4900 Exam II to Final Flashcards
(130 cards)
1
Q
Static tests
A
Measurement of a nutrient or its metabolite in the blood, urine, or body tissue. Nutrient level may not reflect nutrition status of individual, or weather the body as a whole is in excess or depletion.
2
Q
Functional status
A
Measurement of a nutrients performance in the body, the failure of the physiologic processes that rely on that nutrient for optimal performance. May only reflect limited info on nutrition status.
3
Q
Is urinalysis a goo point of care test
A
Yes, reliable, but could be more sensitive
4
Q
How does urinalysis work?
A
Colorimetric reactions
5
Q
What is the urinalysis point of care used to test for?
A
A general health screen for renal & metabolic disease. Can monitor disease - infections, kidney, liver, urinary tract. Check status of diabeties.
6
Q
Normal urinary pH
A
4.5-8.0
7
Q
normal urinary specific gravity
A
1.002-1.035
8
Q
proteinuria
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> 150 mg/24hrs, or 10mg/100 mL
9
Q
glucosuria
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> 50mg/dL
10
Q
Ketones
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anything more than trace indicates high fat oxidation
11
Q
nitrates in urine
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indicate bacterial infection
12
Q
Microscopic evaluation of the urine
A
RBCs, WBCs, epithelial cells, casts, bacteria, yeast, crystals. Any of these on the urine are indicate disease.
13
Q
What is the most common nutrient deficiency in the US?
A
Iron, and is the most common cause of anemia
14
Q
What other nutrient deficiency can result in anemia?
A
B12 and folate.
15
Q
Anemia
A
A hemoglobin level below the normal reference range for individuals of the same sex and age.
16
Q
Stages of iron deficiency
A
Depleted stores. Early functional iron deficiency (without anemia). Iron deficiency anemia.
17
Q
Indicators of depleted iron stores?
A
Serum ferritin concentration have decreses 400µg/dL, TIBC goes up.
18
Q
Early functional iron deficiency (without anemia)
A
Transferrin saturation 70 µg/dL. Serum transferrin receptor >8.5mg/L. Adverse physiologic consequences can begin to occur.
19
Q
Iron deficiency anemia
A
Hemoglobin concentration < 80 fL. Also, ↓ serum ferritin, transferrin saturation, hemoglobin & MCV, and increases erythrocyte protoporphyrin
20
Q
Iron deficiency anemia is associated with what type of RBCs?
A
Microcytic. MCV < 80 fL
21
Q
Is there a single test that is diagnostic for iron deficiency anemia?
A
No
22
Q
Where is iron stored in the body
A
On hemosiderin in the bone marrow
23
Q
Total body iron in men and women
A
Men = 3.6g (3-4). Women = 2.4g (2-3)
24
Q
Ferritin
A
40-160 µg/L. Primary storage form of Fe in the body, is also an acute phase protein. Found in the blood and tissues. An early indicator of iron deficiency.
25
Ferritin as iron status indicator
Most sensitive test available for detecting iron deficiency. Decreases occur before anemia and RBC changes. No longer a good test once serum depletion occurs.
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Transferrin
Normal = 200-400 mg/dL. Binds iron in plasma & transports to bone marrow, and areas using Fe. An indicator of protein status.
27
Serum iron
Is the amount of iron bound to transferrin. Level is a measure of the amount of iron bound to transferrin. Levels fall between depletion of tissue iron stores and anemia. Could be normal in people with early iron deficiency.
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Normal serum iron for men, women, infants, child
Men 65-110µg/dL. Women 50-170 µg/dL. Infants 100-250µg/dL. Children 50-120µg/dL
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total iron binding capacity
Measures the amount of iron capable of being bound to serum proteins & provides an estimate of serum transferrin. Is increased with depletion of iron stores.
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Transferrin saturation %
A ration of TIBC to serum iron. The % of transferrin with bound iron. More sensitive measure of iron status than either TIBC, or serum iron.
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Normal transferrin saturation % in males and females
Male 15-50%. Female 12-45%. NHANES < 16% = deficiency.
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What is the best laboratory indicator of body iron stores?
Serum ferritin level, which drops substantially in people with iron deficiency.
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Functional iron tests
Hemoglobin, hematocrit, Mean corpuscular hemoglobin, mean corpuscular V, MCHC, Iron deficiency, Iron deficiency anemia.
