Term
| What types of pts have increased requirements of vitamins and minerals? |
|
Definition
pregnancy and lactation
growth
severe trauma
HIV
malabsorption syndromes
substance abuse
certain medications |
|
|
Term
| What is the purpose of a DRI? |
|
Definition
Dietary Reference Intakes
-formulated to focus on the prevention of chronic dz |
|
|
Term
| Fat soluble vitamins, ADEK, are stored where? What kind of symptoms occur when given in megadoses over an extended period of time? |
|
Definition
|
|
Term
| How is vitamin A absorbed? |
|
Definition
as Retinol and beta-carotene
Retinol is the most active form
Retinol absorbed from animal sources, beta carotene from plant sources |
|
|
Term
| How is Vitamin A transported? |
|
Definition
| via enterocytes for transport into the lymoh and the blood |
|
|
Term
| Where is Vitamin A stored? |
|
Definition
|
|
Term
| What do deficiencies in Vitamin A cause? |
|
Definition
night blindness (a progressive type of blindness)
xeropthalmia (which can progress to irreversible blindness) |
|
|
Term
| Toxicity of Vitamin A occurs with intakes greater than _________. |
|
Definition
|
|
Term
| What are the fxns of vitamin D? |
|
Definition
sterol hormone-
PTH hormone relationship- intestinal absorption of calcium and phosphorus, and then regulation into bones, teeth and cartilage
Calcitonin
skin
liver
kidneys |
|
|
Term
| What 3 pathologies occur as a result of Vitamin D deficiency? |
|
Definition
rickets
tetany
osteomalacia/osteoporosis
*pts will have bone pain, bowed legs and visible beading on ribs or chest
*sometimes will see a deep indentation bw breasts from sternal bone on elderly affected by rickets |
|
|
Term
| What results from a vitamin D toxicity? |
|
Definition
| kidney stones, nausea, headaches, weakness, anorexia, frequent urination weight loss, irregular heartbeat, weak bones or muscles. |
|
|
Term
| What are the food sources of Vitamin D? |
|
Definition
| milk, eggs, fish oil, cheddar cheese, margarine |
|
|
Term
| What are the fxns of Vitamin E? |
|
Definition
MOST POWERFUL ANTIOXIDANT
antioxidant, protecting polyunsat. fatty acids within the cell membranes from perioxidation
inhibits cell proliferation, pltlt aggregation and monocyte adhesion
role in maintenance of fertility |
|
|
Term
| What are the effects of a vitamin E deficiency? |
|
Definition
rare
-neurologic dysfxn, loss of DTRs, |
|
|
Term
| What are the effects of a vitamin E toxicity? |
|
Definition
not very toxic
-if does get to high amts can effect the ability to clot (by interfering with vitamin K formation |
|
|
Term
| What are the requirements of vitamin E? |
|
Definition
MUST BE ABLE TO ABSORB FAT
-people with pancreatic insufficiency cannot absorb fat well |
|
|
Term
|
Definition
| fortified cereals, almonds, spinach... |
|
|
Term
| What is the fxn of vitamin K? |
|
Definition
blood clotting factors
bone development |
|
|
Term
| If someone is on coumadin, we want to put them on a ______ vitamin K diet. Keep both of these levels steady in order to keep their ____ level at a healthy level? |
|
Definition
low- bc vitamin k and coumadin would be counteractive
INR |
|
|
Term
| Why do newborns receive a shot of vitamin k at birth? |
|
Definition
vitamin k is produced by intestinal bacteria, but not produced yet when born
This prevents hemorrhagic dz of the newborn aka this shot allows liver to produce adequate levels coag factors |
|
|
Term
| With regards to vitamin k deficiency, who does this normally occur in? |
|
Definition
people with fat malabsorption
people on prolonged antibiotic care (detroys intestinal microorganisms)
-will have signs of impaired coagulation: easy bruising, mucosal bleeding and hematuria |
|
|
Term
| Toxicity is uncommon, but people do have allergic rxns, what are the S/S? |
|
Definition
| severe jaundice in infancy |
|
|
Term
| WHat are the sources of vitamin k? |
|
Definition
| kale, spinach, grapes carrots |
|
|
Term
