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Clinical Nutrition 2 > Nutritional Assessment - 2 > Flashcards

Nutritional Assessment - 2 Flashcards

1
Q

Considerations of pre-albumin in renal disease?

A

Kidney often excretes prealbumin, thus will reflect a higher value

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2
Q

When there a drop in visceral protein, what is it most often associated with?

A

Major blood loss and inflammation from surgeries, NOT indicative of nutritional status

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3
Q

Albumin half-life?

A

14-20 days

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4
Q

Mild depletion albumin?

A

28-35

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5
Q

Moderate depletion of albumin?

A

21-27

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6
Q

Severe depletion of albumin?

A

<21

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7
Q

Mild depletion of TIBC?

A

36-44

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8
Q

Moderate depletion of TIBC?

A

22-35

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9
Q

Severe depletion of TIBC?

A

<22

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10
Q

Half-life of pre-albumin?

A

1-3 days

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11
Q

Mild depletion of pre-albumin?

A

0.13-0.20

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12
Q

Moderate depletion of pre-albumin?

A

0.07-0.13

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13
Q

Severe depletion of pre-albumin?

A

<0.07

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14
Q

Mild depletion of TLC? Elderly?

A

1.5-1.8 1.2-1.8

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15
Q

Moderate depletion of TLC? Elderly?

A

0.9-1.5 0.8-1.19

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16
Q

Severe depletion of TLC? Elderly?

A

<0.9 <0.8

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17
Q

When are albumin, and other visceral proteins decreased?

A

-Inflammation -Infection -Liver disease -Protein losing states -Surgery, stress, catabolic states, malnutrition, corticosteroid therapy

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18
Q

In what inflammation state is pre-albumin increased?

A

-Corticosteroids -CKD due to less excretion

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19
Q

What is low albumin associated with?

A

Increased risk of morbidity and mortality

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20
Q

When does TLC increase?

A

-AIDS -Malignancies -immunosuppressive drugs

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21
Q

Patient is admitted well nourished for unexpected bowel surgery, Post-op he has a fever, and on POD 8 he is NPO for the past 8 days. Albumin = 19 g/L, what is your impression?

A

-Recall that 1/2 life of albumin is 14-30 days, thus it has not been enough time for albumin to be reflective of nutritional status -Likely due to fever, inflammation and post-catabolic state post Sx. -Initiate post-op nutrition to ret bowel until PO intake can resume

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22
Q

Patient presents w/ albumin of 36 g/L and TLC of 1.2. Impression in 40 y/o?

A

-Albumin reflective of mild malnutrition -Mild deficit of TLC -Thus, indicative of mild malnutrition

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23
Q

Patient presents w/ albumin of 36 g/L and TLC of 1.2. Impression in 80 y/o?

A

-Albumin good for age -Mild deficit of TLC -Nutritional status likely OK, reflective of aging and not nutritional status

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24
Q

Pre-albumin/trasnthyretin 1/2 life?

A

2-3 days

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25
Q

Which has a larger body pool size, pre-albumin or albumin? What is the significance?

A

-Albumin > Pre-albumin -This means that pre-albumin could rapidly change

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26
Q

Discuss the sensitivity of pre-albumin

A

-Decreases in malnutrition quickly -Increase quickly with adequate kcal -May help confirm low-protein intake with adequate energy -Negative APP

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27
Q

When may the ebb & flow phases indicate about nutritional status?

A

-Not reflective -The ebb phase (eliciting of hormones/inflammation_ will cause a sharp decrease, whereas flow phase will return to normal

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28
Q

When are low values of pre-albumin observed?

A

-Liver diseases -Sepsis (inflammation, infection) -Protein-losing enteropathies (IBD, cancer) -Acute catabolic states (trauma, surgery)

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29
Q

What may increase pre-albumin?

A

-CKD (less catabolism) -Corticosteroids

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30
Q

Why may someone with IBD, but on glucorticoids may display normal pre0albumin, despite being malnourished?

A

-IBD decrease pre-albumin -Glucocorticoids increase pre-albumin

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31
Q

What is the order of protein utilization during malnutrition?

A

lean mass -> visceral proteins –> organ mass

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32
Q

Which study showed that pre-albumin is not a nutritional indicator, but rather of the diseased state?