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Hemoglobin (Hgb)
Iron-containing molecule found in RBCs. An indicator of late iron deficiency. Most widely used test for iron-deficiency anemia.
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What is the most widely used test for iron deficiency anemia?
Hemoglobin (Hgb)
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Normal ranges for Hgb in males, females, pregnancy,
Male 14-18 g/dL. Female 12-16 g/dL. Pregnant female > 11 g/dL.
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Hgb for newborns, children
Newborn 14-24 g/dL. 2wk - 18yo 12-15.5 g/dL
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Critical values for Hgb
< 5 or > 20 g/dL
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What is the point of care device for Hgb
HemoCue.
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Hematocrit (Hct)
aka packed cell V. The percentage of RBCs making up the entire V of whole blood. Decreased in late stage iron deficiency.
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Normal Hct for men and women, pregnancy
Males 40-54%. Females 37-47%. Pregnancy >33%
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Factors that may influence Hgb, & Hct
Altitude. Hemodilution/concentration. Dehydration.
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What occurs in stage one iron deficiency
Serum ferritin levels decrease. No other effects
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What occurs in stage II iron deficiency
Iron stores are depleted. ↓ transferrin saturation % <15%. ↑TIBC. ↑ Erythrocyte protoporphyrin. Hgb shows little decrease at this point, physiological effects begin to be felt. sTfR ↑, shows depletion before anemia occurs.
45
What occurs in stage III iron deficiency
Is iron-deficiency anemia - microcytic, hypo chromatic anemia. Serum ferritin, transferrin saturation, Hgb, & MCV are decreased. Erythrocyte protoporphyrin is increases >100µg/dL. Hgb is below normal <82
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sTfR
is not affected by inflammation, or acute phase proteins. Regarded as a valuable tool in diagnosing iron deficiency and monitoring erythropoiesis.
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Three forms of anemia
Microcytic = MCV < 80 fL & decreased Hgb. Macrocytic = MCV >100fL. Hypochromic = abnormally low Hgb, & MCHC < 27pg
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Mean Corpuscular Volume (MCV)
The average V of RBCs. Indicates the size of RBCs.
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Normal range of MCV
80-100 fL for both men and women.
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Increased MCV indicates?
Macrocytosis - deficiency of folate, or B12. Chronic liver disease, chronic alcoholism, cytotoxic chemotherapy
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Decreased MCV indicates?
Microcytosis - chronic iron deficiency, lead poisoning, Thalassemia, anemia of chronic diseases.
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Mean Corpuscular Hemoglobin (MCH)
The amount of hemoglobin in RBCs.
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Normal MCH in men and women
26-34 pg
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Mean Corpuscular Hemoglobin Concentration (MCHC)
The average concentration of hemoglobin in the average RBC.
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Iron deficiency anemia
The single most prevalent nutrient deficiency in the world. A deficiency in the size or number of RBCs, or the amount of Hgb they contain.
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Koilonychia
Spoon shaped nails, a symptom of iron deficiency anemia.
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Angular stomitus
Is associated with deficiency of Fe.
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Iron overload
aka hemochromotosis. Maybe genetic - heterozygous. Hemolytic anemias, or increased iron ingestion.
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Hemochromatosis symptoms
Fatigue. Cirrhosis, or diabetes. bronze skin. Abdominal pain, heart problems. Increased risk of hepatocellular carcinoma
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Total body iron of ? may indicate hemochromatosis?
>5g. Normal is 3-4g
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Alanine Aminotransferase (ALT)
aka SGPT. An enzyme found in large concentrations in the liver, & to lesser extent in the kidneys, skeletal muscles, & myocardium. Increased in the blood when these organs are damaged, such as alcoholism, hepatitis, cirrhosis, bile obstruction, drop toxicity.
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Aspartate Aminotransferase (AST)
aka SGOT. An enzyme found in large concentrations in the myocardium, liver, skeletal muscles, kidneys, & pancreas. Increased levels are seen in the blood 8-12hrs after these organs are damaged.
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Alkaline Posphatase (ALP)
An enzyme found in the liver, bone, placenta, and intestine. Increased when bone is diseased, or in growth periods, also in some live diseases.
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Lactic (lactate) dehydrogenase (LDH)
An enzyme found in the cells of many organs, released when cells are damaged. Are 5 isoenzyme forms that are organ specific.
