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