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Lab Values MNT RD

Terms in this set (91)

Albumin
Normal Range: 3.5-5.0 g/dL
Increased with Dehydration
Decreased with:
-Overhydration
-Inadequate pro intake
-Protein malabsorption
-Impaired synthesis(CHF, cirrhosis, acute stress)
-Excess loss ( burns, nephrotic syndrome, pressure ulcers)
-Synthesized in Liver..makes up 60% of total pro
Half-life: 12-21 days
Negative Acute Phase Respondents
Albumin
Prealbumin
Retinol binding protein (RBP)
Transferrin
Normal Range:
-M:215-365 mg/dL
-F: 250-380 mg/dL
Synthesized in Liver
Transports iron; normally 30-40% sat w/iron
NOT a sensitive indicator of visceral protein status in the presence of iron deficiency anemia
-Half-life: 8-10.5 days
Increased Transferrin
-Iron deficiency anemia
-Pregnancy (3rd trimester)
-Chronic Blood loss
Decreased Transferrin
PCM
Pernicious anemia
Iron Overload (ex: massive blood transfusion)
Chronic infection
Prealbumin (transthyretin or thyroxin-binding prealbumin)
Normal Range: 15-36 mg/dL
Synthesized in liver
Transported in the serum as a complex of retinol-binding protein and Vitamin A
Half-life 2-3 days
Increased prealbumin
CKD
Decreased Prealbumin
malnutrition
inflammation/stress/infection
liver damage
Retinol Binding Protein (RBP)
Normal range: 2.6-7.6 mg/dL
Synthesized in the liver
Transports retinol
Half-life: 10-12 hours
Increased RBP
advanced kidney disease
Decreased RBP
PCM
Vitamin A deficiency/zinc def
chronic liver disease
C-Reactive Protein (CRP)
Normal range: <1.0 mg/dL
Synthesized in the liver
Found at almost undetectable levels in most people
Negative correlations w/albumin and prealbumin
CRP is NOT elevated w/malnutrition unless inflammation is ALSO present
(ex: malnutrition +unstable DM, lupus)
Positive Acute Phase respondents
CRP
Increased CRP
bacterial infectious disease (bacterial meningitis, acute rheumatic fever)
Inflammatory disorders (lupus, rheumatoid arthritis, Crohn's)
Acute Injury (including MI)
Indicators of visceral protein status
albumin
prealbumin
RBP
CRP
transferrin
Creatinine-Height Index (CHI)
Normal range varies w/client height
CHI=actual urinary creatininex100/ideal urinary creatinine
-index of lean body mass w/normal kidney function
-indicator of quantity of muscle mass, and the amount excreted in the urine is normally constant from day to day.
-Indicator of somatic(muscle) protein status
CHI interpretation
>80% :zero-mild depletion
60-80% moderate depletion
<60% severe depletion
Increased CHI
Conditions that increase muscle mass (intensive physical training)
Decreased CHI
PCM
Conditions that decrease muscle mass ( wasting disease)
Aging (due to decreased muscle mass)
Nitrogen balance
calculated as the difference between nitrogen intake and output
-Insensible losses reflect nitrogen lost from sources such as feces, sweat, hair, skin and the 3to4 g added to the equation takes that into account
Nitrogen balance equation
((grams protein ingested)/6.25)-(urinary nitrogen + 3 or 4 g)
-use in 24 hour urine test
What is the only biochemical measurement that reflects both somatic and visceral protein status?
Nitrogen balance
Positive nitrogen balance
indicative of N retention, or anabolism(growing children, pregnant women) + adults who are adding mass or recovering from injury or illness
Negative nitrogen balance
indicative of N loss or catabolism (starvation, PCM)
Zero nitrogen balance
indicates equilibrium (healthy adults)
What is nitrogen balance influenced by?
