nutrition Flashcards
what is the function of electrolytes
-maintain electrical neutrality and conduct action potentials in nerves and muscles
-help move nutrients into body cells and move waste out of the body
-maintain a healthy water balance
-help stabilize the the bodies’ acid/base pH
what is the function of Na
-main extracellular ion
-maintains fluid balance
-plays a major role in action potential of nerve and muscle cells
*regulation: RAAS causes Na reabsorption
natriuretic hormone causes Na excretion
135-145 mmol/L
what are the signs and causes of hyponatremia
causes: low Na intake, vomiting, diarrhea, SIADH, diuretics, renal and liver disease
signs: seizures, come, vomitng, headache, respiratory arrest
what are the causes and signs of hypernatremia
-unreplaced fliud loss via skin
-fluid loss via GI tract
-hypertonic saline administration
-hypertonic tube feeding
-OTC meds with lots of salt
signs: dehydration, tachycardia, disorientation,
what is the function of K
-intracellular
-3.5-5.3
-maintain cell function
-Na K ATPase (pumps K into the cell)
-regulates heart and muscle contraction
*regulation: insulin and beta 2 agonists shift K into cells
-stimulation of alpha adrenoceptors release K from cells
what are the causes and signs of hypokalemia
- hyperaldosteronism (thiazide/loop diuretcis, heart failure, cirrhosis)
-K moves into cells (beta agonists, metabolic alkalosis)
signs: bradycardia, low BG, fainting, muscle weakness
what are the causes and signs of hyperkalemia
-kidney disease
-crush injury
-drugs (ACEi, angiotensin agonists, potassium sparing diuretics, aldosterone blockers)
-metabolic acidosis
-signs: bradycardis, low BG, respiratory failure, diarrhea
what is the function of calcium
-help release hormones and neutransmiters
-muscle contraction, enzyme activity, nerve function, blood clotting, cell division,
-most calcium is incorporated in bones
-10% is complexed with phosphate and citrate and the remainder is bound to albumin
-levels controlled by PTH and Vit D
-2.2-2.6
what are the causes and signs of hypocalcemia
-low PTH or Vit D
-sepsis
-alcoholism
-acute pancreatitis
signs: spasms, seizures, anxious, dermatitis, impetigo, cardiomyopathy
what are the causes and signs of hypercalcemia
-Vit D overdose
-hyperparathyroidism
-malignancy
-carcinoma of lung
-chronic kidney disease
sign: kidney stones, dehydration, constipation, bone pain
what is the function of phosphate
-anion located in bone
-strength and rigidity to bone and teeth
-energy production (component of ATP)
-Cellular signaling (activation of enzymes and regulation of gene expression)
-acts as a buffer for hydrogen
what are the causes and signs of hyposphatemia
-nutritional deficiency
-meds (antacids, diuretics, chemotherapy)
-alcoholism
-hormonal imbalances (hyperparathyroidism, growth hormone deficiency)
-malabsorption syndromes (chrohn’s disease)
-respiratory alkalosis
signs: constipation, muscle weakness, bone pain, respiratory and cardiac issues
what are the causes and signs of hyperphosphatemia
-hypoparathyroidism
-hypothyroidism
-excessive phosphate intake
-meds that contain phosphate
-tumor lysis syndrome
-signs: calcium imbalances, renal complications, boe and joint issues, cardiovascular complications, neuromascular abnormalities
what is the function of Mg
-intracellular cation that acts as a cofactor in enzymatic reactions
-involved in ATP metabolism
-involved in neurological functioning and neurotransmitter release
-muscle contraction (Mg makes Ca uptake by sarcoplasmic reticulum)
-DNA and RNA stability
causes and signs of hypomagnesemia
-inadequate intake
-malabsorption disorder
-alcoholism
-diuretics and PPIs
signs: muscles and nerves more excitable
-abnormal eye movement
-seizures
-abnormal heart rhythm
what are the causes and signs of
-excessive Mg intake
-Mg containing medications
-hypothyroidism
-kidney dysfunction
signs: nausea and vomiting
weakness, hypotension, confusion, respiratory depression, abnormal heart rhythm
what is the physiology of fluid overload
-ascites (peritoneal cavity fills with fluid)
-pleural effusion (lungs)
-pericardial effusion
-joint effusion
treatment: draining and furesomide
what are the symptoms of fluid overload
-tachycardia
-hypertension
-wet mucous membrane
-warm oedematous skin
-increased peripheral and pulmonary oedema
-weigh gain
how to assess if patient is hypo or hypervolimic
-fluid balance (fluid hey drink and excrete)
-blood pressure, heart rate
-capillary refill time
-NEWS score
-passive leg raising (if it fixes blood pressure, it’s a fluid issue)
-serum electrolytes
what are the resuscitation steps
-isotonic fluids: 500ml over 15 minutes, repeat up to 4 times
-use crystalloids that contain sodium in range 130-154
-consider human albumin solution only in severe sepsis
what are the routine maintenance steps
-25-30ml/kg/day of water
-1 ml/kg/day of K, Na, Cl
-50-100g/day of glucose
-give less fluids to older patients, cardiac failure or renal impairment
-re-assess daily
what is the treatment of hyperkalemia
-calcium gluconate: reduce arrythmias by antagonizing 30ml over 5 minutes (protect cardiac myocytes)
- rapid acting insulin (10 units in 50ml of 50% over 15 minutes)
-salbutamol 10-20mg to be nebulised
-sodium zirconium cyclosilicate 10mg PO
what is the composition of TPN
-Dextrose (D-glucose)
-lipids (soybean, glycerol and egg phospholipid)
-proteins (aminosin, travasol, novamine, heptamine)
L-amino acids and glitamic acid (no glumate)
-electrolytes (Mg, K, Ca, Cl, Na)
-phosphate
-vitamins
-Zinc (co-factor for enzymes), copper (iron transporter), magnese (activator of enzymes), chromium (net function)
what are the challenges of PN
-solubility
-stability (sedimentation, coalescencse, flocculation
-osmolarity (limited- in PPN large amounts of nutrients can cause inflammation and thrombosis)-CPN there’s higher flow rate so TPN is diluted rapidly
peripheral,<900, central: 1500-2800
-multi-chamber bags
-sterility
