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Med Nutr I final

Biochemical assessment

Creatinine levels indicate Urine- muscle mass, decrease suggest muscle depletion Serum- index of kidney function, increases with kidney malfunciont
3- Methyl histidine levels indicate muscle mass, increase suggests muscle catabolism
Total protein indicates visceral protein status
Normal total protein values 6.0-8.2 g/dL
Function of 'total' protein in blood collectively they maintain osmotic pressure; this means a decrease in total protein causes interstitial edema
Total protein value for impaired visceral protein status <6.0g/dL
Impaired visceral protein status results in... decreased tissue oxygenation, interstitial edema (also decrease blood pressure),
Interstitial edema... occurs as water from blood shifts to intercellular spaces Intestinal edema decreases nutrient absorbtion and may cause diarrhea
Issues of refeeding to increase total protein increasing osmotic pressure (water goes back to blood volume)can result in respiratory and circulary system overload Therefore refeed slowly
Function of albumin 1. Maintain oncotic pressure (composes 50-50% Tpro) 2. Transport nutrients, esp Ca
Half life of albumin 14-18 days
Normal albumin values 3.5-5.0 g/dL
Albumin value indicating impaired visceral protein status <3.5 g/dL
Albumin value suggesting high risk of mortality <2.0 g/dL
Albumin levels associated with decreased tissue oxygenation and interstitial edema <2.6 g/dL
Albumin, - or + APRP? - APRP
Function of Transferrin Transport iron indicator of visceral protein status if iron status is OK
Serum TfReceptors represents... and index of cellular iron status
Half life of Transferrin 8-10 days
Transferrin _______ with iron deficiency increases (along with sTfR) attempts to deliver Fe to cells; This confounds it as an indicator of visceral protein status
Transferrin is + or - APRP? - APRP
Half life of Prealbumin 2-3 days
Function of prealbumin binds 1:1 with retinol binding protein to transport thyroxine decreases with impaired visceral protein status can be messure of adequACY OF dietary repletion
Prealbumin is + or - APRP - APRP
Half life of Retinol Binding Protein 12-25 hours (*most sensitive indicator of visceral protein status)
Function of retinol binding protein 1. binds with preablumin 1:1 to transport thyroxine 2. indicator of visceral protein status 3. indicator of adequacy of dietary repletion
Retinol Binding Protein is - or + APRP - APRP
Insulin like growth factor (=Somatomedin C) -indicator of visceral protein status -Maybe indicator of refeeding -regulates anabolic activity of fat, muscle, cartilage, and T cells
Fibronectin -indicator of visceral protein status -involved in wound healting, cell adhesion, differentiation, growth, and opsonization
Function of Haptoglobin 1. transport extra corpuscular hemoglobin to liver 2. + APRP
Haptoglobin is + or - APRP + APRP Sequesters hemoglobin(and thus iron)from blood to prevent its utilization by bacteria
Function of Hemopexin 1. Binds and transports free heme to liver; in traumatic times, this keeps iron from being used by bacteria 2. + APRP
Hemopexin is + or - APRP? + APRP Sequesters heme (and thus iron)from blood to prevent its utilization by bacteria
Function of Ferritin 1. Indicator of iron stores (decreases with iron deficiency) 2. + APRP which sequesters iron to prevent its utilization by bacteria
Ferritin is + or - APRP + APRP Stores iron to prevent its utilization by bacteria
Alpha 1 antitrypsin 1. Inhibits proteases released into circulation during phagocytosis (limits damage after immune cells perform their function) 2. + APRP
Alpha 1 antitrypsin is + or - APRP + APRP Limits damage(of body) from proteolytic enzymes released during phagocytosis (immunity) by inhibiting proteases
Antithrombin III binds serum proteases, thus inhibiting the activity of thrombin and other blood clotting proteins
Orsomucoid (= Alpha 1 Acid glycoprotein) + APRP involved in wound healing
Orsomucoid is + or - APRP? + APRP involved in wound healing
Function of C- Reactive Protein Marker of inflammation and infection; increases (up to 1000 fold in some cases) 4-6H following trauma, and in heart disease, hyperglycemia, diabetes, metabolic syndrom, exercise....