| Why is toxicity unlikely in water soluble vitamins? |
|
Definition
excreted, when capacity has been reached bc cant be stored in fat
-this is also why you need a daily supply to avoid deficiency symptoms |
|
|
Term
| Thiamine deficiencies affect 4 systems: GI, nervous system, cardiovascular, muscular? Describe each? |
|
Definition
GI- anorexia, indigestion, constipation, gastric atony
Nervous- damage to myelin sheath, pain and lack of sensation
Cardio- weak heart muscle, cardiac failure, edema
muscular- fibromyalgia |
|
|
Term
| Whay does thiamine affect all the aforementioned systems? |
|
Definition
bc is a catalyst to turn carbs and proteins into energy
-thus you are not using the food that you eat appropriately
A low level of thiamine may actually cause the GI system to shut down. |
|
|
Term
|
Definition
the deficiency disease of thiamine
-occurs particularily in people who are alcoholics
S/S: poor appetite, irritability, apathy, confusion, weight loss--> advance to abn heart rhythms and heart failure |
|
|
Term
|
Definition
|
|
Term
| What are the requirements of thiamin affected by? |
|
Definition
alcoholism (always think of thiamine when you see wernicke's encephalopathy)
infections, elderly, chronic illness
increased with metabolic demand (pregnancy and infancy/childhood) |
|
|
Term
| Riboflavin is Vitamin B_. |
|
Definition
|
|
Term
| Riboflavin is stable to ____ but destroyed easily by _____. |
|
Definition
|
|
Term
| Where is riboflavin absorbed? excreted? |
|
Definition
small intestine with phosphorus
excreted in the urine |
|
|
Term
| What are the fxns of riboflavin? |
|
Definition
flavoprotein enzymes (FMN and FAD in Krebs Cycle):
responsible for glucose breakdown, all of our cells run on glucose:
-deamination
-respiratory chain
-H+ transfer
huge role in normal growth and deveopment
glycogen production and digestion of fats
maintains normal mucous membranes and protects the nervous system, skin and eyes |
|
|
Term
|
Definition
tissue inflammation and breakdown
cheilosis (dryness around mouth)
glossitis
seborrheic dermatitis
newborns= hyperbilirubinemia |
|
|
Term
| T or F: If deficient in one B vitamin, probably deficient in the others. |
|
Definition
|
|
Term
| The amino acid, __________ is converted to make Niacin |
|
Definition
tryptophan
60 mg of tryptophan = 1 g of niacin |
|
|
Term
|
Definition
|
|
Term
| What are the fxns of niacin? |
|
Definition
coenzyme in tissue and cellular oxidation rxns
NAD (catabolic) and NADP (anabolic)
converts protein and glycerol to glucose to yield high energy
High doses lower cholesterol
Required for normal maintenance, development and fxn of the skin, GI tract and nervous system |
|
|
Term
| Niacin is involved in 20 different rxns in our body that produce ______. |
|
Definition
|
|
Term
| _ vitamins keep the mosquitoes away. |
|
Definition
|
|
Term
| Where is Niacin primarily found? |
|
Definition
protein-rich foods, a deficiency is rare in the US:
meat
peanuts
beans
peas
enriched grains |
|
|
Term
| What ia the niacin deficiency? |
|
Definition
"Pellagra"
-involves skin: dermatitis
-involves nervous system: confusion, apathy
4 Ds: Dermatitis, dementia, diarrhea and death |
|
|
Term
| Can Pellagra be reduced by giving the pts Niacin? |
|
Definition
|
|
Term
| What are some factors that affect Niacin intake? |
|
Definition
growth
pregnancy
lactation
illness
trauma |
|
|
Term
| Pyridoxine is Vitamin B_. |
|
Definition
|
|
Term
| What are the fxns of pyridoxine? |
|
Definition
involved in a lot of rxns pertaining to protein via the coenzyme (pyridoxal phosphate)
-Decarboxylation
-Deamination
-Transamination
-Hemoglobin synthesis
-AA transport
-Conversion of tryptophan to Niacin
-CHO & fat metabolism
heme synthesis
synthesis of serotonin, dopamine, NE and histamine
converts tryptophan to niacin |
|
|
Term
| What can cause a pyridoxine deficiency? |
|
Definition
anemia
Infant formula causes CNS disturbances
