from external sources until they are \_\_\_\_\_\_ A. 2-3 Months old B. 4-6 Months old C. 6-8 Months old D. 8-12 Months old
B. 4-6 Months old
Breast milk contains highly bioavailable iron but in amounts that are not sufficient to meet the needs of infants older than 4 to 6 months
https://ods.od.nih.gov/factsheets/Iron-HealthProfessional/
True or False: Anemia of chronic disease is the second most common type of anemia after iron deficiency anemia.
True:
In people with anemia of chronic disease, inflammatory cytokines upregulate the hormone hepcidin. As a result, iron homeostasis is disrupted and iron is diverted from the circulation to storage sites, limiting the amount of iron available for erythropoiesis.
https://ods.od.nih.gov/factsheets/Iron-HealthProfessional/
\_\_\_\_\_\_\_\_\_\_\_\_\_\_ a disease caused by a mutation in the (HFE) gene, is associated with an excessive buildup of iron in the body A. MTHFR Mutation B. Hemochromatosis C. Sickle Cell anemia D. None of the above
B. Hemochromatosis
About 1 in 10 whites carry the most common HFE mutation (C282Y), but only 4.4 whites per 1,000 are homozygous for the mutation and have hemochromatosis [95]. The condition is much less common in other ethnic groups.
https://ods.od.nih.gov/factsheets/Iron-HealthProfessional/
Some evidence indicates that in healthy people, iron supplements ______ the absorption of levodopa (found in Sinemet® and Stalevo®), used to treat Parkinson’s disease and restless leg syndrome, possibly through chelation
A. increase
B. decrease
C. Does not have an effect
https://ods.od.nih.gov/factsheets/Iron-HealthProfessional/
The simultaneous ingestion of iron and levothyroxine can result in clinically significant ______ in levothyroxine efficacy in some patients
A. increases
B. decreases
C. does not have an effect
https://ods.od.nih.gov/factsheets/Iron-HealthProfessional/
Gastric acid plays an important role in the absorption of
_____ iron from the diet. Because proton pump inhibitors, such as lansoprazole (Prevacid®) and omeprazole (Prilosec®), _____ the acidity of stomach contents, they can reduce iron absorption
A. non-heme, reduces
b. heme, increases
c. heme, reduces
d. non-heme, increases
A. non-heme, reduces
https://ods.od.nih.gov/factsheets/Iron-HealthProfessional/
Dietary zinc may promote wound healing by which of the following mechanisms?
a. Promotes epithelial cell differentiation
b. Reduces the inflammatory response
c. Prevents oxidation of lipids in cell membranes
d. Increases collagen synthesis
d. - Dietary zinc may promote wound healing by increasing collagen synthesis at the site of the wound. Collagen synthesis is essential for tissue repair.
