Nutrition Flashcards
Caisson’s Disease
Every 30 ft, increase 1 atm. Nitrogen gasses dissolved in tissue. If come up too quickly, bubbles = bends to stop blood flow.; Tx=hyperbaric O2.
Anorexia
Distorted body image in anorexia -> dec. GnRH -> dec. FSH/LH -> amenorrhea + osteoporosis.
Bulimia
No weight necessarily. BINGE eating + vomiting. Metabolic alkalosis -> respiratory acidosis (leading to hypoxia) -> PVC’s –> R on P -> Vfib; Mallory-Weiss or Borhaeve.
Obesity
BMI = kg/m2. Main complication = HTN (unclear mech) -> LV hypertrophy -> HF; gall bladder; cancers (lots of aromatization of 17-steroids -> estrogens; endometrial ca, breast ca; colon ca
Fat-soluble vitamins
ADEK, more likely to stored in fat —> greater chance for toxicities.
Water-soluble vitamins
All co-factors for biochemical rxns.
Vitamin A
Important for growth in children! (FTT). Visual (-dopsins) -> nictolopia (night blindness). Prevents squamous metaplasia (e.g. eye cuboidal -> white spots of metaplasia –> keratomalacia).
Hypervitaminosis A
Big-game hunter eating bear livers. Cerebral edema. Papilledema -> HA (pseudotumor). Liver toxicity.
Vitamin D deficiency
Sunshine is most way to get it. Not in breast milk. Reabsorbs Ca+ and phosphate in jejunum and needs to be hydroxylzed TWICE (1st in liver for 25, 2nd in kidney for 1-alpha-hydroxylase). PTH is responsible for synthesis of 1 alpha-hyroxylase (proximal tubule). Main f(X) = mineralization of bone and cartilage.
Parathyroid
Reabsorption of Ca2+ (DCT at thiazide area) via a channel. On thiazides, leaves channel open for calcium to go in -> hypercalcemia. Decreases reabsorption of Phosphate and Bicarbonate at the PCT. Helps Vitamin D get 2nd hydroxylation in kidney. Alpha-hydroxylase
Vit D + Parathyroid
Vit D gets to Osteoblast –> Release of alkaline phosphatase -> mineralization of cartilage and bone. You would think parathyroid receptor for osteoclast. Instead, calcitonin into osteoclast –> inhibition of it to stop bone resorption. PTH acts on osteoblast to release IL-1 (= osteoclast-activating factor) -> osteoclast breaks down bone to maintain calcium levels. Sex hormones check IL-1 (estrogen or testosterone).
Vitamin D deficiency etios
Etios - lack of sunshine, poor diet, liver disease (increased CYP450 will dec. vitamin D). Phenytoin + OCP = not working OCP. Gamma-glutamyl transferase - enzyme of SER (revved up by drugs) –> increased Gamma-glutamyl transferase (pick up alcoholic), RENAL disease is most common (therefore CKD patients get 1,25-OH Vit D).
Vit D deficiency drugs
Rickets and osteomalacia. Rickets - craniotabes (soft skulls), rachitic rosaries (excess of ostoid). Pathologic fx’s. Type 1 = missing alpha-1 hydroxyls. Type 2 = missing the receptor for vitamin D
Hypervitaminosis D
Hypercalcemia -> hypercalcuria = stones
Vitamin E
Maintains CELL MEMBRANE by preventing lipid peroxidation (via phospholipase), neutralizes oxidized LDL (very atherogenic).
Deficient vitamin E
Very uncommon. CF patients w/ malabsorption of fat. (ADEK malabsorption). Hemolytic anemia (cell membrane). Posterior column disease, spinalcerebellar type diseases. Neuro + hemolytic.
Vitamin E toxicity
1100 U. Prevents of synthesis of vitamin K dependent coagulant factors (1972, C&S). Anti-coagulated and synergistic in activity with warfarin.
Vitamin K
Most of it is synthesized by COLONIC bacteria (anaerobes). Which is why we give Vit K to babies (isn’t in breast milk); to prevent hemorrhagic disease of the newborn. Usu. after 5 days, make their own b/c colonized. Made as K2 by bacteria. Converted to K1 (via Epoxide reductase - EPOXI glue). K1 gamma-carboxylates the Vit-K dept coagulation factors -> ACTIVATES them. They are the ones that need to be bound to Ca2+ to form a clot. The glutamic acid get carboxylated, allowing Ca2+ to bind those factors -> clot. Warfarin inhibits epoxide reductase (prevents K2 -> K1)
Vitamin K deficiency
Broad spectrum antibiotics. Poor diet. Newborn. Malabsorption. Hemorrhagic diathesis.
Vitamin C
Hydroxylates proline and lysine (Golgi apparatus) of collagen. Unstable blood vessels -> bleeding gums (lose you’re teeth); hemarthrosis. Perifollicular hemorrhage (red ring around the follicle). Corckscrew hairs. Glossitis. Cheilosis. (Ancillary tx for methhemoglobinemia)
Excess Vitamin C
Renal stones. Increase in URIC acid and others. (Vit D also has stones when toxic).
Thiamine deficiency
Thiamine is cofactor for Pyruvate dehydrogenase, alpha-ketoglutarate dehydrogenase, alpha-ketoacid dehydrogenase, transketolase (Pentose shunt). ATP depletion. Dry beriberi = peripheral neuropathy (ATP needed for myelin), nystagmus. Wet beriberi = cardiomyopathy (biventricular; different from alcoholic cardiomyopathy). Most common cause is EtOH. *D5 -> glucose is used with thiamine -> subclinical thiamine deficiency -> neurological problem. Therefore should give in IV thiamine
Niacin deficiency
Pellagra - Diarrhea, dermatitis (hyperpigmentation in sun-exposed areas), dementia. All the redox reactions w/ NADH. Tryptophan can be used to make niacin and serotonin. Nicotinic acid is least expensive lipid lowering drug (SE = flushing!) for familial combined hyperlipidemia.
Riboflavin
FAD, FMN. Glutathione reductase req. riboflavin.
