Nutrition Flashcards
lab Values
Nutrition
- Malnutrion Albumin Level : <3.5
- Edema: <2.7
- Normal Level: 20 to 50
-
Moderate Depletion : 10 to 15
* Severe Depletion: <10
Screen for Nutrional Anemia: Iron, B12, Folate
Lymphopnea: Nonspecific Marker, ID malnutrition
Thrombocytopenia: Lack of Vit C and Folate
Protein Requirements
- Protein Higher in aninals products followed by beans, cereals, roots
- Increase Protein: Injury or Malnutrition
*** Decreased Protein: **Renal insufficiency & Liver Failure…. b/c - Cirrhosis protein intact can lead to Encypholopathy b/c cannot convete amonia into urea
Carbohydrates
W O2 demends
Large amount 02 required for carbohydrate
* Caution in respiratory compromised
* Increase C02 (hypercapnia )
- Consider use of lipids in place of carbs
Enteric TF
Initial : 24 to 48 HRS;
Goal Rate: 48 to 72 hrs
Consult Diatary
High Risk/Aspiration: Duodenal Tube (Dophalf )
Long term : >6wks TF
Contradication : circulatory shock, Mesenteric Ischemia, Bowel obstruction or Ileus
Enterial Routes
NG: Stomach; Avoid Gastritis
ND: Duodenum; ok reflux
TPN
Hospital >7 days
post up 5 to 7 days
7 to 10 TF not meed requirements
Watch for Propofol
Water Soluble Vitamins
- B, Ascorbic Acid
- Excess Eliminated, Body does not store
- CAnnot Store, Excreate by urine , Dissorlve fast
Fat Soluble Vitamins
**A, D, E, K **
* Absorbed by fat Globules
* Travle via small Intesine
- Stores in liver and fat tissue
Vitamin A
Fat Soluble
* * **Retinol **
* Retinaldehyde: **molecular for vision **
* Retinoic Acid: Morphogenesis, growth cell differention
* Iron utilization and immunity
Vision, Iron, Morphogenesis, grown cell differention
Vitamin A Sources
2 forms found in Human food
- ** Preformed: Retinoids**
- – Found in animal-based foods such as
- liver, fish, eggs, and dairy products. **
- The most active form is retinol, which the body can readily use.
Provitamin A (Carotenoids) – Found in plant-based foods, particularly colorful
_ fruits and vegetables like **carrots, sweet potatoes, and spinach. **The most common type is beta-carotene, which the body converts into retinol as needed.
animal Based: Liver, fish, eggs, dairy products
Fruit and Vegetables car
Vitamin A
Deficiency
Chronic deficiency exacerbated by
**infection **
**Zinc Deficiency: **
Interferes with Vitamin A mobilization
- Usually due to Malobsorption, celiac disease
Vitamin A
Clinical Manifestation
Mostly kids
Vision issues
Vitamin A :
Toxicity
Increase ICP
Vertigo
Double vision
seizures
Exofiliated Dermititis
Death
Vitamin A
DX
TX
Retinol level
Vit A 15 mg PO QD x 1 month
Vitatimin C
**Ascorbic Acid **
Antioxidant Activity
Promotion of nonheme iron absorption
Conversion dopamin to norepinephrone
Vitamin C :
Source
Citrus Fruits
Green Vegetable (brokely )
Tomatoes,
Potatoes
**Vitamin C **
Cause of Deficiency
Smoking
- Hemodialysis
- Pregnancy, Lactation, stress
- Poor,
- elderaly,
- ETOH
Macrobitotic diets
Vitamin C
Deficiancy /name disease
Scurvy (which vitamin? )
- Impaired formation and mature connetive Tissue
Inflamed and bleeding - Leukopenia : WBC < 4,000 (low WBC)
- bleeding gums ; low WBC.
——————————————-
***Osterognesis Inperfecta **
brittle bones that break easily,
often with little or no trauma.
