regulate body temp, med for metabolic reactions, lubricant for joints, eliminate waste thru urine
Distribution of h2o
ICF 2/3 ECF 1/3
Maintaining fluid balance
assessed by checking Na levels in the blood Hypothalamus - ADH kidneys conserve h20 Kidneys - Aldosterone conserve h2o and Na (starts with renin)
over production of ADH d/t - meds, tumors on pituitary and hypothalamus sym - edma, low Na
Diabetes Insipidus (DI)
ADH deficiency d/t - head trauma, meds sym - excessive thirst, high Na in blood
hyponatremia (over hydration)
low Na in the blood -increases ICF vol, headaches, swelling (CHF d/t left ventricle fatigue --> back flow fluid, pulmonary edema) -pushes h2o into tissues and cells causing swell and burst -must retain 3 liters before edema *happen to athletes who don't consume electrolytes
BMP (basic metabolic panel)
fishbone Na, Cl, BUN, Glu K, HCO3, Cr
-regulates ECF and ICF -critical for energy metabolism (Na/K pump)
Na normal levels
Aldosterone on Na
Low reabsorb Na from the blood High excrete excess Na
>145 -h2o loss, dehydrated, too much saline -labs high Na, BUN, Glu *each 3 rise in Na = 2.2 # of fluid loss
<136 -over hydration, fluid retention, SIAH -labs low Na, BUN, Alb *each 3 drop in Na = 2.2 # of fluid gain
Serum Osmolality equation
2 Na + BUN/ 2.8 + Glu/ 18
high - dehydration, hyperglycemia, hypernatemia low - over hydration, ascites, SIADH, post op
Blood urine nitrogen -test of kidney function -directly related to Pro
BUN norm vals
High - azotemia (high nitrogen), increased PRO, dehydration, UTI, starvation Low - liver dz (hard to make urea), malnutrition low pro, over hydration,
nitrogenous waste product of PCr produced at constant rate relative to muscle mass, age, and gender
Serum Crt normal values
0.6 - 1.2 mg/dL
increase: renal dz (creatine excretion reduced)(Crt +3), blocked urinary track, starvation Decrease: pro energy malnutrition
>23 dehydration and acute kidney dz, CHF <10 liver damage or low pro diet
Glucose normal values
70 - 99 mg/dL
ht/wt = > 90% IBW dyspigmentation of hair/skin low serum albumin FeDA ketonuria
Serum Ferritin - low (storage form of iron) TIBC - high Transferrin -high
MVC >94 S/s - anorexic, wt loss, high homocysteine (3-4 to develop) Risk - preg women, infants, poverty Diagnosis - RBC folate and homocysteine levels
MVC >94 S/S - SOB, loss of appetite, high homocysteine causes - lack of intrinsic factor, stomach acidity, poor absorption diagnosis - MMA (by product broken down by b12) risk - older adults, GI conditions
Alanine Amino Transferase (ALT) Alkaline Phosphatase (ALP) Aspartate Amine Transferase (AST) Gamma Glutamyl Transpeptidase (GGT) High = liver dz, central obesity, some meds
K normal values
3.5 - 5 mEq/L
Heart enzymes and effects if high
CPK - releases after a heart attack Troponin - releases after a heart attack more sensitive -indicates heart damage
intracellular cation acid -base balance renal system buffer fluid balance with Na/K pump
You have a patient admitted that you suspect is malnurished. You would like to check his visceral protein status; which lab(s) would you request and why?
PreAlbumin Serum Albumin need to rule out stress to body first
A pt is admitted to the hospital because of MI. Which labs would be elevated?
CPK or CK Troponin enzymes released with heart damage
You have a patient who has been vomiting numerous times daily since admission for a severe influenza. Which labs do you suspect to be low do to vomiting?
Chloride - decreased with vomiting and diaherra NA down K - fluid balance
A pt comes in with Trigycerides of 450. He wants to know what could be causing these levels; what do you tell him?
effected by sugar, simple CHO, alcohol, liver failure, medications
You have a pt who has an elevated AST and GGT. He also has a history of alcoholism. What has occurred?
A diabetic pt has a FBG of 250. He wants to know what FBG are ideal. What do you tell him?
anything under 100 mg/dL
A 45 y/o man comes in with a cholesterol level of 320. He asks for the desired level; what do you tell him?
desirable is under 200 5 to 1 ratio of Cholester/HDL
You screen a 70 y/o with a total cholesterol of 95, PAB 3 mg/dL, and MAC of 14 cm. What could be going on?
malnutrition cholesterol is very low
When osm is high, what condition could be occurring?
dehydration, alcohol intoxication, uremia, hyperglycemia, elevated BUN d/t dz
A pt has 8% body fat with a slightly elevated Crt level. What could be going on?
starvation, rapid muscle loss or high meat intake
When ism is low, what condition could be occurring?
over hydration, ascites, SIADH, post op status, hyponatremia
A pt is a double amputee with low Crt. Should you be concerned? Why/ why not?
not concerned because lost wt d/t amputation
Your pt has albumin of 2.6, BUN of 12, and TLC of 1,000. What could be going on?
Albumin mod BUN WNL TLC mod --> low pro RESULT: moderately malnourished with PEM poor pro intake, liver dz
You have a pt that has macrocytic anemia (MVC: 110). Why is it important to distinguish which B-vit is causing anemia? What tests will you order to determine the cause of macrocytic?
B/c by product of a metabolic reaction to be broken up and excreted by folate and B12 (12 activates folate) MMA test for B12
Pt was admitted with pneumonia, and you suspected the he is also suffering from FeDA. Serum ferritin is 180 (low) and transferrin is 200. The doctor asks you if he should start iron supplementation through the pt IV. What should you tell him?
