Unit 3-Energy, Exercise, and Body Weight//Unit 4- Water, Electrolytes, and Contaminants Flashcards

1
Q

Unit 3: Energy, Exercise, and Body Weight

Universal currency of energy = ____

WHY do we need energy?

• To perform mechanical work
– Muscle contraction, cellular movement
• _____ ________of molecules and ions across
biological membranes
• Synthesis of _____________ from simple
precursors

A

 ATP

Active transport

macromolecules

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2
Q

Unit 3: Energy, Exercise, and Body Weight

ATP Is the primary donor of ____ ______ for metabolic and other biochemical reactions
• ATP turnover is very high in the body; each molecule lasts about a minute before being consumed
• The total amount in the body is ~100g, however strenuous exercise consumes ______/MIN
• ATP regeneration must therefore be highly efficient!
–Carbon-containing fuel molecules like glucose or fats, are oxidized to CO2 and the energy release is used to convert ___ & _____ to ATP

A

free energy

~500g/min

ADP and PI

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3
Q

Unit 3: Energy, Exercise, and Body Weight

Energy from food is extracted in three stages
———— Stage 1:————————
• Large, complex molecules are broken down into usable units
• Fats are broken down to fatty acids and glycerol
• Polysaccharides are processed to glucose and other simple sugars
• Proteins are hydrolyzed to amino acids
• No energy is generated here!!!

A

STAGE ONE IS BASIC BUT KNOW….

No energy is generated here!!!

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4
Q

Unit 3: Energy, Exercise, and Body Weight

————–Stage 2:————————–
• Numerous small carbon compounds are degraded to a
common end product – ____________
• Some energy (ATP) is generated in this step, but some is also _________

A

Acetyl CoA

consumed

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5
Q

Unit 3: Energy, Exercise, and Body Weight

———————Stage 3:——————————–
• The acetyl group of acetyl CoA is completely oxidized to ______
•__________ are released, captured by intermediates (NAD+ and FAD), and used to power a proton
gradient that synthesizes large amounts of ATP

A

CO2

Electrons

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6
Q

Unit 3: Energy, Exercise, and Body Weight

The function of the citric acid cycle is to accept 2-carbon
fragments and ________ them to CO2
• This produces high-energy electrons that are then used to reduce molecular oxygen (O2) to water.
• Electrons are accepted by ____ &_____ to form NADH and FADH2

A

oxidize

NAD+and FAD

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7
Q

Unit 3: Energy, Exercise, and Body Weight

Energy Requirements = Dietary Energy Intake

• Required for growth or __________ in a person of
defined age, gender, weight, height, and physical activity
• In pregnant and lactating women, it includes the needs for deposition of tissue and production and secretion milk
• An ___OR_____ person needs may be increased or
decreased

A

maintenance

ill or injured

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8
Q

Unit 3: Energy, Exercise, and Body Weight

——-Total Energy Expenditure (TEE) or
Estimated Energy Requirement (EER)—————-

1—_____ _________ ______________ (BEE)
= _________ energy expenditure compatible with life
– Reflects the energy used over a 24 hour period while physically and mentally at REST and in a thermoneutral environment
– Measurement should be taken after sleep and 10-12 hours post-prandial
– ___% TO ____% of total energy expenditure (TEE)

A

Basal energy expenditure

Minimal

60% to 70%

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9
Q

Unit 3: Energy, Exercise, and Body Weight
——-Total Energy Expenditure (TEE) or
Estimated Energy Requirement (EER)—————-

2—_______ __________ OF ________ (TEF)
– Energy needed for consumption, digestion, and absorption of FOOD
– Accounts for about ____% of TEE
– Obligatory includes synthesis and storage
– Facultative thermogenesis is excess energy expended
– Affected by ____________ of the diet, eating schedule, and spices

A

Thermic effect of FOOD

10

composition

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10
Q

Unit 3: Energy, Exercise, and Body Weight
——-Total Energy Expenditure (TEE) or
Estimated Energy Requirement (EER)—————-

3—-__________ __________ (AT)
– Energy expended during sports or fitness exercise and activities of daily living
– Most variable component of ___
– Affected by body size, efficiency of individual habits of motion, and ______ _________

