Nutrition (Iron, Vitamins, Calcium) Flashcards
(45 cards)
1
Q
General Info about Iron (3)
A
- Critical component of enzymes, cytochromes, myoglobin and hemoglobin
- Females need significant amount of iron in order to adequately have enough iron to make up for menstrual loss; screen for iron deficiency anemia
- Essential for brain growth
2
Q
7-12 month old daily iron requirement
A
11 mg/day
3
Q
1-3 year old daily iron requirement
A
7 mg/day
4
Q
4-8 year old daily iron requirement
A
10 mg/day
5
Q
9-13 year old daily iron requirement
A
8 mg/day
6
Q
14-18 year old daily iron requirement (male and female)
A
Male: 11 mg/day
Female:15 mg/day
7
Q
19-21 year old daily iron requirement (male and female
A
Male: 8mg/day
Female: 18mg/day, but if pregnant then 27mg/day
8
Q
Vitamin A (4)
A
- Found in green leafy vegetables, carrots, sweet potatoes, and liver
- Growth and health of epithelial cells in eye, respiratory, urinary, and digestive tract
- Lack of Vitamin A is most common cause of preventable blindness in children
- Keratonemia → eat a lot of carrots and skin turns yellow/orange
9
Q
Vitamin A Clinical Manifestations (7)
A
- Nyctalopia (night blindness)
- Corneal xerosis: dried out cornea
* Painful b/c cornea is full of nerve endings
* No tears in bottom of eye b/c so dry - Keratomalacia (ulcerations)
* Can lead to blindness
* Ciliary injection (emergency) - Blindness once ulcerations occur
- Failure to thrive and depressed immune function
- Increased risk of diarrhea disease
- Bitot spots: accumulation of dead microbateria and dead cells on the eye
10
Q
Thiamine (B1) (4)
A
- Found in yeast, legumes, pork, rice, cereals, milk and vegetables
- Cooking can destroy it
- If you are deficient, you will develop Wernicke-Korsakoff syndrome or in infancy cardiac failure
- Rare to see children deficient in thiamine because of cereal intake
11
Q
BeriBeri Syndrome (4)
A
- what younger children/infants tend to get with Thiamine (B1) deficiency
- Cardiac failure
- Loud piercing cry
- Vomiting
12
Q
Wernicke-Korsakoff Syndrome (6)
A
- Irritability
- Peripheral neuritis
- Decreased tendon reflex
- Loss of vibration sense
- Aseptic meningitis
- Ataxia
*from Thiamine (B1 deficiency)
13
Q
Riboflavin (B2)
A
Found in enriched food, fish, eggs, meat, green vegetables, yeast and milk.
*Malabsorption due to celiac disease, short gut syndrome, etc could lead to riboflavin deficiency
14
Q
Riboflavin deficiency manifestations (7)
A
- Cheilosis
* Abnormal condition of the lips characterized by scaling of the surface and by the formation of fissures in the corners of the mouth. - Glossitis
- Keratitis (corneal or ciliary injection)
- Photophobia
- Seborrheic dermatitis
- Sore throat, hyperemia of mucosal surfaces
- Normocytic anemia
15
Q
Where is Niacin (B3) found?
A
Milk and eggs in large quantities
*Malnutrition and tryptophan deficient corn diets can occur
16
Q
Niacin Deficiency clinical manifestations (3)
A
3 Ds
- Diarrhea
- Dementia
- Dermatitis (sunburn on the photosensitive areas of the skin)
17
Q
B12 (Cyanocobalamin) (3)
A
- Enterocytes in the terminal ileum absorb 12 and allow it to be recycled
* B12 is reabsorbed in the ileum; so if ileum is cut out then can’t absorb B12 - Excreted in bile and reabsorbed in the terminal ileum
- Large stores of B12 in the liver
18
Q
Clinical Manifestations of B12 Deficiency In younger children
A
includes poor growth and development with difficulties with movement
19
Q
Clinical Manifestations of B12 Deficiency In older children (2 categories)
A
- Neurological—developmental delay, paresthesia, impaired vibratory, proprioceptive sense, hypotonic, seizures, ataxia, memory loss, depression, weakness, poor school performance
- Hematologic—macrocytic anemia, thrombocytopenia, leukopenia pancytopenia
20
Q
Common Causes of B12 Deficiency (7)
A
- Surgical removal of stomach
- Chronic inflammation of pancreas
- Intestinal parasite
- Medication (metformin)
- Genetic diseases such as celiac disease, bacterial overgrowth
- Decreased intake: Vegan/malnutrition
- Increased requirements occur in HIV and hemolytic anemia
21
Q
Diagnosis of Vitamin B 12 deficiency (hypocobalaminemia) (3)
A
- Methlymalonic acid (MMA)
- Homocysteine level
- B12 Level (only one that directly measures B12)
22
Q
Methlymalonic acid (MMA) (3)
A
Indirect measurement of b12 levels
- Increased methylmalonic acid levels in deficiency
- Sensitive (those with the disease almost always test positive) but not specific (those that test positive do not always have the disease).