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Megaloblastic anemia
Large, immature RBCs with diminished O2 capacity. Can be caused by B12, or folate deficiency.
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folic acid deficiency
Reduced RBCs, leukocytes, platelets. Stores are depleted in 2-4mo. Are four stages of folate deficiency.
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Bilirubin
Breakdown of heme. Build up in blood indicates poor function in liver/kidney.
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Blood Urea Nitrogen (BUN)
Normal excretion product of N (signifies protein metabolism; high levels = renal failure.
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Calcium (chem profile)
High serum levels indicate failures; not bone density. CO2 - levels reflect acid/base balance.
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Vitamin A
Serum most common biochem marker; dark adaptation; RDR
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Vitamin C
Serum, plasma, WBC (esp granulocytes)
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Vitamin B6
Serum, urine, RBC B6, or B6 specific enzyme load tests.
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What are the best status markers for vitamins?
The best status markers may measure 'system failure' or 'a metabolite back-up', or metabolic reaction and NOT serum level of nutrient.
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Vitamin C functions
Formation of collagen, Maintenance of capillaries, bone, and teeth. Promotes iron absorption, and protects vitamins & minerals from oxidation.
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Scorbutic gums
A symptom of scurvy. Gingival redness in the triangle shaped inder-dental papillae between teeth.
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Corkscrew hairs
In hyperkeratotic follicles are pathognomonic of scurvy, or vitamin C deficiency.
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Is there a reliable functional indicator for vitamin C?
No reliable functional indicator for vitamin C. Static tests are most used.
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Static tests for vitamin C
Serum, or plasma AA - most commonly used & better indicator of recent diet. Leukocyte AA - best indicator of stored Vit C.
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Who is at greatest risk of Vit C deficiency?
non-Hispanic white males.
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What is the best indicator of Vit C stores?
leukocyte vit C levels better represent cellular stores & total body pool of vit C.
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The most common and informative biochemical indicator of vitamin B6 status is?
plasma PLP. pyridoxal 5'-phosphate (PLP). Is a reflection of tissue storage. Asthma, CHD, pregnancy may lower PLP with out B6 deficiency.
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plasma PL
pyridoxal. Is bound tightly by hemoglobin. Used as an additional indicator of B6 status, used along with PLP
83
Urinary 4-pyridoxic acid
The major urinary metabolite of Vit B6. Indicative of immediate dietary intake. Requires 24hr urine collection. Is a functional indicator of B6 status.
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Tryptophan load test
Measure of B6 status. PLP is required to convert tryptophan to nicotinic acid. With out PLP urinary Xanthurenic acid is elevated because it cannot be converted to nicotinic acid.
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What are conflicts during the tryptophan load test?
pt. can consume no protein. Exercise, LBM, individuality, amount of tryptophan used, estrogen, oral contraceptives, pregnancy.
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Methionine Load Test
Methionine can not be converted without PLP. Without PLP then higher urinary cystathionine and cysteine sulfuric acid. Requires 24hr urine collection & controlled protein intake.
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Erythrocyte alanine transaminase (EALT)
Is a RBC transaminase that requires PLP. Is a functional indicator of B6 status. The addition of PLP to a sample of EALT shows increased activity of EALT
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Functions of Zinc
Component of numerous enzymes - protein synthesis, wound healing, immune function, tissue growth & maintenance.
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Severe Zn deficiency causes?
dwarfism & hypogonadism
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What is the best indicator of Zn status?
There is NO sensitive biochemical or functional indicator.
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What are the static measures of Zn status?
Are available, but are complicated by normal homeostatic control of Zn. Also, serum levels affect by factors unrelated to nutritional status.
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Conservation of Zn
Conserved by gut-enteropepatic circulation = less Zn secretion. Distribution of Zn to higher priority areas.
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What non-nutritional factors influence plasma Zn levels.
↓ levels can result from stress, infection, inflammation, oral contraceptives, & corticosteroids. ↑ levels can result from fasting and RBC hemolysis.
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What can serum Zn status tell us?
may tell whole body pool size, although it is not reliable to tell us what was in the diet, or how the body is re-distributing.
95
Metallothionen
A protein found in most tissues but primarily in the liver, pancreas, kidney, and intestinal mucosa. Also in the SERUM & RBCs. Maybe an indicator of Zn status, esp when used in conjunction with plasma Zn
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How does metallothionen indicate Zn status
When both metallothionen and plasma Zn concentrations are low a Zn deficiency is indicated. Metallothionen is not an acute phase indicator
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Hair Zn
Shows long-term Zn status.