A

Activity thermogenesis

TEE

fitness level

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11
Q

Unit 3: Energy, Exercise, and Body Weight

Factors Affecting Resting Energy Expenditure (REE)

REE is used in place of BEE most often today, and are often used interchangeably. REE is usually __-___% higher than BEE.
Body size (direct prop)
• Body composition (direct prop with LBM)
• Age (indirect prop)
• Gender (M>W, 5-10%)
• Hormonal status
• Caffeine, nicotine, and alcohol (increases REE)
• Fever (increases REE by 7% per °F over 98.6 °F)
• Extreme environmental temperatures
***REE is measured using ______ ________ through the use of a ventilated hood system

A

10-20%

indirect calorimetry

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12
Q

Unit 3: Energy, Exercise, and Body Weight

Units of Energy Measurement
• Kilocalorie (kcal)-----------1 kcal = \_\_\_\_\_\_ kj
– Carbohydrate = 4 kcal/g
– Protein = 4 kcal/g
– Fat = 9 kcal/g
– Alcohol 7 kcal/g 

Kilojoule (kJ)—non–U.S. countries; the metric value
1 kj = energy req. to move 1 kg a distance of 1 m (using a force of 1 N)
– Carbohydrate = 17 kJ
– Protein = 17kJ
– Fat = 38 kJ

A

4.18

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13
Q

Unit 3: Energy, Exercise, and Body Weight

Measuring Energy Expenditure
1 •_____ calorimetry
– Measures amount of heat produced by the individual
– Very expensive!
2 • _______calorimetry
– Used in clinical practice, particularly in intensive care and burn units
– Equipment is known as metabolic cart or monitor
– Provides information on substrate utilization through the respiratory quotient (RQ)
3 • Doubly labeled water
– Using radiolabeled water,_____ production is measured, and then equated to TEE

A

Direct

Indirect

CO2

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14
Q

Unit 3: Energy, Exercise, and Body Weight
____ = Volume of CO2 EXPIRED/volume of O2
CONSUMED to metabolize a particular molecule
RQ values:
>1.0 = fat synthesis
1.0 = carbohydrate
0.85 = mixed diet
0.82 = protein
0.7 = fat
0.67 = alcohol

A

RQ

macronutrient(s)

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15
Q

Unit 3: Energy, Exercise, and Body Weight

_____ _____ ______= (TEE)

Age, weight, height and PA are the only variables

HEIGHT = METERS
WEIGHT = KILOGRAMS
AGE = YEARS
PA =  coefficient
A

Total Energy Expenditure

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16
Q

Unit 3: Energy, Exercise, and Body Weight

Macronutrients are __________
-produces energy when metabolized

A

ergogenic

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17
Q

Unit 3: Energy, Exercise, and Body Weight

———4 Focal Points————–
1 • Metabolic rate in the human body is affected by several variables, including daily TEE, two-thirds of which is the ______
2 • The energy cost of physical activity is the most variable of factors related to an individual’s______ and can be altered by the individual.
3 • Energy expenditure can be measured by several methods, but only ________calorimetry provides an RQ.
4 • Energy expenditure equations are commonly used with an activity factor to estimate energy needs.

A

BEE.

TEE

indirect

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18
Q

Unit 3: Energy, Exercise, and Body Weight

How much Carbs, Protein and Fat should you eat?  Example: your TEE is 2,500 kcal/day
1----Percentage of kcal from
Carbs: 60%
Protein: 10%
Fat: 30%
Alcohol: 0
2---Atwater Coefficient---
CARBS--4.0 kcal/g
PROTEIN--4.0
FAT--9.0
ALCOHOL--7.0
3---Carbs: (2500 kcal/day x 0.60)/4 kcal/g = 375 g/day
Protein: (2500 x 0.10)/4 = 62.5 g/day 
Fat: (2500 x 0.30)/9 = 83.33 g/day
A

KNOW

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19
Q

Unit 3: Energy, Exercise, and Body Weight

Desirable Body Weight or Optimum Body Weight
1–• Balancing energy intake and energy expenditure
is the basis of ______ __________ throughout
life.
2—Intake > Expenditure = Normal growth, pregnancy,
obesity, recovery from illness, HYPOthyroidism
• Intake = Expenditure = Normal condition of healthy
adults
3–• Intake

A

weight management

diabetes mellitus and malabsorption

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20
Q

Unit 3: Energy, Exercise, and Body Weight

Theoretical Body Composition Model for a Man and Woman

1—Essential body fat—Necessary for physiologic
function. About ___% of body weight in men and __% in women
2–Storage body fat—Energy reserve under the skin,
primarily triglycerides in adipose tissue. Around the internal organs to protect them from trauma. Most considered expendable.

