click below
click below
Normal Size Small Size show me how
Med Nutr I final
Biochemical assessment
Question | Answer |
---|---|
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 |