When do C-Reactive Protein levels decrease? When pt is entering anabolic phase
High risk C-Reactive protein level? >3mg/dL
C-Reactive Protein is + or - APRP + APRP marker of inflammation and infection
Function of Alpha2 Macroglobulin + APRP which augments immune function
Alpha2 Macroglobulin is + or - APRP + APRP Augments immune function
Function of Metallothionein + APRP which stores zinc (to prevent its use by bacteria) and scavenges free radicals
Metallothionein is - or + APRP? + APRP stores zinc (to prevent its use by bacteria) and scavenges free radicals
Function of Ceruloplasmin 1. functions to transport 90% of blood copper 2. + APRP with oxidase activity that promotes Fe transport and stimulates SOD activity
Ceruloplasmin is + or - APRP? + APRP has oxidase activity that promotes Fe transport and stimulates SOD activity
Function of Ig or Ab Bind antigens and foreign substances to aid in their destruction
Function of Complement Binds Ab-Ag complexes to destroy Ag
Prothrombin time indicates... plasma clotting activity; elevations suggest impaired clotting activity
Conditions with increased Prothrombin Time 1. Liver disease 2. Vitamin K deficiency
Nitrogen Balance indicates... + = anabolism or high protein intake - = catabolism of body protein or low protein intake
WBC count indicates... increase = Illness or infection; used to calculate TLC
RBC count indicates... increase has various causes decrease indicates an anemia of Fe, folate, &/or B12
RBC count is A count of the number of RBC per unit volume in venous blood
Function of Hemoblobin? Respiration- Binds and carries CO2 and O2 to and from lungs and tissues
Hemoglobin levels indicate.... decrease = Fe deficiency anemia, or folate or B12 anemia
Hemoglobin measures... the amount of hemoglobin contained in a dL or blood
Hematocrit (Hct)measures [= Packed Cell Volume (PCV)] the proportion(%)of total volume of blood that is RBC (measured after centrifugation)
Hematocrit indicates decrease = anemia
Mean Corpuscular Volume (MCV) measures the size of RBC,(measure is microliter cubed); used to establish the type of anemia
Mean corpuscular volume indicates increase = macrocytic anemia as seen with folic acid and vitamin B12 deficiencies decrease= microcytic anemia as seen with Fe deficiency anemia
Mean corpuscular hemoglobin (MCH) measures represents the content (by weight) of hemoglobin within each RBC
Mean corpuscular hemoglobin indicates normal = identifies anemia as normchromic, as with B12 and folate deficiency anemia decrease = identifies anemia as hypochromic as with Fe deficiency anemia
Mean Corpuscular Hemoglobin concentration (MCHC)measures the amount of Hgb in dL of blood
Mean Corpuscular Hemoglobin concentration (MCHC)indicates normal = identifies anemia as normchromic, as with B12 and folate deficiency anemia decrease = identifies anemia as hypochromic as with Fe deficiency anemia *decreases especially with chronic anemia
Platelet (thrombocyte) count indicates increase = increased risk for blood clots not used to assess nutritional status
Red Blood cell distribution width (RDW) measures the coefficient of variation of RBC size
Red Blood cell distribution width (RDW) indicates increase (means large variation in size)= anemia
Labs associated with Fe deficiency*** usually microcytic and hypochromic decreased ferritin, decreased Tf satuation, decreased serum Fe, decreased RBC count, decreased MCV, decreased MCH, decreased HCT*, decreased HGB*, increase Transferrin, increased sTfR
Labs differentiating B12 and folate anemias Both have increased MCV 1. Serum B12 and folate concentrations 2. Methymalonic acid- increase suggests b12 deficiency 3. Schilling Test- assess B12 absorbtion problems
Reticulocyte count incidates number of young rbc is an index of bone marrow activity to generate rbc increases with effective treatment of anemia
Erythrocyte sedimentation rate (ESR)indicates increase = inflammation
Total lymphocyte count measures the number of wbc that are lymphocytes
Normal lymphocyte count 5000-10,000 cells/mm3
Lymphcyte deficiency <1500 cells/mm3 mild = 1200-1500 moderate = 800-1200 severe = <800
Lymphocytopenia is associated with <1500 lymphocytes/mm3 is associated with limited immune reserves and impaired visceral protein status (also drug therapy, infection, age...)