Good health associated with:
____-_____% of body weight in MEN
_____-______% in WOMEN

A

3

12

10% to 25%

18% to 30%

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21
Q

Unit 3: Energy, Exercise, and Body Weight

Body Mass Index (BMI)
• BMI = weight / height2 (kg/m2)
• General comparison between body wt and _____

BMI RANGE FOR MEN AND WOMEN 
18.5 – 24.9 Normal 
25 – 29.9 Overweight
30 – 34.9 Obese
35+ Clinically obese
A

health

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22
Q

Unit 3: Energy, Exercise, and Body Weight

Methods of Measuring Obesity
1 • BMI-----------Know the cutoffs!!
2 • Waist circumference:
> \_\_ inches in men
> \_\_ inches in women
3 • Waist-to-hip Ratio (WHR):
> 0.85 in men
> 0.73 in women
****Varies according to race and age.  Older people are allowed higher WHR, younger less
A

40

35

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23
Q

Unit 3: Energy, Exercise, and Body Weight

Etiology of Obesity X 11
1 • Heredity—obesity gene? Twins show genetic component
2 • Imbalance of intake versus output
3 • Lack of exercise
4 • Sleep, stress, and circadian rhythms
– Chronic sleep deprivation
– Cortisol
5 • Set point Theory:body maintains its normal weight and body fat level with internal regulatory controls that dictate how much fat one has!!
6 • Thermic Theory: low level of brown adipose tissue. Less futile cycles into heat
7 • Psychological: tendency to eat when depressed
8 • Adipocyte Theory:_______ obesity increases adipocyte number!!
9 • Socioeconomic: Affordability and availability of food
10 • Cultural: Feasting, etc
11 • Lifestyle: Snacks, football Sunday, etc

A

Infant

MOST IS COMMON SENSE

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24
Q

Unit 3: Energy, Exercise, and Body Weight

Etiology of Obesity: Set point Theory
• Idea: The body has a mechanism to regulate its fat
size
• Evidence: Humans and animals can restore normal
body weight when allowed to eat freely after ________ OR_________.
• Mechanism: Unknown. Blood levels of a group of
peptides are being investigated for their effects on
appetite.

A

starvation or forced feeding.

