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Chem 2 Exam 3 > Trace/Toxic Elements, Vitamins, and Nutrition > Flashcards

Trace/Toxic Elements, Vitamins, and Nutrition Flashcards

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1
Q

Essential element

A

if a deficiency impairs a biochemical or functional process and replacement of the element corrects this impairment

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2
Q

Nonessential trace elements

A

trace elements are of medical interest primarily because many of them are toxic.

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3
Q

The absorption, transport, distribution, metabolism, and elimination of elements are important to the …

A

clinical significance of disease states or toxicity

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4
Q

Specimens for analysis must be collected with attention to details such as…

A

anticoagulant, collection apparatus, and specimen type

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5
Q

Ubiquitous presence of trace metals in the environment have extraordinary measures that are required to prevent …

A

contamination of specimens

-Royal blue stopper with or without EDTA additive.

-Prevent environmental contamination (sample cups, pipettes, water, etc.)

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6
Q

***Atomic Emission Spectroscopy

A

Quantification of an element by measuring the intensity of emitted radiation from an aerosolized sample.

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7
Q

***Atomic Absorption Spectroscopy

A

Determination of element quantity through the absorption of optical radiation by fee atoms in the gas phase.

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8
Q

Aluminum is the most _____ metal in earth’s crust.

A

abundant

-Absorption, transport, and Excretion
–Ingestion, inhalation, and parenteral absorption
—–Concentrates in bone (50%) and lung (25%)

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9
Q

Where is Aluminum found?

A

industrial and household items

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10
Q

Explain the absorption, transport, and excretion of aluminum…

A

-This metal can be ingested, inhaled, and parenteral absorbed. (concentrates in bone 50%) and lung (25%)
-Transported bound to proteins (transferrin)
-Urine accounts for 95% of excretion; 2% in bile

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11
Q

Aluminum is transported bound to

A

proteins (transferrin)

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12
Q

Aluminum is in 95% of urine excretion and 2% in

A

bile

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13
Q

What are the Health Effects and Toxicity of aluminum?

A

-Interferes with enzyme activity
-Encephalopathy, anemia, bone disease, and progressive dementia

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14
Q

Arsenic has both _____ and _________ properties

A

metallic, non-metallic

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15
Q

Where is Arsenic found?

A

pesticides, pigments, manufacturing processes

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16
Q

The largest source of exposure of Arsenic is in

A

food

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17
Q

What are the health effects and toxicity of Arsenic?

A

-Acute and chronic states and fatal at low doses
-GI, cardiovascular, hepatic, dermatologic, renal involvement
-One of the most common poisons in history

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18
Q

What are the absorption, transport, and excretion factors of Arsenic?

A

-Ingestion and inhalation
-Hepatic metabolism
-Organic arsenic is clearly rapidly; inorganic and methylated are more toxic

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19
Q

This metal is a soft, bluish-white metal-can cut with a knife

A

Cadmium

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20
Q

This metal is used in industry, soil contamination

A

Cadmium

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21
Q

What are the absorption, transport, and excretion factors of Cadmium?

A

-Ingestion (5%) and inhalation (10-50%)
-Higher in females and smokers than males and nonsmokers
-Urine accounts for 95% of excretion; 2% in bile

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22
Q

What are the Health Effects and Toxicity of Cadmium?

A

-No role in human physiology
-Affects liver, bone, immune, blood, pulmonary, and nervous system

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23
Q

This metal is used in manufacturing stainless steel

A

Chromium

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24
Q

What is the absorption, transport, and exretion of Chromium?

A

-Ingestion, inhalation, and dermal absorption
-Cr6+ easier to absorb and more toxic than Cr3+
-Transported bound to albumin and transferrin

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25
Q

What is the health effects and toxicity of Chromium?

A

-Cr3+ is an essential element for insulin action, Cr6+ an oxidizing agent
-Lung irritation and dermatitis are more common; liver, kidney, and immune system,

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26
Q

This metal is relatively soft yet tough metal and excellent electrical and heat conducting.

A

Copper

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27
Q

This metal is an important cofactor and critical for the reduction of iron in heme synthesis

A

Copper

-Hepatic copper (10% of total copper in the body)
-Found in cornea, spleen ,intestine, and lungs

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28
Q

What is the Absorption, Transport, and Excretion of Copper?