**Vitamin C **
Toxicity (too much )
Abdominal Pain, D/V
Hemolysis G6PD deficiency
Vitamin C
TX
Vitamin C 200 mg PO QD
May decrease URI
Vitamin E
other nama
Tocopherol
Vitamin E
overview
**Tocopherol **
- Designation for Stereoisomers of Tocopherols and
Tocotreinols - Chain breaking antioxidant and peroxyl radica savenger
-
Protects LDL and Polyansaturated fat oxidation
(Oxidated LDL moves rapidly to atrial wall and engorge them with cholesterol. Blocking arteries can lead MI and CVI
Vitamin E
Sources
* Sunflower oil, wheat germ, soybean, corn oils
- Meat, nuts cereal, grains, fruits, vegetables
Vitamin E
Deficiency
Only occurs in severe and prolonged malabsoption diseases
Vitamin E
Deficiency
Clinical Application (s/s )
- Peripheral neuropathy, children Areflexia can occur ( toxic gate)
- Ophthalmoplegia, skeletal myopathy & pigmented retinopathy
- Vitamin E may help prevent macular degeneration
Favorable therapeutic effects in nonalcoholic steatohepatitis (NASH)
**Vitamin E toxicity reduce **platelet aggregation & interfere w/ vitamin K metabolism (contraindications pt on coumadin and anit-Plt agents) **
Contraindication of Vitamin E
- Patient on Coumadin
- Vitamin E toxicity reduce platelet aggregation & interfere w/ vitamin K metabolism
- (contraindications pt on coumadin and anit-Plt agents)
Vitamin E
Treatment Plan
Symptomatic
Alpha-Tocopherol
800 to 1200 mg PO/d: short
Vitamin E 15mg/d for all adults
Vitamin K
Other name
Overview
**Phytonadione **
**Forms of Vitamin K **
Vitamin K 1: phylloquuinone (vegtable)
Vitamin K 2: Menaquinones (bacteria flora)
Activity blood clotting, Bone maetabolism, Calcium levels
Vitamin K
Source
Green leafy vegetables
Margarine
Liver
Vitamin K
Deficiency
- Chronic Small intestinal Disease (celiac and Crhohn’s
after small bowerl resection
Broad Spectrum Antibiotics, can precipitate Vitamin K deficiency reduction of gut bateria
Medication induced: obestiy meds (orvestatin ) can change INR
Vitamin K
Clinical Application
- Hemorrhaging
- Dx based on elevated PT or reduced clotting factors **
No toxic dietary amount - High doses impair actions of Vitamin K antagonis antigoaulants
- IF elevated PT not reduced by Vitamin K, it’s not Vitamin K deficiensy
Treatment Plan
Vitamin K
Depending on situation
Vitamin K 1 to 10 PO/IV x 1
Supratherapeutic INR and
**No bleeding **
Vitamin K 2.5 mg PO x1 for INR 4.5-10
Vitamin K 2.5-5 mg PO x1 for INR >10
Supratherapeutic INR
W/Bleeding
Vitamin K 2.5-5 mg PO x1 for minor bleeding
Vitamin K 10 mg IV x1 over 10-20 minutes for major bleeding
B 1 (other name )?
Thiamine
water soluble
B1
Thiamine
**Energy Generation **
Peripheral Nerve Conduction
BI
Sources
Yeast, organ meat, pork, Legumes, beef, whole grains, nuts
B1
Deficiency
** Result of poor dietary intake ( culture that rice base diet on tea, rice, coffee, raw fish , shelfish contain > contain . can destroy thiamine ) ***
- Westernized Counties: Alcoholism and Chronic Illness, like Cancer )
thiamin defeciency
Diseases
Beriberi wet/dry
Wernicke’s encephalopathy
Beriber wet
- Cardiovascular symptoms (CHF, cardiomagrly )
- Perippheral Neuritis
- Peripheral edema
Occurs > 3 month deficiency
Beriberi Dry
**thiamine deficiency **
Affects the legs most markedly
* Difficulties form rising from sitting postion
Wernicke’s Encephalopathy
Thiamine deficiency (Nervoous system )
Horizontal Nystagmus
Weakness of extraocular muschles
Cerebral ataxia
mental Impairment
Wernicke-Korsakofff syndrome
Memory loss
confabulatory psychosis
Lenth is unknow of psychosis
B1 Diagnosis
B1 diagososis base on
clinical presantition
laboratory
B1
Threatment Plan
- Thiamine 200 mg IV TID until further improvement in acute symptoms
*THen 10 mg QD PO
Always threat alcoholics when refeeding them to avoid Lactic Acidosis
B2 (another Nama )
Riboflavin (another name)
B2
Overview
**Riboflavin **
- Metabolism of fat, carbohydrates and protein
- Acts Respitory: coenzyems and
- electron donor
B2
Sources
**Milk
enriched breads
**cereal (most abondate )
Lean meat
fish, egges.