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Unit 3: Energy, Exercise, and Body Weight Appetite Altering Peptides:Orexigenic Peptides Orexigenic: Peptides that INCREASE appetite – Agouti-related peptide – Neuropeptide Y – Melanin Concentrating Hormone (MCH) – Orexins (hypocretins) ALL FOUR RELEASED BY ____________-
BRAIN
26
Unit 3: Energy, Exercise, and Body Weight Appetite Altering Peptides:Orexigenic Peptides Orexigenic: Peptides that INCREASE appetite – Insulin RELEASED BY??
PANCREAS
27
Unit 3: Energy, Exercise, and Body Weight Appetite Altering Peptides:Orexigenic Peptides Orexigenic: Peptides that INCREASE appetite Ghrelin RELEASED BY??
STOMACH ****Blood ghrelin is lowest after a meal, rises prior to next meal
28
Unit 3: Energy, Exercise, and Body Weight Appetite Altering Peptides:Anorexigenic Peptides Anorexigenic: Peptides that DECREASE appetite – ______ ________: blocks ghrelin – _______ ________: delays stomach emptying, acts on satiety center in brain – Cholecystokinin ALL RELEASED BY INTESTINE!!
Peptide YY ***Injection with Peptide YY decreases appetite in humans Glucagon-like peptide
29
Unit 3: Energy, Exercise, and Body Weight Appetite Altering Peptides:Anorexigenic Peptides Anorexigenic: Peptides that DECREASE appetite – Melanocortin: binding R inhibits intake RELEASED FROM WHAT ORGAN??
BRAIN
30
Unit 3: Energy, Exercise, and Body Weight Appetite Altering Peptides:Anorexigenic Peptides Anorexigenic: Peptides that DECREASE appetite Leptin: regulates intake of kcal, C, F, but not percentages of each. Does not prevent obesity!!! RELEASED BY??
Adipocyte
31
Unit 3: Energy, Exercise, and Body Weight Brain Neurotransmitters • Norepinephrine and dopamine —released by sympathetic nervous system in response to dietary intake >>>> mediates hypothalamus = _______ food intake • Fasting and semistarvation decrease levels of these neurotransmitters = __________ food intake
decreased increased
32
Unit 3: Energy, Exercise, and Body Weight ``` OBESITY Health Risks and Longevity Diabetes • Heart disease • Hypertension • Hyperlipidemia • Gallbladder disease • Some cancers • Nonalcoholic fatty liver disease (NASH) • Atherosclerosis • Respiratory insufficiency & sleep apnea • Joint diseases / arthritis • Metabolic Syndrome ```
DON'T GET FAT!!
33
Unit 3: Energy, Exercise, and Body Weight ---------Metabolic syndrome (MetS)----------- • Includes three or more of the following: 1 – Waist circumference >102 cm (40 in) in men and >88 cm (35 in) in women 2 – Serum triglycerides of at least ____ mg/dL 3 – High-density lipoprotein (HDL) level
150 135/85
34
Unit 3: Energy, Exercise, and Body Weight NIH recommends loss of ________/wk for BMI 27 to 35; 1 to 2 lb/wk for BMI >35 ***1lb ~3500 kcal
0.5 to 1 lb
35
Unit 3: Energy, Exercise, and Body Weight Physical Activity X 7 1 • Increases proportion of LBM to fat 2 • Offsets decrease in RMR with weight loss 3 • Strengthens cardiovascular integrity 4 • Increases sensitivity to insulin 5 • Expends more energy 6 • ______ TO ___ min/day recommended for weight loss (at least 30 minutes; moderate intensity) – Ideal intensity: 60-80% VO2 max or ___-___% max heart rate (Max heart rate is approximately 220-age) 7 • Aerobic and resistance training
60 to 90 70-85
36
Unit 3: Energy, Exercise, and Body Weight Surgical Procedures • Bariatric surgery—for morbidly obese only; BMI ___ or above—Should have tried and failed with numerous weight-management plans—Gastric resection • Jaw wiring • Liposuction • NIH suggests dietary, exercise and behavior modifications for __+ months prior to any of these procedures
45 6
37
Unit 3: Energy, Exercise, and Body Weight Focal Points x 4 1 • Overweight and obesity in adults (____ %) in the United States have reached epidemic numbers. Even more alarming is the increasing rate (.____%) of overweight in children and adolescents. The United States is not alone in terms of trends; they exist worldwide. 2 • Obesity has severe associated risks: type 2 diabetes, hypertension, atherosclerosis, some cancers, sleep apnea, infertility, gallbladder disease, and liver disease; increased visceral fat has an important influence on metabolic and cardiovascular risk factors. 3 • A chronic disease model involving both caloric restriction, increased physical activity and lifestyle interventions in the context of an interdisciplinary approach offers the best treatment options for the patient. 4 • Stopping weight gain or achieving a moderate loss should be promoted as a treatment goal; an achievable __% to __% loss of initial body weight can improve glycemic control, blood pressure and lipid profile in most patients