energy intake, hormones (growth hormone, testosterone, thyroxin, corticosteroids)
-Nitrogen balance does not indicate the site of retention
Indicators of Somatic Protein status
CHI
anthropometrics
Nitrogen balance
Red Blood Cell Count
Normal Range:M 4.3-5.9x10^6mm^3
F 3.5-5.9x10^6mm^3
-Not a sensitive test for iron, Vit B12, or folate deficiencies
Decreased RBC
Hemmorrhage
Hemolysis
Marrow Failure
Hemoglobin (Hgb or HB)
Normal Range: M 14-18 g/dL
F 12-16 g/dL
Hgb picks up oxygen from the lungs and transports it to the cells. From the cells, it carries carbon dioxide to the lungs to be exhaled
-Hgb is composed of 2 pairs of amino acid chains (globin) and 4 heme groups
Increased hemoglobin
dehydration
Decreased hemoglobin
iron deficiency anemia
malnutrition
hemorrhage
Hematocrit (Hct)
Normal Range:
-Adult M: 42-54%
-Adult F: 37-47%
Hct is the measure of the percentage of RBD in total blood volume
-Usually 3x hemoglobin concentration
Increased Hct
dehydration
Decreased Hct
iron deficiency anemia
Malnutrition
Mean Corpuscular Volume (MCV)
Very important measure
-Will tell you if the possibilty of B12-folate def
-Measure of the size of a single red blood cell
Normal range: 80-99 fL(femtoliters)
Increased MCV
Folate deficiency
B12 deficiency
Macrocytic red blood cells
Decreased MCV
advance iron deficiency
Chronic blood loss
Lead poisoning
-Normocytic anemias may occur with PCM or with decreased Hgb synthesis
Mean corpuscular Hemoglobin (MCH)
Normal Range: 27-31 picograms
Measure of the average weight of hemoglobin w/in a red blood cell
-Increased=macrocytic
-Decreased-microcytic
Mean Cell hemoglobin Concentration (MCHC)
Normal Range: 31-36 g/dL
-Describes color of red blood cell
-Red blood cells cannot accomodate more than 38 g/dl of hemoglobin so hyperchromia is not possible
total iron binding capacity (TIBC)
Normal Range: 270-400 mg/dL
Increased w/iron deficiency
Decreased: megalobastic anemias
hemolytic anemia
acute and chronic inflammatory disease
-Depends on the number of free binding sites on transferrin
-Intracellular iron availability regulates the synthesis& secretion of transferrin
Dietary Requirements for RBC production
iron, vitamin B12, folic acid
Total Cholesterol
<200 Desirable
200-239 Borderline High
>240 High
LDL Cholesterol
<100 Optimal
100-129 Near or above optimal
130-159 Borderline High
160-189 High
>190 Very High
HDL
<40 Low
>60 High
(Two add together to be 100)
Increased Cholesterol
Hyperlipidemia
High fat/high cholesterol diet
Uncontrolled DM-makes lipids from sugar--> treat DM first
Biliary cirrhosis
Decreased Cholesterol
Malnutrition
Malabsorption
Liver Disease
T/F: If taking statin even if cholesterol <100, leave them for heart protection
True
Where is cholesterol synthesized?
Mainly Liver and Small Intestines
Role of LDL
To carry cholesterol to peripheral tissues
Role of HDL
Carry cholesterol to the liver for excretion
Triglyceride Levels Greater than _____ in the blood may result in pancreatitis.
1000 mg/dL
What are triglycerides transported by?
VLDL, LDL
Triglycerides
<150 desirable
150-199 Borderline
200-499 High
>500 Very High
Increased triglycerides
hyperlipidemia
Uncontrolled DM
alcoholic cirrhosis
pancreatitis
Decreased triglycerides
malnutrition
Malabsorption
Glucose
Normal range: 70-100 mg/dL
Increased glucose
uncontrolled DM
dehydration
acute stress response
corticosteroid therapy
acute pancreatitis
Cushing's syndrome
Decreased glucose
insulin overdose
overhydration
liver disease
Endocrine disorders (Addison's disease, hypothyroidism)
Non-nutritional factors that affect glucose
stress, infection, smoking
Glycosylated hemoglobin
measures the percentage of hemoglobin bound to glucose.