Brocholi, legumes
B2 Deficiency
Dietary Deficiency
B2 defecinecy
Clinical Application
**Non speicific s/s **
**Mucoutaneous lesion
**corneal vascularization
**Anemia
**Personality changes
B2 DX
urinalry Riboflavin
Erhtyrocyte glulathione reductase activity:
B2
Treatment Plan
Riboflavin 5 to 25 pO QD
B3
Anothe Name
Niacin (another name )
B3 Overview
**Niacin **
- Refers to Nicotinic and Nicotinamide
- Precursor of Nicotnamid adenine dinucleotide (NAD ad NADP (NAD) phosphate
- Play role i oxidation and reduction reactions
- DNA repair in calcium mobilizatin
B3 Sources
Beans
Milk, meat, eggs
**Cerial (LOWER) **
B3 Deficiency
Alchoholism
Vitamin 6
Tryptophan deficency (help melotonin )
B3 (Niacin )
Disease Deficiency ?
Pellagra
*** Pellagra
**B3 (Niacin ) deficiency **
Found w people eating corn base diet (china , africa, India)
- Loss of appetite, general weakness, irritability, abdominal pain, vomiting : **EArly sighns **
- Bright red glossitis and skin rash
- Pigmented and scallin (particularly areas exposed to sunlight )
- Casal’s necklace (advaced disease)
Vitamin B 3 (niacin)
Toxic level
Cause flushing starts face
and **hepatic toxicity **(most serius )
Jauncide
which Vit cause hepatic Toxicity
Jaundice
B3 Niacin
Threatment of B3 (Niacin )
- Nicotinic Acid 100 to 200 PO TID x 5 days
- **High doses for tx use tx elevated cholesterol and triglycerided levells **
Vitamin B 4
another Name
Choline (anothe name )
B4 (Choline )
overview
- Choline is a precursor of acetylcholine, phospholipids and betaine
* - Necessary cell membrane structural integrity, cholinergic neurotransmission, lipid & cholesterol metabolism
- Dietary requirement depends on status of other nutrients (foley, B12 )
B4 (Choline )
Vitamin Sources
Eggs yolks
wheat germ
organ meat and milk
B4 (Choline )
Deficiency
- TPN devoid of choline and
Heavy execise
B4 (Choline )
Clinical Application
- Deficiency leads to fatty liver & skeletal muscle damage (High CPK levels )
B4 (Choline )
Toxic levels
Hypotension,
cholinergic sweating,
diarrhea,
**salivation & **
fishy body odor
Vitamin B4 (Choline )
Treatment Plan
- Vitamin B4 550 mg/d (men) & 425 mg/d (women)
- Suggested for patients with dementia & CV disease
B5 another name
Pantothenic Acid ( another name)
B5 (Pantothenic Acid)
Overview
Panothenid
Fatty acid metabolism in synthesis of chelesterol and steroid hormones
B5 (Pantothenic Acid)
Source
- Ubiquitous in food supply
- Liver, yeast, egg yolks, whole grains, and vegetables (food )
B5 (Pantothenic Acid)
Deficiency
rare in Human subjects
cause experimenta diet
B5 (Pantothenic Acid)
Clinical application
GI disturbance, depression, muscle cramps, paresthesia, ataxia, hypoglycemia
B5 (pantothenic Acid )
Diagnosis
Low urinary vitamin levels
B6 anothe name
Pyridoxine (another name )
Vitamin 6 (pyridoxine )
Deficiency
Aloholism
Isoniazid (use tuberculosis )
Microcytic Hypochromic anemia
Hyperchomocysteinemia (cardivascular )
** if you did all work no explanation look for B6
B 7 (another name )
Biotin (another name )
B7 (Biotin )
- Biotin assist in gene expression, glucogenesis, fatty acid synthesis
- Carbon dioxide carrier
B7 (Biotin )
Deficiency
Low dietary intake
Inborne errors of metabolism
B7 (Biotin )
Clinical Application
- Depression or hallucinations, paresthesia, anorexia and/or nausea
- * Scaling, seborrheic erythematous rash
- *** Occur around eyes, nose and mouth & extremities **
B9 (another name )
Folate (B9 )
B9 (Folate )
Overview
Folate
RBC formation
Healthy cell growth and function
B9 (folate )
sources
- Dark green leafy vegetables, beans, peas, **fruits ** (banana, oranges , srawberries ) and nuts
- Synthetic form of folate is folic acid
- Essential component of prenatal vitamins
- Fortified foods
Crucial pregancy (spinal cort )
B 9 (Folate )
Deficiency
Nutritional Folate
No longer a problem in indusrialized countries
Essential component of prenatal vitamins
Fortified foods
**alchholism
B9 (folate )
clinical application
tx
**Clinical Application **
Risk for heart disease & stroke ###
Helps to control homocysteine levels
Cardiovascular complications
Cancer
Depression
Macrocytic anemia (elevated MCV )
Treatment Plan
Folate 400 mcg PO QD