Lymphocytosis is associated with (= increased TLC) infection, cancer
Induration of <5mm on three antigen skin tests indicates.. anergy (=the inability to fight against foreign Ag, may require reverse isolation)
Induration >5mm even once indicates immune competence
Prognositic Nutrition index indicates estimated risk of anergy, sepsis, and death higher value (%)= higher risk
Prognostic Nutrition Index utilizes these tests... Albumin, Triceps skinfold, Transferrin, and delayed hypersensitivity (Ag skin test)
Best predictors of mortality albumin (in pt with sepsis and anergy) prognostic nutrition index
Optimal LDL concentration <100 mg/dL
High LDL concentration >130 mg/dL (medicated at >160)
Causes of high LDL concentrations - genetic disorders - high saturated and trans fat diets - high cholesterol diets - elevated BG
Optimal HDL concentrations >60 mg/dL
Low HDL concentration <40 mg/dL
High total cholesterol > 200 mg/dL associated with increased risk of heart disease (medicated >240)
Low total cholesterol <150 mg/dL associated with malunitrition, liver disease, sever sepsis, anemias, ...
Implications of increased Tc and LDLc - increased risk for heart disease - pt may benefit from diet with lower cholesterol and fat and increased soluble fiber
High TG concentrations >200 mg/dL
Implications of high TG - increased risk for heart disease - pt may benefit from decreases dietary simple carbohydrates
Kidney function tests (~3) - BUN - Creatinine (serum) - Uric acid
Liver function tests (5) - SGPT or ALT - SGOT or AST - Gamma glutamyl transferase (GGT) - Alkaline phosphatase (ALP) - Lactate dehydrogenase (LDH)(5 and total) Some inclue PT and bilirubin
Heart Function tests (6) - Creatine Phosphokinase (CPK0= Creatine kinase (CK), MB* isoform - SGOT or AST - Lactate dehydrogenase 1(LDH) - Troponin - Myoglobin
Pancreas Function tests (3) - Serum amylase - serum lipase - SGOT or AST
increase ast, ldh, and ck may indicate myocardial infarction
Gastrointestinal function tests: PLE decreased albumin, Tpro, Palb (blood loss) decreased B6, zinc, Ca (albumin loss) decreased iron, bhg, hct, etc (blood loss) increased NH3 (
Liver disease is indicated by increased AST, ALT, GGT, ALP, and LDH (5) PT and bilirubin may also increase
Alcohol intake may be indicated by increased ALT,AST, bilirubin, and amylase,
Myoglobin increases ? hours after heart attack 2-4 hours
Troponin increases ? hours after heart attack 4-6 hours
Soap formation is indicated by decreased serum MG, not Ca
Lactose intolerance is indicated by increase in hydrogen breath test
Carbohydrate malabsorption is indicated by sustained increase in urine or serum levels of d-xylose after d-xylose test
Steatorrhea is indicated by fecal fat test
Hydration status is indicated by serum osmolarity, and serum Na, K, Cl, BUN, albumin, hgb, hct increases = dehydration decreases = overhydration
Muscle trauma is indicated by increased LDH
Bone trauma is indicated by increased alk phos, and P if jaw, amylase also increases (salivary)
Low serum P indicates phophorus deficiency
Low serum Fe indicates nothing alone, must look for other indicators of Fe deficiency
Serum Na indicates primarily water balance
Low serum K indicates usually K deficiency, but...
Low serum Mg indicates Mg deficiency or soap formation
Created by: saranonymous