No b/c both are a sign of phys stress on the body. He needs to heal before you assess
Pt has been admitted with rebel failure and metabolic acidosis. Will his blood K levels be high or low?
High because they will not be passed out of the body
A pt has a blood Ca level of 11.3 mg/dL (high). What can occur if levels stay elevated for a long time? What are some potential causes of high blood calcium?
kidney stones -- d/t extremely high Vit D levels hyperparathyroidism -- PSH released in excess
Your client has been diagnosed with metabolic syndrome. What are characteristics of this condition?
high waisted circumference obesity diabetes hypertension high cholesterol or trigyclerides
Richard is a 62 y/o male admitted with a hx of alcohol liver dz and cirrhosis. What would you expect to with Richard's liver function tests?
the number would be elevated d/t impaired function
Richard is a 62 y/o male admitted with a hx of alcohol liver dz and cirrhosis What would you expect Albumin to be elevated or lowered? Why?
Low b/c albumin is made by the liver which would lead to decrease production with impaired function of the organ
Richard is a 62 y/o male admitted with a hx of alcohol liver dz and cirrhosis. Would you expect BUN to be elevated or lower? Why?
Low b/c decreased PRO metabolism
Dietary Approach to stop hypertension developed to lower BP with meds heart healthy benefits and helps lower cholesterol Focuses on Vit and mineral intake Americanized Meditterain diet Na 1500 mg/ day
Waist circum = greater 40 men and 35 women Trig > 150 mg/dL HDL < 50 mg/dL BP > 130/85 mm Hg FBG > 100 mg/dL Effects 35% of adults ---> higher risk for CVD
Therapeutic lifestyle changes diet lifestyle changes through diet and exercise -no smoking main focus is to reduce sat fat lowers ldl and keeps hdl
What is the first test we assess when checking fluid status?
Albumin and Prealbumin article
these are not good markers of nutrition status --> acute phases reactants and are effected by many other things in the body
What happens to serum Albumin levels during infection or trauma? How could this impact your nutrition assessment?
body lowers amount of pro being made impact leads to inaccurate read
What happens to serum albumin levels during marasmus?
normal d/t decreased pro and kcal intake but body compensates
Prealbumin is considered a more sensitive indicator of Protein status than albumin. Why?
b/c it has a shorter half life of 2-3 days
What happens to Transferrin during iron deficiency anemia? Why?
increases b/c stands for transfer iron but with anemia body will try to trap it
Kwashiorkor albumin levels are used to diagnose. Why?
fluid is pushed out leading to ednma which measures inflammation
Nutritionally speaking, why is it valuable to measure serum levels of C - Reactive Protein?
b/c you naturally aren't supposed to have this in your body d/t stress
What can lab values be effect by?
collection procedure time of day hydration status recent exercise health stress
Why is important to take into account lab values that impacted by hydration status when assessing pt?
helps to see if direct effect of the illness or rule out other problems
Low serum albumin can indicate
physiological stress acute malnutrition
What is the best biochemical test to diagnose impaired iron status
What are other tests used to assess iron status?
Mvc down with deficiency MCH pale Hemoglobin/Hematocrit low in def TIBC increase
What happens to Na, K, Mg during refeeding syndrome? What are some physical effects that can come from these values being off?
1) low blood volume, insulin anabolicly active pushes electrolytes back to the cells with food 2) lead to death, nausea, vomitting
CRP maker of inflammation
to fix treat underlying condition to fix
Hcy market of inflammation
more effected by diet d/t fat intake and b vitamins - break down substance
Why is important to accurately identify the cause of macrocytic anemia?
b12 activates folate
Side effects of b12 deficiency
high homocysteine levels nerve damage wt loss fatigue depression
Sources of folate
fortified foods green leafy vegetables beans
How does diet effect serum Ca levels?
through vitamin D and Ca consumption not as strictly controlled through food more through body regulation
When learning about acid base - balance, there were two compensatory mechanisms that kick in to try and get blood pH back to normal. Which occurs first?
Risk factors of NADFL
Obesity central Type II DM (insulin resistance)
Key points with acid-base balance
respiratory compensation can occur within minutes renal compensation may take 3-5 days compensation may not be 100% successful
plasma pH - low primary disturbance - increased PCO2 Compensation - increase renal acid excretion w/resulting increase in serum bicarbonate Cause - emphysema, COPD, respiratory retain CO2
plasma pH - high Primary disturbance - decreased CO2 Compensation - decreased renal acid excretion w/resulting decrease in serum bicarb Cause - intense exercise, anxiety, excessive expiration
Plasma pH - low primary disturbance - decreased HCO3 Compensation - hyperventilation w/resuling low PCO2 Cause - diarrhea, uremia, ketoacidosis, uncontrolled DM, starvation, high fat/low cho diet, renal failure
Plasma pH - high Primary disturbance - increased HCO3 Compensation - hyperventilation with resulting increase in PCO2 Cause - diuretic use, vomiting, loss of chloride
The parathyroid glands help control calcium use and removal by the body. They do this by producing parathyroid hormone (PTH). PTH helps control calcium, phosphorus, and vitamin D levels in the blood and bone.
When calcium level is too low, the body responds by making more PTH. This causes the calcium level in the blood to rise.
When one or both of the parathyroid glands grow larger, it leads to too much PTH. Most often, the cause is not known.
Bones become weak, deformed, or can break High blood pressure and heart disease Kidney stones Long-term kidney disease
Hyperparathryiodism dietary treatment
Drinking more fluids to prevent kidney stones from forming Exercising Not taking a type of water pill called thiazide diuretic Estrogen for women who have gone through menopause Having surgery to remove the overactive glands (usually for people under age 50)