A

-Ingestion, inhalation, and dermal
-Transported bound to proteins (albumin)
-Bile accounts for 98% of excretion; < 3% in urine/sweat

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29
Q

What are the Health Effects and Toxicity of Copper?

A

-Important for many metalloenzymes
-Heaptic and renal damages; neurologic symptom; mucous membrane irritant
-Wilson’s disease - copper rings in the eyes

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30
Q

For nutritional deficiency, serum copper levels are ______, while in urine copper levels are ______

A
  • serum copper levels are low
  • urine copper levels are low
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31
Q

For acute copper toxicity, serum copper levels are ______, while in urine copper levels are ______

A
  • serum copper levels are high or very high
  • urine copper levels are high
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32
Q

For Chronic copper toxicity, serum copper levels are _____, while in urine copper levels are _______

A
  • serum copper levels are high
  • urine copper levels are high
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33
Q

For Wilson’s disease, serum copper levels are _____, while in urine copper levels are ____

A
  • serum copper levels are normal or low
  • urine copper levels are high or very high
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34
Q

For Menkes disease, serum copper levels are ________, while urine copper levels are ____

A

-serum copper levels are low
-urine copper levels are high

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35
Q

What is the Absorption, Transport, and Excretion of Iron?

A

-Ingestion (10% of ingested is absorbed ); Fe3+ must be reduced for absorption
-Transported bound to proteins (ferritin)
-Iron is lost primarily by desquamation o f epithelia, red cell loss to urine and feces, and menstruction

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36
Q

What are the health effects and toxicity of Iron?

A

-important for hemoglobin , myoglobin, enzymes
-efficiency and overload states possible
-also stored as ferritin and hemosiderin in BM, spleen, and liver
-Iron deficiency in 15% worlds population

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37
Q

The Laboratory Evaluation of Iron status includes…

A

-Hemoglobin and RBC indices, total Fe, TIBC, % saturation, transferrin, and ferritin

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38
Q

Measurement of serum iron concentrations refers specifically to the

A

Fe3+

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39
Q

Early morning sample collection is preferred for this metal because of diurnal variation

A

Iron

-No visible hemolysis

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40
Q

This is the primary plasma iron transport protein, which bind iron.

A

Transferrin

-Saturated with aprox. 25-30% iron
-The additional amount of iron that can be bound is the unsaturation iron-binding capacity (UIBC)

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41
Q

This is the theoretical amount of iron that could be bound if transferrin and other minor iron-binging proteins present in the serum/plasma were saturated.

A

Total Iron-Binding Capacity (TIBC)

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42
Q

Percent saturation of Iron

A

Also called transferrin saturation is the ratio of serum iron to TIBC

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43
Q

This is the major iron storage protein in the body . This is more sensitive and reliable test for demonstration of iron deficiency.

A

Ferritin

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44
Q

The concentration of ferritin is directly proportional to the total ..

A

iron stores in the body

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45
Q

This metal is a soft, bluish-white, highly malleable, and ductile that was previously used in gasoline and paint

A

Lead

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46
Q

What is the absorption, transport, and excretion of Lead?

A

-primarlily ingestion and inhalation
-99% is absorbed by RBC; liver, kidney and brain with heights in bone (90%)
-Urine accounts for 76% of excretion; 16% in feces, remainder in hair, sweat, nails

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47
Q

What are the health effects and toxicity of lead?

A

-no physiological role
-higher absorption in children; leads to neurological symptoms and low IQ anemia

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48
Q

This metal is a production of steel.

A

Manganese

49
Q

What is the Absorption, transport and excretion of Manganese?

A

-Primarily ingestion; inhalation and dermal limited
-foudn mostly in fat and bone
-bile accounts of rmajoity of excretion

50
Q

What are the health effects and toxicity of Manganese?

A

-Important for many metalloenzymes and enzyme activation
-Deficient and toxic states have been observed
-Deficient: clotting issues, dermatitis, elevated serum Ca, Phos, ALP
-Toxicity: nausea, vomiting, he ache, disorientation, anxiety, compulsive laughing or crying (managenes madness)

51
Q

This metal is known as “quicksilver”, heavy, slivery metal, liquid at room temperature

A

Mercury

52
Q

What are the 3 naturally occurring oxidation states of Mercury?