66. 3% 17. 1 5--10%
38
Unit 3: Energy, Exercise, and Body Weight Anorexia Nervosa 1 • A disease characterized by: – Refusal to maintain a minimally normal body weight – Body image distortion – Amenorrhea in postmenarchal females 2 • May be one of two subtypes a – Restricting b – Binge eating and purging 3 • Prevalence of disease – 0.3% to _____% of women; rate is about one-tenth in men – Initial presentation is usually during adolescence or young adulthood – Genetic, environmental, and psychosocial factors – ___---_____% of patients die
3.7% 5--25%
39
Unit 3: Energy, Exercise, and Body Weight Clinical Characteristics and Medical Complications ----Anorexia nervosa----- – Cachectic and prepubescent body habitus – Lanugo: dry and brittle hair – Hypercarotenemia – _______ intolerance, cyanosis of the extremities – PEM and cardiovascular complications – __ complications – Osteopenia – Effects on growth and development in children and adolescents
cold GI
40
Unit 3: Energy, Exercise, and Body Weight -------Bulimia Nervosa------- • Characterized by repeated episodes of binge eating followed by inappropriate compensatory behaviors to prevent weight gain – Self-induced vomiting, laxatives misuse, diuretic misuse, ________ ______________, or fasting • ___% to ___% of adult women • Binge = consumption of an unusually large amount of food in a discrete period • Psychiatric comorbidities
compulsive exercise 1--3%
41
Unit 3: Energy, Exercise, and Body Weight Clinical Characteristics and Medical Complications of Bulimia Nervosa • Usually ________ weight and __________ behavior • Signs of self-induced vomiting (Russell’s sign) • Results of chronic vomiting can include esophagus and stomach damage • Effects of laxative and diuretic abuse include electrolyte imbalance and cardiac arrhythmia.
normal secretive
42
Unit 3: Energy, Exercise, and Body Weight Physical Signs and Symptoms of Anorexia Nervosa and Bulimia Nervosa
SEE SLIDE 58 AND PRINT FOR SEMINAR USE!!
43
Unit 3: Energy, Exercise, and Body Weight "OTHER" DISORDERS 1---Eating Disorder Not Otherwise Specified (EDNOS) – A diagnostic category for eating disorders that meet most, but not all, criteria for either anorexia nervosa or bulimia nervosa 2---• ______ _________ Disorder – Characterized by binge-eating episodes at least twice a week for a 6-month period – No inappropriate compensatory behaviors after a binge – Occurs in late adolescence – Emotional distress and feeling of powerlessness – Most are overweight – Night eating syndrome and sleep disorders
Binge-eating ***Treatment includes inpatient hospitalization, residential treatment, day hospitalization, intensive outpatient treatment, and outpatient treatment
44
Unit 3: Energy, Exercise, and Body Weight Psychotherapeutic Treatment * Behavioral reinforcement * Psychotherapy, cognitive-behavioral therapy, family or marital therapy * Assessment instruments * Treatment usually 1 year or more * Compared with anorexia, bulimia patients are generally more open to ___________ * ___________, separation anxiety, and generalized anxiety must also be treated
Depression intervention
45
Unit 3: Energy, Exercise, and Body Weight Nutrition Assessment • Laboratory assessment • Vitamin and mineral deficiencies – Hypercarotenemia, iron deficiency anemia, osteopenia, and osteoporosis • Fluid and electrolyte balance – Significant problems with vomiting and laxative and diuretic abuse • Energy expenditure – Low ____ in anorexia; unpredictable in bulimia • ________________ assessment
REE Anthropometric
46
Unit 3: Energy, Exercise, and Body Weight Prognosis • Relapse in anorexia: up to ____% of patients require rehospitalization • Enduring morbid food and weight preoccupation • Outcomes are better in ___________patients • High mortality rates associated with___________ • Relapse in __________ high
50% younger anorexia bulimia
47
Unit 3: Energy, Exercise, and Body Weight Focal Points • Anorexia nervosa and bulimia nervosa must be understood and appreciated as potentially _______disorders characterized by periods of ________ • Refeeding in eating disorders requires the ___________ effort of medical and mental heath professionals with the support of friends and family. • Nutrition rehabilitation can correct some (i.e., hypometabolic state, vital sign instability) but NOT all (organ mass, bone mass, and growth) of the pathophysiologic consequences of malnutrition in eating disorders. • Successful long-term treatment can take _______, and the expectation of a quick cure should be dispelled.
