Nutrition Flashcards
Hypernatremia Causes S/S
Hypernatremia
• Usually due to dehydration• Excess sweat with salt
intake• Excess diuretics with salt
intake• Nausea and vomiting with
high salt intake • Burns
S/S: confusion, neuromuscular excitability,
hyperreflexia, seizures, coma, cerebrovascular damage with subcortical or subarachnoid hemorrhage, venous
thrombosis
hyponatremia Causes S/S
Hypovolemic hyponatremia
• Extrarenal fluid loss
• Renal fluid loss (diuretic therapy) • Diuretics • Nausea and vomiting • Diarrhea • Burns • Pancreatitis •Rhabdomyolysis• Small intestine obstruction• Opioids, NSAIDs • Addison’s disease• Hypothyroidism• Chronic pain • Cirrhosis • Heart failure• Chronic Renal Disease
S/S: lethargy, confusion, altered mental status, stupor, neuromuscular hyper-excitability, hyper-reflexia, seizures, coma, death
Sodium (Na) Diagnostic
Both: serum or urine
electrolyte osmolality
Hyponatremia Treatment
Red flag: refer to ER immediately • Saline drip• Fluid restriction• Removal of diuretics
Hyperkalemia Causes
Hyperkalemia
• Acute renal failure• Chronic kidney disease• Rhabdomyolysis• Burns• GI bleed• Adrenal insufficiency• Hyper-potassium supplementation • Bleeding ulcers• Penicillin use
Hyperkalemia S/S
S/S: flaccid paralysis, cardiac
tonicity with weakness or paralysis (mostly asymptomatic) Caution: ACE inhibitors, potassium sparing diuretics, urinary obstruction, renal
failure, advanced heart failure
Hypokalemia Causes
Hypokalemia
• Chronic diarrhea with laxative use• Clay (betonite) ingestion • Vomiting • Protracted gastric suction • Heavy Gan Cao (glycerraziause )or chewing tobacco • Cushing’s syndrome• Bartter syndrome: mutations to diuretic loop, sensitive ion transport in the loop of Henle • Medications• Diuretics: Thiazides, loop diuretics, osmotic diuretics, laxatives, high dose penicillin, theophylline intoxication
Hypokalemia S/S
S/S: muscle weakness, cramping, fasciculations, paralytic ileus, hypoventilation, hypotension, tetany, rhabdomyolysis, polyuria, secondary polydipsia
Hyperkalemia Diagnostic
Hyperkalemia: Serum K levels, EKG, Renal evaluation EKG: if levels are >5.5 mEq/L, patient will have slow conduction with increased PR interval, short QT which will be tall, peaked T wave
Hypokalemia Diagnostic
Hypokalemia: Serum potassium, 24 hour urine potassium and serum mg levels EKG: do if serum levels are <3 mEq/L. Reading includes: Sagging of ST segments, depression of T wave, elevated U wave
Hyperkalemia Treatment
Hyperkalemia: Beta-2 agonist, hemodialysis, IV calcium solution, IV insulin or glucose RED FLAG FOR Hyperkalemia: Lithium, NSAIDS, trimethoprim, Heparin, Cyclosporine, Direct Renin Inhibitor, Angiotensin II receptor blockers, ACE inhibitors, Digoxin, Beta blockers, adrenal insufficiency
Hypokalemia Treatment
Hypokalemia: Potassium supplements, IV potassium (banana bag) High-risk in patients on: Digoxin, insulin, beta antagonists (for asthma), also patients with left ventricular dysfunction
Hypercalcemia Causes
Hypercalcemia: • Hyperparathyroidism • Cancer with bone metastasis • Paget’sdisease • Osteoporosis • Paraplegia, quadriplegia • Lymphoma • Multiple myeloma • Vitamin A & D toxicity • Tuberculosis • Contaminated glassware with blood • Prolonged venous stasis due to tourniquet being left on too long) • Myxedema • Cushing’sdisease • Addison’sdisease • Medications: lithium, Theophylline, Thiazide
Hypercalcemia S/S
S/S: constipation, anorexia, nausea and vomiting, abdominal pain, polyuria, nocturia, polydipsia, delirium, confusion, psychosis, stupor, coma neuromuscular
Hypocalcemia: Causes
Hypocalcemia: • Hypoparathyroidism • Vitamin D deficiency • Renal Disease • Magnesium depletion • Acute pancreatitis • Hypoproteinemia • Septic shock • Hyperphosphatemia • Anticonvulsant use
Hypocalcemia: S/S
S/S: carpopedal spasm, parasthesia of the lips, fingers and feet; general muscle aching, facial spasms, dry scaly skin, brittle nails, candida infections, brittle, coarse hair, cataracts
Hypocalcemia Diagnostic
Blood calcium
Hypercalcemia Diagnostic
Total serum, calcium, chest X-ray, urine calcium
Hypocalcemia Treatment
Hypocalcemia:
IV calcium gluconate for tetany
Oral calcium and vitamin D for chronic hypocalcemia
Hypercalcemia Tx
Hypercalcemia:
IV saline and Furosemide, Bisphosphonates, hemodialysis
Hyperphosphatemia Causes
Hyperphosphatemia: • Hypoparathyroidism • Excess enema use • Diabetic ketoacidosis • Rhabdomyolysis • Systemic infections • Tumor-lysis syndrome
Hyperphosphatemia S/S
S/S: hypocalcemia, tetany,
soft tissue calcemia
Hypophosphatemia Causes
Hypophosphatemia:
• Recovery phase of ketoacidosis• Acute alcoholism• Severe burns• Under nutrition • Hyperparathyroidism• Cushing’s syndrome• Hypothyroidism• Hypomagnesemia and hypokalemia• Diureticuse• Theophyllineintoxication• Chronic fasting• Vomiting or diarrhea