A

Hg0, Hg1+, Hg2+

53
Q

What is the Absorption, transport, and excretion of Mercury?

A

-Inhalation most common; ingestion , cutaneous injection, dental
-Kidney major storage organ, followed by liver, spleen, and brain
-Fecal and urinary excretion

54
Q

What are the Health Effects and toxicity of Mercury?

A

-No physiologic role
-CNS and PNS toxicity; can damage most organs/tissues before symptoms occur

55
Q

What’s the Absorption, Transport, and excretion of Molybdenum?

A

-Up to 80% absorbed by ingestion
-Found mainly in liver, skeleton, and kidneys
-Bound to alpha2-macroglobulin and RBC membranes
-Maininly urinary secretion

56
Q

What are the health effects and toxicity of Molybdenum?

A

-important cofactor for several enzymes
-deficiency and toxicity is rare

57
Q

This metal is used in electronic industry, nutritional supplements, pigments, pesticides, dandruff shampoos, fungicides

A

Selenium

58
Q

What’s the Absorption, transport, and excretion of Selenium?

A

-Ingestion is most common (up to 50% of diet is absorbed)
-Urine accounts for most excretion; some excretion in sweat and exhalation

59
Q

What are the Health effects and toxicity of Selenium?

A

-important antioxidant and for thyroid hormones synthesis
-deficient states lead to cardiomyopathy; toxic states cause GI, tachycardia, CNS symptoms

60
Q

This metal is bluish-white lustrous metal, stable in dry air, becomes covered in white coating with moisture exposure

A

Zinc

61
Q

What’s the Absorption, transport , and Excretion of Zinc?

A

-Ingestion is most common
-Primarily found in muscle (60%) and bone (30%)
-Rbc the up most of the zine in blood (80%)
-Fecal accounts most excretion

62
Q

Health effects and toxicity of Zinc

A

-Important for enzyme activity, DNA/RNA, membrane structure, among others
-Deficiency causes growth inhibition and testicular atrophy toxicity is rare

63
Q

Vitamins are

A

small molecules important as cofactors in many biologivial/enzumeatic reactions

64
Q

Vitamin-related situations that the laboratories may assay for determination of

A

health status

65
Q

Deficiency

A

due to either inadequate diet, inadequate GI absorption, competing organisms (ex. parasites)

66
Q

Insufficiency

A

due to increased metabolism that mandates intake and absorption of greater than normal levels

67
Q

Toxicity

A

abnormally high intake that can lead to pathology (mostly leading to either hepatic or kidney damage)

68
Q

Fat soluble vitamins

A

-Vitamin A (Retinol
-Vitamin D
-Vitamin E
-Vitamin K

69
Q

Water Soluble Vitamins

A
  • Ascorbic acid (Vitamin C.)
  • Thiamine ( Vitamin B1)
  • Niacin (Vitamin B2)
  • Riboflavin (Vitamin B4)
  • Pantothenic acid ( Vitamin B5)
  • Pyridoxine (Vitamin B6)
  • Biotin (Vitamin B7)
  • Cyanocobalamin (Vitamin B12)
  • Folic acid
70
Q

This type of vitamin dissolve in Fat before absorbed into blood stream

A

Fat Soluble Vitamins

71
Q

The process to dissolve fat soluble vitamins requires what kind of acids from the liver?

A

bile acids

72
Q

What breaks down fat so it interferes with absorption of fat soluble vitamins?

A

Lipase

73
Q

What carries/transports fat soluble vitamins?

A

Lipoproteins ( LDL - Vitamin E)

74
Q

Where is Fat soluble vitamins stored primarily?

A
  • intestines
  • liver
  • fatty tissues
75
Q

Water soluble vitamins dissolve in what?

A

water

76
Q

Where are water soluble vitamins stored?

A

There not stored in the body.

77
Q

How are water soluble vitamins eliminated?

A

regularly in urine and feces

78
Q

True or False: water soluble vitamins are needed constantly re-supply

A

True

79
Q

These type of vitamins have a less change of toxicity. Except renal damage, which can impair excretion

A

Water soluble vitamins

80
Q

This is a complex system that varies based on vitamin.

A

Vitamin Metabolism

81
Q

For vitamin metabolism, what is the major site of vitamin absorption in the human body?

A

The small intestine

82
Q

In Vitamin Metabolism, how are nutrients picked up and absorbed in a cellular level?