-Greatest value to measure for poorly controlled DM based on Diabetes Control and Complication Trials (DCCT)
-A1c <7.0% recommended for DM
a1c
Normal: <5.7%
Prediabetes: 5.7-6.4%
Diabetes: 6.5%
Good DM control: <7.0%
Fecal fat
Normal: 5-7g/24 hours
Increased Fecal Fat
deficiency of pancreatic digestive enzymes (chronic pancreatitis, cystic fibrosis, pancreatic carcinoma, pancreatic resection)
-bile duct obstruction
-impairment of intestinal absorption (celiac disease, tropical sprue, surgical loss of functional bowel)
BUN
Normal: 10-20 mg/dL
-Measures the amount of urea( a by-product of protein metabolism) in the blood
-Values of 50-100 mg/dL or higher indicate serious renal failure
Increased BUN
Impaired renal function
dehydration
increased protein catabolism (stress, starvation, fever, burns)
GI bleeding
Decreased BUN
Overhydration
Severe liver damage (hepatitis, poisoning)
Low protein, high CHO diet
Creatinine
Normal: M: 0.6-1.3
F: 0.5-1.2
A by-product of the metabolism of muscle creatine phosphate to form ATP
-It is produced at a constant rate, based on a pt's muscle mass/kidney function
-Interpreted w/ BUN.
-Unlike BUN, not significantly affected by dehydration or malnutrition
-increased BUN/Cr=impaired kidneys
Increased BUN/Normal Cr=dehydration
Serum Sodium
Normal: 135-148 mEq/L
-Major Cation of ECF
Increased sodium
dehydration
excessive Na+ in IV fluids
Hypoaldosteronism
Excessive sweating
Decreased Sodium:
overhydration
Water intoxicatoin
CHF
Peripheral edema
Serum Potassium
Normal: 3.5-50 mEq/L
-Potassium ions are pumped out of the cell as sodium ions are pumped into the cell
-Sodium/potassium pump plays a key role in the maintaining normal neuromuscular contractions
Increased potassium
-kidney failure
-uncontrolled DM
-dehydration
Symptoms: confusion, vomiting, muscle cramps, cardiac arrhythmia
Decreased potassium
PCM
Diarrhea/severe vomiting
K+-wasting diuretics
Symptoms: muscle weakness, cramps, cardiac arrhythmia
Serum Calcium
8.4-9.5 mg/dl
3 components: calcium bound to protein, calcium in complexes (ex: cal phosphate), and ionized calcium
-More than half bound to albumin so if albumin calcium may be falsely low. Can be corrected w/formula:
(0.8x (4.0-Pt's albumin)) + serum Ca
Ionized Calcium
Normal: 4.4-5.2 mg/dl
-Called free calcium because it is NOT bound to protein or any other substances to form complexes
-NOT affected by changes in plasma protein levels so prefered test
Serum Phosphorus
Normal: 2.7-4.5 mg/dl
Increased Phos
kidney failure
hypoparathryoidism
Noncompliance w/binder therapy (in CKD)
Decreased Phos
Hyperparathryoid
Refeeding syndrome
Partial pressure of Carbon Dioxide (PCO2)
Normal: 35-48 mm Hg
Leptin
Signals to brain that person is full
Obesity linked to high leptin levels
-leptin resistance /result in excessive food intake/obesity
-low leptin levels are considered a precursor to obesity
-Leptin produced in fat cells
Ghrelin
Produced by the stomach
-"hunger hormone"
Helps regulate intake, body weight, by stimulating hunger, slowing metabolism, and decreasing the body's ability to burn fat (increasing abdominal fat)
-May control stress eating
Atomic Weight Sodium
23
Valence 1
Atomic Weight Potassium
39
Valence 1
mEq formula
(milligrams/atomic wt) x valence
How many degrees F does BMR rise for each degree above 98.6?
7% per degree
How many degrees C does BMR rise for each degree above 37?
13% per degree
Drug Interactions w/ Enteral Feedings
-Only w/oral administration, IV solutions do not apply
-Oral Levothyroxin(synthroid)
--hold feedings 1 hour before and 1 hour after
-Oral Phenytoin (Dilantin)
--hold feedings 2 hours before and 2 hours after
-IV Propofol (Diprivan)
20% lipids provide ___ kcal/ml
2.0 kcal/ml
10% lipids provide ____ kcal/ml
1.1 kcal/ml
Hallmark of refeeding syndrome
Hypophosphatemia
THIS SET IS OFTEN IN FOLDERS WITH...