chronic relapse. collaborative years *****HELP: www.anad.org National Association of Anorexia Nervosa and associated disorders 1.847.831.3438
48
Unit 4: Water, Electrolytes, and Contaminants __________________ involves the gastrointestinal (GI) tract, kidneys, and brain working together
Homeostasis
49
Unit 4: Water, Electrolytes, and Contaminants Distribution of Body Water X 3 1--Water content of the fat-free body mass is remarkably __________ 2--Extracellular water (ECW) ~___% BW – Plasma, lymph, spinal fluid, secretions 3---Edema: abnormal accumulation of fluid in interstitial spaces. AKA “______ ________”
constant. 20% Third spacing
50
Unit 4: Water, Electrolytes, and Contaminants Water Balance 1. Daily INTAKE is equivalent to LOSSES 2. Thirst control centers are in ventromedial and ______ __________ near ADH (vasopressin) regulating centers 3. Kidneys release ____ to produce angiotensin II=thirsty
anterior hypothalamus renin
51
Unit 4: Water, Electrolytes, and Contaminants Metabolic water: oxidation of 100 g of fat, carbohydrate, and protein yields 107, 55, and 41 g of water or about_______TO_________ mL/day
200 to 300
52
Unit 4: Water, Electrolytes, and Contaminants Water Elimination 1--___________water loss: via kidneys as urine and via GI tract in feces. Kidney is primary regulator of sensible water loss. 2---_________ water loss: air expired from lungs and water vapor lost through the skin
Sensible Insensible
53
Unit 4: Water, Electrolytes, and Contaminants Water Balance – Water elimination 1---Water elimination – GI tract: __-___ L of digestive juices / day – All but ~100 mL is reabsorbed by ileum and colon 2---Older people have a harder time, increasing risk of dehydration and hypernatremia (Hypernatremia is generally not caused by an excess of sodium, but rather by a relative deficit of free water in the body. For this reason, hypernatremia is often synonymous with the less precise term, dehydration.)
7--9
54
Unit 4: Water, Electrolytes, and Contaminants Reabsorption along the Nephron ``` 1---Water reabsorbed at the: • Proximal convoluted tubule (__-____%) • Loop of Henle (~5%) – Thin descending 2--- NONE at • Thin ascending • Thick ascending • Early distal convoluted tubule (macula densa) ```
65-75
55
Unit 4: Water, Electrolytes, and Contaminants Function of the Kidney: Filtration: 1--Electrolytes such as sodium, chloride, bicarbonate are highly _______. Very little appears in the urine. 2---Nutritional substances, such as amino acids & glucose ________ reabsorbed from the tubules. Very little/none appears in the urine even though large amounts are filtered by glomerular capillaries 3---Waste products:Urea & ___________ 4---Electrolytes: Sodium Chloride 5.---Nutritional: Amino acids & Glucose 6---Organic: Acids & Bases
reabsorbed completely Creatinine
56
Unit 4: Water, Electrolytes, and Contaminants Signs of dehydration: headache, fatigue, decreased appetite, lightheadedness, poor skin turgor, concentrated urine, decreased urine output, sunken eyes. ----Loss of ___-____% body water reduces muscle work capacity by 20-30%
4--5%
57
Unit 4: Water, Electrolytes, and Contaminants Water Requirements 1----No storage of water occurs 2---(~ 0.5 oz/lb adults, 1 oz/lb kids, 2.5 oz/lb infants) 3---Usually about ____ L for males and 2.7 L for females 4---The FNB has NOT established an upper limit (UL) on water intake,
3.7
58
Unit 4: Water, Electrolytes, and Contaminants Water intoxication – 2 types 1. Excessive intake of water---Increases _____ volume and cells swell. Swelling of brain = headache, nausea, vomiting, muscle twitching, convulsions, stupor, coma, death 2. Intake of water without Na+--in re-hydration More K+ moves to outside of cells  Hypotension, convulsions, muscle cramps. Death reported in marathon runners - water w/o Na+ = ___________
intracellular hyponatremia
59
Unit 4: Water, Electrolytes, and Contaminants Deficiency of Water – Consequences * Impairs food ingestion, digestion, absorption * Impairs blood ______, transport of nutrients and metabolic wastes * Hypotension * Impairs regulation of body temperature * Constipation * Reduced________________, in general * Impairs physical performance
circulation metabolism
60