- MMA is elevated in 90-98% of patients with B12 deficiency
23
Q
Homocysteine level (2)
A
- Elevated homocysteine levels denote vitamin B12 o folate deficiency so again not specific
- Indirect level of B12
24
Q
Vitamin C (4, including manifestations w/ deficiency)
A
- Scurvy or Barlow disease occurs after 1-3 months of deficiency
* Frankel’s line is seen on X-ray in scurvy - Newborns are protected since human milk and formula contains vitamin C
- Bleeding, osteopenia, and gingival disease are sign of vitamin C deficiency
- Could be due to failure to thrive, not eating, Munchosen syndrome (starving child to get attention)
25
Folic Acid/Folate (3)
1. Coenzyme in the metabolism of nucleic and amino acid
2. Women of child-bearing age should be taking folic acid! Vital for women because it prevents neural tube defect
* Average female of child bearing age does not meet requirements
3. Prevents megaloblastic anemia
26
1-3 year old folic acid requirement
150 micrograms
27
4-8 year old folic acid requirement
200 micrograms
28
9-13 year old folic acid requirement
300 micrograms
29
14-21 year old folic acid requirement
400 micrograms
30
Calcium (3)
1. Essential for blood clotting, muscle contractions, nerve transmission, bone and teeth formation
2. Need to ask about calcium intake during childhood and adolescence; this is when calcium goes into the bones and deficiency will affect the patient throughout life
3. Same levels needed during pregnancy
31
0-6 months calcium requirement
200mg/day Al,1000 mg/day UL
32
7-12 months calcium requirement
260 mg day Al,1,500 mg/day UL
33
1-3 years calcium requirement
700 mg/day Al, 2500 mg/day UL
34
4-8 years calcium requirement
1000 mg/day Al, 2,500 mg/day UL
35
9-18 years calcium requirement *males and females)
Males: 1000mg/day Al, 2,5000 UL
Females: 1,300mg/day Al, 3,00mg/day UL
36
Vitamin D (5)
1. All newborns need to be started on vitamin D within the first few days of life
2. Cod liver oil, liver, mackerel and sardines are natural sources
3. Fortified foods and sun are two main sources
4. Vitamin D3 is three times more potent than D2
* Should get D3 supplement of 1,000 units/day
5. Autoimmunity disease could be due to a lack of vitamin D; Data is showing that you really need to get enough vitamin D
37
Vitamin D requirements
Daily Requirements: recommended that all infants and children, including adolescents, have a minimum daily intake of 400 IU of vitamin D beginning soon after birth
38
Stage I of Vitamin D deficiency
25-OH-D level decreases, resulting in hypocalcemia and euphosphatemia; 1,25-OH2-D may increase or remain unchanged
39
Stage II of Vitamin D deficiency
25-OH-D level continues to decrease; PTH acts to maintain calcium through demineralization of bone; the patient remains eucalcemic and hypophosphatemic slight increase in the skeletal alkaline phosphatase level
40
Stage III of Vitamin D deficiency
Severe 25-OH-D deficiency with hypocalcemia, hypophosphatemia, and increased alkaline phosphatase; bones have overt signs of demineralization
41
Clinical Stages of Vitamin D deficiency (8)
1. Dietary calcium absorption from the gut decreases from 30%–40% to 10%–15% when there is vitamin D deficiency
* Not absorbing calcium as well with vitamin D deficiency
2. Risk of fracture as the calcium mobilizes from the bone
3. Leads to osteopenia, osteomalacia, osteoporosis
4. Can also cause immune deficiencies
5. Low concentrations of 25-OH-D trigger the release of PTH in older infants, children and adolescents in an inverse relationship not typically seen with young infants; the increase in PTH mediates the mobilization of calcium from bone, resulting in a reduction of bone mass; as bone mass decreases, the risk of fractures increases
6. Rickets
7. Enlargement of the skull, joints of long bones, and rib cage; curvature of spine and femurs; generalized muscle weakness
8. Abnormal immune function with greater susceptibility to acute infections and other long-latency disease states
42
Potential latent disease processes associated with vitamin D deficiency (4)
1. Dysfunction of the innate immune system is noted with vitamin D deficiency
2. Immunomodulatory actions may include
3. Potent stimulator of innate immune system acting through Toll-like receptors on monocytes and macrophages
4. Decrease threshold for long-latency diseases such as cancers (including leukemia and colon, prostate, and breast cancers), psoriasis, diabetes
43
Vitamin D deficiency presentation at Infancy (5)
1. Failure to thrive
2. Seizures and tetany due to calcium deficiency
3. Widened cranial sutures
* Need to measure fontanel at every visit! It should be decreasing!!!!
4. Frontal bossing
5. Hypotonic
44
Vitamin D deficiency presentation during childhood and adolescence (6)
1. Bony changes
2. Delayed tooth eruption
3. Bowed legs
4. Kyphosis
5. Pelvic abnormalities
6. Pot belly
45
Vitamin E (4)
1. Found in variety of foods
2. Results from malabsorption, short bowel cholestatic liver disease
3. Fredereich Ataxia
4. Serum alpha tocopherol level less than 5 mg