A

-Obeserved the biochemistry fo two groups of ICU patients on TPN, where group one had increased pre-albumin and the other had decreased pe-albumin. -However the two groups had similar weight, BMI, energy intake, protein intake, no differences in mortality, hospital or ICU stay

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33
Q

Half life of RBP?

A

2 hours

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34
Q

RBP is synthesized in the ___ and degraded in the ____

A

liver kidney

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35
Q

When is RBP high?

A

-Kidney disease

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36
Q

When is RBP low?

A

-Liver disease -Vitamin A deficiency

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37
Q

RBP is sensitive to ____ but not to low protein intake, thus it is not ____

A

-PEM -protein specific

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38
Q

What can RBP help us interpret?

A

-Confirm low protein intakes with adequate energy -Low values coincide with RBO -Similar to pre-albumin, follow RBP for recovery with nutritional support

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39
Q

What is ferritin?

A

The storage form of iron, which will be mobilized within the context of iron deficiency

40
Q

When is ferritin important to interpret ?

A

-GI issues -Blood losses -Suspected anemia

41
Q

When does ferritin increase?

A

-Infection -inflammation -Trauma -Iron overload -Viral hepatitis

42
Q

Does increased ferritin mean decreased iron status?

A

No, must interpret against other marker, such as CRP and RBC panel

43
Q

Half life of ferritin?

A

72 hous

44
Q

if both HMG and ferritin are low, more likely indicative of what?

A

Nutritional status

45
Q

Elevated ferritin?

A

>310

46
Q

Normal ferritin?

A

21-310

47
Q

Low ferritin?

A

<10

48
Q

What is transferrin?

A

transport protein for iron, which will increase within the context of iron deficiency, with less saturation but increased TIBC

49
Q

half-life of transferrin?

A

8-9 days

50
Q

Arrange the body pool sizes of the following visceral proteins from largest to smallest: -Transferrin -Albumin -Pre-albumin

A

Albumin –> Transferrin –> Prealbumin

51
Q

When is transferrin low?

A

-PEM -Sensitive to PEM and refeeding

52
Q

What is transferrin affected by?

A

-Liver disease -Protein losing enteropathies -hemodilution

53
Q

What is the normal range of CRP?

A

<10 mg/L usually 1 mg/L

54
Q

Discuss the + APP response of CRP after inflammation

A

Begins to increase within 46 hours after the initial tissue injury and will continue to increase several hundred fold within 24-48 hours

55
Q

When does CRP increase? When does it decrease? What must happen to indicate healing?

A

-Elevated during the acute-phase response -Returns to normal with the restoration of tissue structure and function -Must come down to indicate healing

56
Q

The rise of CRP is ____ an doubles every ___

A

exponential 8-9 hours

57
Q

What is a direct and quantitative measure of the acute phase reaction?

A

CRP

58
Q

Half life of CRP?

A

<24 hours

59
Q

What is the ultimate measurement of protein metabolism?

A

Nitrogen balance

60
Q

goal of nitrogen balance?

A

Reach zero nitrogen balance, +/- 2 g/day

61
Q

What does measuring nitrogen balance require?

A

1) 24 hr urine collection 2) Diet intake assessment 3) Consideration of + 4 g output for random losses

62
Q

How do we calculate nitrogen output?

A

24 hr urea mmol/35.7 = N output

63
Q

How to we calculate nitrogen input?

A

24 hr protein intake g/ 6.25 = N input

64
Q

N balance equation

A

Intake - (Output + 4 g)

65
Q

When is anabolism indicated from nitrogen balance?

A

When NB is > 0 +/- 2 g/day

66
Q

When may NB be realistic?

A

In the ICU setting, as urine catheters are often in palce

67
Q

Why may measuring NB be preferential than visceral proteins with respect to protein status?

A

NB is less affected by fluid shifts than plasma proteins

68
Q

You wish to calculate nitrogen balance on an ICU patient and have the following data available. They are receiving 1.8 L daily of TPN containing 4% AA consistently for the past 3 wk. What is your assessment?