• Long term antacid use
Hypophosphatemia S/S
S/S: usually asymptomatic, anorexia, muscle weakness,
osteomalacia, hemolytic anemia, decreased release of
oxygen
Phosphorus (Ph+) Diagnostic (both)
Serum phosphorus levels
Hyperphosphatemia Treatment
Phosphorus restriction or binders
Hypophosphatemia Treatment
Phosphorus replacement, IV phosophorus
Hypermagnesemia Causes
Hypermagnesemia: usually uncommon and/or asymptomatic Hypotension • Respiratory depression • Cardiac arrest • Excess antacid use • Excess laxative use
Hypermagnesemia S/S
S/S: hyporeflexia,
hypotension, respiratory
depression, cardiac arrest
Hypomagnesemia Causes
Hypomagnesemia: • Alcoholism • Chronic diarrhea • Steatorrhea • Small intestine bypass • Preeclampsia/eclampsia • Lactation • Hypercalcemia • Removal of parathyroid tumor • Hypersecretion of aldosterone • Thyroid hormone use • ADH use • Polyurea
Hypomagnesemia S/S
S/S: anorexia, nausea and
vomiting, lethargy, weakness,
personality change, tetany,
carpopedal spasm
Hyper/Hypomagnesemia Diagnostics
Serum Magnesium Levels
Hypermagnesemia Treatment
Magnsium gluconate Diuretics
Dialysis
Hypomagnesemia Treatment
IV or IM magnesium sulfate,
Oral magnesium salts
Hypernatremia Treatment
Free water IV therapy
Vitamin B1 (Thiamin)
Source: Whole grains, pork, liver, cereal, nuts, legumes, tubers
Function: Carbohydrate, lipid, amino acid, glucose and alcohol metabolism; CNS/PNS cell function, myocardial function
Deficiency/toxicity: Deficiency: Beriberi, Wernicke Korsakoff Enceph
Vitamin B2 (Riboflavin)
Source: Milk, cheese, liver, meat, eggs, cereals
Function: Carbohydrate and protein metabolism, mucous membrane integrity
Deficiency/toxicity: Deficiency: cheilosis, angular stomatitis, corneal vascularization
Vitamin B3 (Niacin)
Source: Liver, red meat, fish, poultry, legumes, whole grains
Function:Oxidation reduction, carbohydrate/cell metabolism
Deficiency/toxicity: Deficiency: pellagra (dermatitis, glossitis, GI and CNS dysfunction) Toxicity: flushing
Vitamin B6 (Pyridoxine)
Source: Organ meats, fish, legumes
Function: Nitrogen metabolism, nucleic acid biosynthesis, fatty acid, lipid and amino acid metabolism
Deficiency/toxicity: Deficiency: seizures, anemia, neuropathies, seborrheic dermatitis Toxicity: peripheral neuropathy
Vitamin B12 (Cobalamin)
Source: Red meat, organ meat, pork, poultry, egg, cereals, dairy
Function: Maturation of red blood cells, neural functions, DNA, myelin repair
Deficiency/toxicity: Deficiency: megaloblastic anemia, parasthesias, ataxia
Folate (Folic Acid/B9)
Source: Leafy greens, fruit, organ meats, enriched cereals
Function: Maturation of red blood cells, synthesis of purines, fetal nervous development
Deficiency/toxicity: Deficiency: megaloblastic anemia, neural tube defect, mental confusion
Vitamin C (Ascorbic Acid)
Source: Citrus fruit, tomatoes, tubers, broccoli, strawberries, sweet peppers
Function: Collagen formation, bone and blood vessel health, carnitine, hormone/amino acid formation, wound healing
Deficiency/toxicity: Deficiency: scurvy (bone defects, gingivitis, loose teeth, hemorrhages)
Vitamin A (Retinol)
Source: Fish liver oil, liver, egg yolk, butter, dark green/yellow vegetables, carrots, yellow and orange fruit
Function: Photoreceptor pigment of retina, epithelial integrity, lysosome stability, glycoprotein synthesis
Deficiency/toxicity: Deficiency: night blindness, hyperkeratosis, xerophthalmia, keratomalacia, morbidity and mortality in young children
Vitamin D (Cholecalciferol)
Source: Direct UVB light, fortified foods, fish liver oil, liver
Function: Calcium and phosphate absorption, bone mineralization repair, insulin and thyroid function, increased immunity, reduce autoimmune disease
Deficiency/toxicity: eficiency: rickets, osteomalacia Toxicity: hypercalcemia, anorexia, renal failure, metastatic calcification
Vitamin E (AlphaTocopherol
Source: Vegetable oil, nuts, legumes
Function: Intracellular antioxidant
Deficiency/toxicity: Deficiency: red blood cell hemolysis, neurologic deficits (Nystagmus) Toxicity: bleeding
Vitamin K (Phylloquinone)
Source: Green leafy vegetables, soy beans, vegetable oil, bacteria in the GI tract
Function: Formation of prothrombin for coagulation and bone proteins
Deficiency/toxicity: Deficiency: bleeding, osteopenia
Common Dietary Deficiencies
Vegan: Vitamin B12 (unless eating yeast or fermented foods), low calcium, Iron, Zinc
Fruitarian: Protein and sodium deficiency
Very low calorie diet: Wasting syndrome when in long term
Fad Diets: Tendency to cause: protein and mineral deficiencies leading to renal, cardiac or metabolic disorders
Alcoholism: Tendency to cause: protein and mineral deficiencies leading to renal, cardiac or metabolic disorders