A

Nutrients enter at a cellular level and are picked up and absorbed via blood capillaries and lymph fluids through the processes of active transport, diffusion and osmosis.

83
Q

In the large intestine, what vitamins are metabolized?

A

Vitamin B-12 and vitamin K are metabolized.

84
Q

What vitamins are the commonly assayed?

A

-Folate (b9)
-Vitamin b12
-vitamin D

85
Q

Which vitamins is the most common vitamin deficiency and can lead to megaloblastic anemia?

A

Folate

86
Q

It is important to differentiate the reason for _______ anemia. Whether it is due to low levels of folate or B12

A

megaloblastic

87
Q

What two other pathologies depend on normal levels of folate?

What test should be both performed?

A

-Increased likelihood of neural tube defects in infants born to mother with a folate deficiency

-increased levels of atherosclerosis related to homocysteine turnover decency on appropriate vitamin levels

Performed on both serum and RBC hemolysate

88
Q

Cobalamin or Cyanocobalamin are other names for Vitamin …

A

Vitamin B12

89
Q

This vitamin is absorption dependent on intrinsic Factor

A

Vitamin B12

90
Q

Vitamin B12 is associated with

A

Megaloblastic anemia
-insufficent dietary B12
Malabsorption
Pernicious anemia

91
Q

What transports Vitamin B12?

A

Specific serum transport proteins helps transport B12 to tissues (transcobalamins)

92
Q

How do we test Vitamin B12?

A

-serum or plasma
-similar to folate assays

93
Q

True or False: Vitamin D is contained in a few foods.

A

True.

Major natural source of vitamin D is synthesis of cholecalciferol in the skin from cholesterol through a chemical reaction that is dependent on sun exposure (specifically UVB)

94
Q

Which vitamin is mostly synthesis of cholecalciferol in the skin and from what lipid helps it through a chemical reaction that is dependent on sun exposure?

A

Vitamin D

95
Q

Why would Vitamin D be important for assessing?

A

Vitamin D

Important for assessing:
-Parathryoid function
-bone development
chronic renal failure
-monitioring vitamine D therapry
-vitamin D toxicity
-small bowel disease
-pancreatic insufficuency
-drug-related hypovitaminosis

96
Q

This vitamin is from diet or skin synthesis and is biological inactive.

What is required for this vitamin to be activated?

A

-Vitamin D

-Enzymatic conversion in the liver and kidney is required for activation

97
Q

Explain the process of Vitamin D metabolism

A
  • Vitamin D is intake or sun exposure and taken to the liver.
  • It converts to 25-hydroxyvitamin D and taken to the kidney
    -It coverts to 1, 25-di-hydroxyvitmain D (active form)
    -Then activates vitamin D receptor (VDR) in target organs

(Lung, colon, small intestine -> calcium to bone)

98
Q

What are the two major goupes of over starvation that are seen in Protein-calorie malnutrition (PCM)?

A

-Marasmus
-Kwashiorkor

99
Q

What is the difference between Marasmus and Kwashiorkor?

A

Marasmus: is deficient of all macronutrients, so you are deficient in protein and calories. MOST severe and general wasting.

Kwashiorkor: You have enough calories, but you don’t have enough protein. Less severe, but you are losing visceral muscle proteins.

100
Q

Do malnourished Staes in western societies present over starvation such as Marasmus or Kwashiorkor?

A

No. You don’t usually see these cases in the U.S, but both malnutrition and starvation can have similar harmful outcomes.

101
Q

True or False: Inadequate nutrition can appear due to any combination of the following:

-Eating disorders such as bulimia, anorexia, nervosa, or depression
-Limited diets
-Cachexia due to cancer
-Maldigesition (primary or secondary)
-Malabsorption (primary or secondary)
-Loss of appetite or ability to eat secondary to disease
-Loss of appetite or ability to eat secondary to therapy (drug, radiation, long term dialysis)
-Surgical outcome (eg. gastrectomy)
-Drug interaction (eg. contraceptives have a negative effect on vitamin status and utilization )

A

True

102
Q

What are the Negative Outcomes of Malnutrition?

