MNT 2 FOR THE SECOND FUCKING TIME!!! Flashcards
Nitrogen Balance
Only biochemical measurement that reflects both somatic & visceral protein – Positive: indicative of N retention or anabolism ( growing children, pregnant women and adults who are adding mass or recovering from injury or illness) – Negative: indicative of N loss or catabolism (starvation, PCM) – Zero balance is indicative of equilibrium (healthy adults) Not a measure of protein anabolism or catabolism Difficult due to 24 hr. urine collection unless the patient has a catheter Changes in kidney function due to inflammation Nitrogen balance= (Grams protein ingested) –(urinary urea nitrogen + 4) 6.25
negative acute phase respondant
albumin, Half life: 18-21 days
transferrin, Half life 8-10 days
prealbumin (transthyretin),Half life 2 days
retinol-binding protein Half life 12 hours,
decrease during the acute-phase response
positive acute phase respondant
C-reactive protein, ct-1 antichymotrypsin, ctt-anritrysin, haptoglobins, ceru- loplasmin, serum amyloid A, fibrinogen, ferritin, comple- ment componentsC3 and C4, and orosomucoid,increase to varying degrees
how to identify Respiratory or Metabolic Acidosis or Alkalosis
Metabolic: changes in bicarbonate level Respiratory: changes in dissolved PCO2 level Alkalosis - high ph Acidosis - low ph Respiratory Acidosis -↑ H2CO3 level from retention of CO2 Respiratory Alkalosis - ↓ H2CO3 level from excessive expiration of CO2 and H2O Metabolic Acidosis - ↑ H+ (↓pH) concentration from increased production, increased ingestion, or increased retention OR ↓ HCO- 3 from extracellular fluid Metabolic Alkalosis - ↓ H+ (↓pH) concentration from increased losses OR ↑ HCO- 3 from abnormal retention of base in extracellular fluid Metabolic Acidosis: increased generation of accumulated acids (diabetes ketoacidosis, lactic acidosis) or bicarbonate losses from the kidneys or GI tract Alkalosis: administration or accumulation of bicarbonate, excessive acid loss (nasogastric suctioning), or loss of ECF as from diuretics Respiratory Acidosis: decreased ventilation and consequent CO2 retention, as in sleep apnea, asthma, aspiration of foreign object, COPD, and ARDS Alkalosis: increased ventilation and elimination of CO2, as in head injury, CHF, pneumonia, and hypoxemia
What is the regular blood PH?
7.35–7.45
What organs controlled the acid-base?
kidney,lungs
How many mg of sodium a tsp of salt contains
1 tsp. has 6 gm of NaCl and only has 2.4
gm of Na
What labs are included in a CBC panel?
Redbloodcells Hemoglobin concentrafon Hematocrit Mean cell volume (MCV) Mean cell hemoglobin (MCII) Mean cell hemoglobin concenuauon (MCHC) White blood cell count flArBC) Differential
What are static vs functional tests?
Static assays measure the actual level of nutrient in the specimen. Examples of this kind of assay include serum iron, white blood cell ascorbic acid, and hair zinc.
Functional assays quantitatively measure a biochemical or physiologic activity that depends on the nutrient of interest
What are the major cation and anion intracellular and extracellular?
ICF - Potassium
ECF - Sodium
Define intracellular, extracellular and interstitial fluids
Intracellular water (ICW) is the water contained within cells and accounts for two thirds of total body water. Extracellular water is commonly estimated to account for one third of total body water or 20”/” of body weight, and includes the water in plasma,ly-ph, spinal fluid, and secretions.Extra’ cellular fluid is the water and dissolved substancesin the plasma, lyrnph, spinal fluid, and secretions and also includes the intercellular(interstitial)water between and around the cells.
What is the blood osmolarity?
The size and number of the nutrient particles in a liter of
solution define its osmolarity. General-purpose formulas
have osmolarities between 300 and 500 mOsm, which is close to the osmolarity of blood and body fluids. Osmolarities of concentrated formulas are higher, ranging from 400
to 700 mOsm. Osmolality is stated as the the number of milliosmoles of solute (particles)per kilogram of solvent,and is usually not used to define the concentration of a formula.