Unit 4: Water, Electrolytes, and Contaminants Electrolytes • Compounds that dissolve into cations and anions in water • Sodium, potassium, magnesium, chloride, and other compounds •______________ electrolytes: sodium, calcium, chloride, and bicarbonate (HCO3-) • ________ electrolytes: potassium, magnesium, and phosphate • Maintain physiologic body functions: osmotic equilibrium, acid–base balance, and intracellular and extracellular concentration differentials
Extracellular ---SCC Intracellular ----PMP
61
Unit 4: Water, Electrolytes, and Contaminants Electrolytes – Table salt = 2/3 tsp 1--• FNB: ____g/ day (1.5g Na+, 2.3g Cl-) To replace amount lost in sweat and get enough dietary 2---• UL: _____ g / day – 90% men consume excess – 75% women consume excess
3. 8 | 5. 8
62
Unit 4: Water, Electrolytes, and Contaminants Sodium • Major CATION (+) of ECF • 35% to 40% of total Na+ is in ______ and NOT very available • Sweat is actually_________ contains little Na+ • Na+ regulates ECF and plasma volume, nerve impulses, and muscle contraction • Readily absorbed from intestine and carried to the kidneys, where it is filtered and then returned to the bloodstream • ____-____% of normal loss occurs through urine; rest is from feces and sweat • Balance is maintained through aldosterone (mineralocorticoid) from adrenal cortex – Blood Na+ INCREASE = thirst receptors in hypothalamus stimulated = thirsty!!! – Estrogen acts similar to aldosterone = Na+ and H2O retention KEY---------• AI ~ 200 mg/day, mean intake is 4 to 5 g/d; recommended is ___ g/d, UL is ____ g/d
skeleton hypotonic; 90% to 95% 1. 5 OF SODIUM 2. 3 OF SODIUM
63
Unit 4: Water, Electrolytes, and Contaminants Chloride * Major ANION (-) of ECF * Maintains _______ ________ and osmotic pressure along with Na+ * High concentrations in cerebrospinal fluid and gastric/pancreatic fluids * Absorbed in intestine; excreted in urine and perspiration * Recommended intake: _____ g/d
water balance 2.3
64
Unit 4: Water, Electrolytes, and Contaminants Magnesium • SECOND most prevalent ___________ CATION (+) – Only about 1% of total Mg2+ is ___________ • About ½ of total Mg2+ is stored in BONE • Important COFACTOR in many enzymatic reactions • Important in bone metabolism, central nervous system, cardiovascular function • High Magnesium levels in green leafy veggies • Recommended intake: ______-________ mg/d
intracellular extracellular 300-400
65
Unit 4: Water, Electrolytes, and Contaminants Calcium * ___% in bone (hydroxyapatite, Ca5(PO4)3(OH));remaining __% has important physiologic functions * Second messenger after binding of hormones or proteins to cell surface (first messenger) * Ca2+ content REGULATED by ________ hormone (stim absorp in GI and release from bones) , CALCITONIN (decrease absorp in GI and release from bones) , VITAMIN D (stim absorp in GI), and phosphorous (inhibits absorp in GI)
99 1 parathyroid
66
Unit 4: Water, Electrolytes, and Contaminants Calcium * Regulates cell _______________ * Blood clotting * ~20% to 60% of dietary calcium is absorbed; tightly regulated to maintain steady serum calcium levels * The ________ are the main source of excretion; about 100 to 200 mg is excreted in normal adult urine * Recommended intake ranges from ______TO______ mg/day depending on age and gender; upper limit is about ______ mg
electroconductivity kidneys 1000 to 1300 2500
67
Unit 4: Water, Electrolytes, and Contaminants Phosphorus * Important constituent of intracellular fluid * 80% of P found in__________Ca5(PO4)3OH * Role in energy metabolism in adenosine triphosphate (ATP) * Phosphorylation reactions in cell * Buffer in ___-_____ balance * Cellular structure in phospholipid membrane * Found in animal products and some dried beans * Recommended intake: __________/d
bones acid–base 700 mg
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Unit 4: Water, Electrolytes, and Contaminants Potassium • Major cation of _______ • Normal water balance, osmotic equilibrium, acid–base balance (along with Na+), neuromuscular activity (along with Ca2+), cellular growth (needed for muscle formation) • Readily absorbed from small intestine • Mostly excreted from urine (80-90%) • Widely distributed in foods; protective against high blood pressure • AI: ________/day – To lower BP, blunt effects of salt, reduce risk of kidney stones • Most Americans consume
ICF 4.7g 50%
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Unit 4: Water, Electrolytes, and Contaminants ``` Sources of Potassium: widely distributed in foods' ----------Excellent foods (> 300 mg)-------------- • Potatoes (sweet) • Squash • Dry beans • Corn • Artichoke • Tomato • Spinach • Avocado • Banana • Mango • Papaya • Cantaloupe • Yogurt ```