A
  • Increased mortality and morbidity
  • impaired wound healing
  • increased rates of infection
  • increased length of hospital stay
103
Q

How is nutritional status determined? (non-laboratory tools)

A
  • Patient history (e.g. weight loss)
    -Evaluation of signs and symptoms (eg. depression, no appetite)
    -Anthropomorphic measurements (height, weight, skin fold thickness, wrist and mid-arm muscular circumference)
    -Functional assays (eg. muscle strength)
    -Body composition (water content, cell mass, bone mass, fat, etc.)
104
Q

What are the most useful laboratory assessment tools for nutritional status to be determined?

A

Selected protein markers.

This can be done in the lab through:
-Hemtology assay
-Immunologoy assays
-Non-protein chemistry

105
Q

What are the protein markers for assessing nutrimental status?

A

-Transferrin
-Transthyretin (Pre-albumin)
-Retinol binding protein (RBP) - responsible for vitamin A transport
-Others ( Albumin, amino acids, insulin-like growth factor-I (IGF-I) - regulatory of cell growth, leptin)

106
Q

True or False: There is currently no single marker that can assess overall national status

A

True.

The individual protein markers tests together for assessing national status may provide information on metabolic status, determine prognosis, and monitoring of nutrition support.

107
Q

What are the Limitations of protein markers for assessing nutritional status?

A

Serum levels can be altered by factors other than the patient’s nutritional status such as:

-Most importantly the acute phase response:
–> Levels should be interpreted along with clinical findings and the results of other investigations including all inflammatory marker such as C-reactive protein (CRP)
-Many affected by liver disease
-Recent food intake
-Hydration changes
-Others

108
Q

** Using a plasma marker (usually _______) is used in conjunction with an acute phase reactant like CRP

A

Pre-albumin

109
Q

If CRP level is normal, a low pre-albumin level indicates

A

protein malnutrition

110
Q

If the CRP level is significantly increased in the presence of low pre-albumin there might be

A

a false decreased in pre-albumin

111
Q

During monitoring, patients with decreasing levels of CRP and increasing levels of pre-albumin indicates

A

an improving nutrition status

112
Q

What do we do if we need to give patient nutrition and they can’t take it in traditionally.

A

We use TPN (Total Parenteral Nutrition). This is where a patient will have a central line inserted in their chest and they get all their nutrition via IV.

113
Q

When would be best or common practice to insert a TPN (Total Parenteral Nutrition) on a patient?

A

-If body weight has decreased more than 5%, and the illness has been present for more than 7 days, forced enteral (feeding) (common in anorexia patient treatment) or parenteral nutrition may be required.

  • Parenteral nutrition is necessary when the GI tract is not properly functioning
  • or when the patient cannot take anything by mouth.
114
Q

True or False: The lab plays a very important role in monitoring TPN

A

True!

114
Q

True or False: the lab plays a very important role in monitoring TPN treatment.

A

True

-Healthcare providers & dietitians look for distinct signs of TPN associated electrolyte and mineral abnormalities. The lab results are the key to determine the course of action with these patients.

115
Q

What are the advantages of TPN treatment?

A

-can help patient return to a healthy weight
-can help maintain their weight while they are going through some kind of treatment
-can help seal the bowel
-can help someone stop rectal bleeding
-can help a patient be in a better condition before surgery is needed
-and it help with nutritional support after surgery

116
Q

What are the risks of TPN?

A
  • catheter sepsis (b/c you are introducing something in your body & leaving it there)
    -Very costly
    -You can end up with hyperglycemia or hypoglycemia
    -you can have live disease or damage
    -can end up with blood clots
    -kidney disease
    -bone disease
    -volume overload
    -you can end up with fluid and electrolyte complications
117
Q

What are the Electrolytes and Mineral Abnormalities Associated with TPN?

A

It’s when they are either not getting enough or too much

-Hypernatremia
-Hyponatremia
-Hyperkalemia
-Hypokalemia
-Hyperchloremia
-Hypercalcemia
-Hypocalcemia
-Hypophosphatemia
-Hypomagnesemia

(not enough/too much sodium, not enough or too much Potassium, too much Cl, too much/not enough Vit D, not enough phosphate, not enough magnesium intake)

118
Q

So what would help with preventing electrolyte and mineral abnormalities associated with TPN?

A

TPN Compounder System.

-This particular system transfer up to 24 ingredients into a final sterile container. Usually done by a pharmacist.

Chem 2 Exam 3 (4 decks)

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