What is insensible or sensible water?
insensible water loss unmeasured water loss(e.g.,when water exits with air expired from the lungs or water vapor evaporates from the skin’s surface)
sensible water loss water that is lost from urine,feces e, m- esisand gastric suction in
values for normal serum sodium
136–145 mEq/L
If sodium is decreased or increased what will suggest
Sodium balance is regulated in part by aldosterone, a mineralocorticoid secreted by the adrenal cortex. When blood sodium levels rise, the thirst receptors in the hypo- thalamus stimulate the thirst sensation. Ingestion of fluids returns sodium levels to normal. Under certain circum- stancessodium and fluid regulation can be disrupted, result- ing in abnormal blood sodium levels. The slmdrome of in- appropriate antidiuretic hormone secrerion (SIADFI) is characterized by concentrated,low-volume urine anddilutional hlponatremia aswater is retained. SIADH can result from central nervous system disorders, pulmonary disor- ders, tumors, and certain medications.
Estrogen, which is slighdy similar to aldosterone, also causessodium and lrater retention. Chanees in water and sodium balance during the menstrual cyc-le,during preg- nancy, and while taking oral contraceptives are partially at- tributable to changesin progesterone and estrogen levels.
What are the lab tests that we can use to evaluate hydration status?
serum sodium,blood urea nitrogen,serum osmolality,and urine specific gravity, hypervolemia BUN, hematocrit.
how to calculate fluids for males and females
3.7L (125oz)for males and 2.7L (91oz)for female
Excess anti-diuretic hormone causes
central nervous system disorders, pulmonary disor- ders, tumors, and certain medications.
how to identify iron, folate, vit B12 and chronic disease anemia and their names
Iron-Deficiency Anemia
Characterized by the production of small
(microcytic) erythrocytes and diminished
level of circulating hemoglobin
Last stage of iron deficiency
Represents the end point of a long period
of iron deprivation
Megaloblastic Anemias
Disturbed synthesis of DNA resulting in
morphologic and functional changes in
erythrocytes, leukocytes, and platelets in
the blood and bone marrow
Usually caused by folic acid or vitamin B12
deficiency or both
Pernicious Anemia
A macrocytic, megaloblastic anemia
caused by a deficiency of vitamin B12,
secondary to lack of intrinsic factor (IF) or
other causes
Affects GI tract and peripheral and central
nervous systems
Associated with Helicobacter pylori
infection
Folic Acid Deficiency
Tropical sprue; pregnancy; infants born to
deficient mothers
Effect on neural tube defects
Prolonged inadequate diet, faulty
absorption and utilization, increased
requirements because of growth
Gluten-induced enteropathy
Medications (e.g., anticonvulsants)
Sideroblastic Anemia
Microcytic, hypochromic form
Inherited defect of heme synthesis enzyme
Buildup of immature sideroblasts; hence
the name
B6
is essential; must replace 25 to 100
times the RDA; may need lifelong
replacement
Hemolytic Anemia
Oxidative damage to cells; lysis occurs
Vitamin E is an antioxidant that seems to
be protective
This anemia can occur in newborns,
especially preemies
What is the role of hydrochloric acid for absorption of vit B12? What is the vit B12 site of
absorption.
HCL activates pepsinogen intrinsic factor to bind to b12 and in the illeum
What are the major characteristics of Sickle cell and Sideroblastic anemia
Sickle Cell Anemia
Chronic hemolytic inherited anemia
Affects one in 600 African Americans
Results in defective hemoglobin synthesis
Episodes of severe pain resulting from
occlusion of small blood vessels
Causes impaired liver and renal function
Important to differentiate from irondeficiency anemia
Sideroblastic Anemia
Microcytic, hypochromic form
Inherited defect of heme synthesis enzyme
Buildup of immature sideroblasts; hence
the name
B6
is essential; must replace 25 to 100
times the RDA; may need lifelong
replacement
What nutrient is related to hemolytic anemia?
vit e
What is MCV? How is it affected by various deficiencies?
Mean Cell Volume - Decreased(microcytic) in presence of iron deficienry,thalassemia trait and chronic renal failure, anemiaof chronic disease; increased(macrocytic)in presenceof vitamin B12or folate deficienryandgeneticdefectsin DNA slmthesis;neither microcytosisnor macrocytosissensitiveto marginal nutrient deficiencies
MNT for nutritional anemias (recommendations, good sources, etc.)
Medical Management and MNT
for Folate Deficiency
Care not to administer folate alone if
vitamin B12 deficiency is present
1 mg/day of oral folate for 2 to 3 weeks
Eat at least one fresh, uncooked fruit or
vegetable or drink 1 glass of fruit juice daily
Fortified foods