know
70
Unit 4: Water, Electrolytes, and Contaminants Acid–Base Balance • Acid–base balance is the dynamic state of equilibrium of H+ concentration • Maintaining the pH level within a normal range of _____to______ is crucial for many physiologic functions and biochemical reactions (kidneys, lungs, buffers) • Acids generated from ingestion and metabolism of food and toxins • Intracellular buffers: _____and_______________ extracellular buffers: _____________and__________-
7.35 to 7.45 proteins and phosphates bicarbonate and carbonic acid
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Unit 4: Water, Electrolytes, and Contaminants 4 Major Acid–Base Imbalances and Possible Etiologies 1 of 4--_____________ ___________________ DISEASE = Conditions involving decreased lung surface area, such as emphysema. Restrictive or obstructive lung diseases. Certain neuromuscular disease in which respiratory function is impaired.
Respiratory acidosis
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Unit 4: Water, Electrolytes, and Contaminants 4 Major Acid–Base Imbalances and Possible Etiologies 2 OF 4-___________ _____________ DISEASE = Aftermath of intense exercise. Anxiety reaction. Early sepsis
-Respiratory alkalosis
73
Unit 4: Water, Electrolytes, and Contaminants 4 Major Acid–Base Imbalances and Possible Etiologies 3 OF 4 ---________ ____________ ``` Diarrhea Uremia Ketoacidosis from uncontrolled diabetes mellitus Starvation High-fat, low-carbohydrate diet Drugs ```
Metabolic acidosis
74
Unit 4: Water, Electrolytes, and Contaminants 4 Major Acid–Base Imbalances and Possible Etiologies 4 OF 4 ___________ ______________ Diuretics use Increased ingestion of alkali Loss of chloride Vomiting
Metabolic alkalosis
75
Unit 4: Water, Electrolytes, and Contaminants Metabolic X 2 __________: increased generation of accumulated acids (diabetes ketoacidosis, lactic acidosis) or bicarbonate losses from the kidneys or GI tract
Acidosis
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Unit 4: Water, Electrolytes, and Contaminants Metabolic X 2 _________: administration or accumulation of bicarbonate, excessive acid loss (nasogastric suctioning), or loss of ECF as from diuretics
Alkalosis
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Unit 4: Water, Electrolytes, and Contaminants Respiratory X 2 _________: decreased ventilation and consequent CO2 retention, as in sleep apnea, asthma, aspiration of foreign object, COPD, and ARDS
Acidosis
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Unit 4: Water, Electrolytes, and Contaminants Respiratory X 2 __________: increased ventilation and elimination of CO2, as in head injury, CHF, pneumonia, and hypoxemia
Alkalosis
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Unit 4: Water, Electrolytes, and Contaminants 1 • Body tries to ________ normal pH by developing compensatory responses to offset the effects of primary disorder – Ex. If respiratory acidosis, then kidneys INCREASE HCO3 -reabsorption, creating a metabolic alkalosis to INCREASE pH. – Ex. If metabolic acidosis, then lungs INCREASE ventilation and CO2 elimination, creating a respiratory alkalosis to INCREASE pH. • MUST distinguish between primary and secondary disturbances • Treat according to _______ problem and its underlying cause • Respiratory compensation takes ______, Metabolic compensation takes ___________
restore primary minutes 3-5 days
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Unit 4: Water, Electrolytes, and Contaminants Focal Points 1 • Acid–base patterns often serve as a common diagnostic tool within medical specialties (Whittier & Rutecki, 2004). 2 • Despite wide daily variations in intake of water and minerals that function as electrolytes, the body strives to maintain a stable internal environment to maintain ____________ ______________ 3 • When normal homeostatic mechanisms are rendered ineffective by _________OR _______ or when intakes exceed the body’s normal regulatory capacities, the internal environment and ultimately cell function are disrupted. 4 • ALL changes in _______ _____ in health and in disease occur in carbon dioxide, electrolyte concentrations, and total weak acid concentrations (Kelllum, 2005). 5 • Knowledge of fluid, electrolyte, and acid–base balance is important for understanding many aspects of nutrition in ________AND _________.
physiologic functioning. disease or injury blood pH health and disease