98
Urinary Zinc
Lower concentrations reported in urine of zinc depleted persons. However, can be impacted by other factors such as cirrhosis, viral hepatitis, sickle-cell, surgery, TPN.
99
Functions of Vitamin A
Vision. Integrity of epithelial cells. Embryonic development. Immune function maintenance.
100
What are the 5 categories of vitamin A status?
Deficient. Marginal. Adequate. Excessive. Toxicity. Clinical signs are evident at the extremes.
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Static tests of Vit A status?
Serum retinol. Liver biopsy. Breast milk
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Functional tests of Vit A status
Dose-response. Epithelial cells of conjunctiva. Dark adaptation tests.
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What is the most common biochemical measure of Vit A in populations?
Measurement of plasma concentration of retinol. Is only indicative of depletion or toxicity.
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How is serum vit A generally found
95% of plasma Vit A is in form of retinol & bound to retinol-binding protein.
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Relative Dose Response (RDR)
aka modified RDR (MRDR). When stores of retinol are high, plasma retinol is little affected by oral administration of Vit A. When reserves are low, the plasma retinol increases markedly after an oral dose.
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Conjunctive Impression Cytology
Vit A deficiency can cause morphologic changes in epithelial cells covering body. Is a reduced number of goblet cells in eye.
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Limitations of conjunctive impression cytology?
Difficult to obtain in children < 3. Infections/ malnutrition limit sensitivity. Is a population tool.
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Dark Adaptation
Best defined function of Vit A. Measures rhodopsin regeneration rate after light exposure. Good test for the individual, can be done in a Dr.'s office.
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What is the "gold standard" of Vit A status
Direct measurement of liver stores.
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Direct measurement of liver stores of Vit A
Biopsy of liver tissue required. 90% of Vit A is in the liver.
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Retinol Isotope Dilution
Known amount of radio-labeled Vit A with fat for absorption. After 2-3 wks blood sample is taken and ration of labeled:non-labeled is taken. Best method to assess person's stores of Vit A. If the isotope is ↑ in the blood then they were deficient.
112
Primary function of Vit D
Maintain serum Ca & phosphorus concentrations in a range that supports bone mineralization, neuromuscular function, & various cellular processes.
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What is the best measure of Vit D status?
Serum concentration of 25-hydroxyvitamin D, the major circulating form of the vitamin.
114
What are the cut points for Vit D deficiency or adequacy?
There has been no systematic, evidence-based development process to establish 25(OH)D cut points.
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Deficiency of Vit D, relative to bone health is at what level?
< 30 nmol/L. 30-50 nmol/L = potentially at risk.
116
What is most widely used measure of I status?
90% of dietary I is excreted in urine, thus urinary I is most widely used.
117
Serum thyroglobulins
Measure of I status - a longer term indicator.
118
What is the most common neurological syndrome caused by one nutrient?
Pernicious anemia. Cause by lack of intrinsic factor (IF).
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Functions of B12
Helps make DNA & RNA and thus important in protein synthesis. Methylates other species (Hcy). Helps make choline (i.e. the basis of neural impact).
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What is the 'gold standard' for B12 status?
No gold standard exists.
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What are the best status markers for B12 deficiency>
tHcy and Methymalonic acid (MMA). Both will be increases in B12 deficiency.
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functions of folate?
Coenzyme transporting single carbon groups from one compound to another in AA metabolism and nucleic acid synthesis. Involved in DNA and RNA synthesis.
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What will be reduced in folate deficiency?
Leukocytes, RBCs, and platelets
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What are the best indicators for folate status?
Serum folate, and RBC folate
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Which folate indicator is the best indicator of tissue stores?
RBC folate concentration
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Who determines a pt's need for a dysphagia diet?
The speech therapist.
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Dysphagia I
pureed foods, pudding-like thickness.
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Dysphagia II
Mechanical altered, or Soft. No raw fruits or vegetables. Soft, moist texture foods.
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Dysphagia III
Mechanical soft, or Chopped. Moist foods, chopped into small pieces.
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Common risk of a dysphagia diet?
Dehydration. Reduced intake. Emotional. Tolerance.