A

1) 1.8 L AA: 1800 ml x 0.04 = 72 ml protein x 1 g/1ml = 72 g protein 2) Take 24 h urea from each week and divide by 35.7 to get to g N and add 4 g for other losses. 3) Calculate for each week, N balance = intake / output Week 1: -8.3 Week 2: -12.1 Week 3: -3.68 All -, but trend is approaching balance

69
Q

___ of calcium is bound to albumin

A

60%

70
Q

Low albumin may reflect low _____ and ____

A

-Serum calcium -Bilirubin As they are both bound to albumin

71
Q

When we see low calcium, what may we want to look at to see if it is truly “low”?

A

See if albumin is low, because then the calcium would be low secondary to lwo albuin

72
Q

Why do we need to measure corrected calcium if albumin is low?

A

Because measured total plasma Ca will change 0.8 mg/dL (0.20 mmol/L) for every 10 g/L change in albumin

73
Q

Corrected calcium (mg/dl) =

A

measured Ca + 0.8 mg/dL x [(40 – albumin g/L)/10]

74
Q

Corrected calcium (mmol/L) =

A

measured Ca + 0.2 mmol/L x [(40-albumin g/L)/10]

75
Q

What type of calcium is the most physiologically important?

A

Ionized, as it is metabolically active

76
Q

What other nutrients are bound to protein, and will be lower secondary to malnutrition?

A

-Zinc -Magnesium

77
Q

Tl Ca is 1.9 mmol/L; albumin is 32 g/L —- Calculate corrected Ca.

A

Corrected Ca = 1.9 + 0.2 x (8/10) = 1.9 + 0.16 = 2.06 (Still low, but lower end of normal range of 2.1 mmol/L)

78
Q

Consequences of high calcium

A

-Irregular heart rhythms -Calcification of soft tissue -Renal/heart failure

79
Q

Consequences of low calcium?

A

-Cardiac issues, nerve transmission issues -Long-term: osteoporosis

80
Q

WHO finding of anemia in the elderly?

A

8-44% prevalence

81
Q

Why increased prevalence of anemia in the elderly?

A

-Kidney function declines, les EPO -Lack of appetite -Malabsorption

82
Q

Anemia Hmg in women?

A

<12 g/dl or <120 g/L

83
Q

Anemia Hmg in men?

A

<13 g/dl or <130 g/L

84
Q

(T/F) Lower HmG is a normal consequence of aging

A

F -in the absence of disease, most older people maintain a normal red cell count, hemoglobin and hematocrit

85
Q

What is anemia of chronic diseases?

A

-Results from extended periods of infection or inflammation -Certain chronic infections/inflammations can influence hematopoiesis

86
Q

What are the impacts of decreased heameopatic function in AOCD?

A

-Shortened RBC life span -Sequestration of iron in inflammatory cells, resulting in a decreased amount of iron available to form RBC -May see microcytic anemia in inflammation

87
Q

Examples of chronic infections which may cause AOCD?

A

-Tuberculosis -Infective endocarditis -Chronic UTI -Chronic fungal infections –> These infections will cause the sequestration of iron

88
Q

Chronic inflammatory disorders which may cause AOCD?

A

-Osteoarthritis -Rheumatoid disease -Collagen vascular disease -Hepatitis -Decubitus ulcer

89
Q

Malignancies which may cause AOCD?

A

-Metastic carcinoma -Hematologic malignancies -Lymphoma

90
Q

Other diseases causing AOCD?

A

-PEM -Crohns disease -Ulcerative colitis -Celiac disease -Renal failure -Blood loss associated with chronic lesions

91
Q

First stage of nutritional anemia?

A

-Depletion of iron stores -Decreased ferritin

92
Q

Second stage of nutritional anemia?

A

-ID without anemia -Decrease transferrin sat, increased erythrocyte protoporphoryin

93
Q

What is erythrocyte protoporphoryin?

A

Pre-cursor to Hbg

94
Q

Third stage of nutritional anemia?

A

-IDA -Decreased hemoglobin and MCV (microcytic)

95
Q

You have a patient who has had chronic blood loss and takes a supplement to help compensate. Her HCT % increase,They developed pneumonia in week 3. What is your assessment? Is iron status improving?

A

-Ferritin cannot be interpreted, as CRP is high and ferritin is sequestered within the context of inflammation

96
Q
A

Clinical Nutrition 2 (21 decks)

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