pregnancy demands (OCP use)
Antituberculin meds
-deficiency characterized by cheilosis, glossitis, dermatitis, depression, confusion and EEG abns |
|
|
Term
| Pantothenic acid and Biotin are B______ vitamins. |
|
Definition
|
|
Term
| Does pantothenic acid have a deficiency state? |
|
Definition
| No, except in long term TPN |
|
|
Term
| What are some of the fxns of pantothenic acid? |
|
Definition
as a component of coenzyme A:
-activates fatty acids (lipgenesis, lipolysis, ketones)
-activates aas
-activates acetyl groups (ATP or cholesterol precursor)
-activates succinnic acid and glycine
synthesis of fatty acids, triglycerides, cholesterol and ach
synthesis of cell membranes |
|
|
Term
| Where is biotin absorbed? |
|
Definition
|
|
Term
| Does biotin have deficiencies? How can the RDA of biotin be met? |
|
Definition
-only with long-term TPN (wt. loss, N/V, nervous inflamm)
TPN doesn't have biotin in it
-seen a lot in pts with colectomies
-RDA can be met via intestinal bacteria synthesis |
|
|
Term
| What are the fxns of biotin? |
|
Definition
works with acetyl- CoA
synthesis of fatty acids and aas
key role in glucose synthesis |
|
|
Term
| Folate (folic acid) is a water soluble _ vitamin. |
|
Definition
|
|
Term
| What are the fxns of folate? |
|
Definition
coenzyme for carbon transfer
synthesis of heme portion of hemoglobin |
|
|
Term
| What is the source of folate? who is at a higher risk of deficiency? |
|
Definition
food sources: animal sources
vegans, vegetarians, alcoholics |
|
|
Term
| When a pt presents in malnutrition and is an alcoholic, what are they always given? (3) |
|
Definition
|
|
Term
| What are the effects of folate deficiency? |
|
Definition
Megaloblastic Anemia
Sprue
If deficient during pregnancy, increased risk of neural defects (spina bifida) |
|
|
Term
| Many ________ are antagonistic to folate. |
|
Definition
|
|
Term
| Ascorbic Acid is Vitamin _. |
|
Definition
|
|
Term
| What are the fxns of ascorbic acid? |
|
Definition
antioxidant
needed for collagen formation (strengthens bones and BVs, anchors teeth into gums, wound healing and tissue repair)
frees iron from storage form
synthesis of Norepinepherine |
|
|
Term
| What is Vitamin C deficiency? |
|
Definition
Scurvy
-delayed wound healing
-depleted during stress; decreases immune response
-hemorrhages around nails, muscle weakness, delayed wound healing, bruised skin, loose teeth, swollen gums, fatigue and depression |
|
|
Term
| How long does it take for deficiency symptoms to appear with Vitamin C? |
|
Definition
|
|
Term
| Vitamin C is the _________ water soluble vitamin. |
|
Definition
|
|
Term
| What are the sources of ascorbic acid? |
|
Definition
citrus fruits
tomatoes
-easily lost in food preparation and cooking |
|
|
Term
| Cobalamine is Vitamin B__. |
|
Definition
|
|
Term
| where is cobalamine absorbed? |
|
Definition
| ileum bound to intrinsic factor |
|
|
Term
| What are the food sources of cobalamine? |
|
Definition
animal foods
organ meats
milk and milk products
-vegetarians can become deficient |
|
|
Term
| What are the clinical effects of cobalamine deficiency? |
|
Definition
pernicious anemia:
Without intrinsic factor as a carrier, heme cannot be formed
Folate will correct blood problem but neurological degeneration will proceed
Sprue
Elderly |
|
|
Term
| What 2 processes is cobalamine essential for? |
|
Definition
| cell replication and neurological function. |
|
|
Term
| MINERALS!!!!!!! how do they occur in the body? |
|
Definition
| occur in the body as salts or organic compounds |
|
|
Term
| What are the 3 categories of minerals? |
|
Definition
major minerals
trace elements
ultra-trace elements |
|
|
Term
|
Definition
inorganic substances that occur as salts or as a component of organic compounds
-Many have established roles in health maintenance |
|
|
Term
| What are the major minerals? |
|
Definition
calcium
phosphorus
magnesium
sodium
potassium
chloride
sulfur |
|
|
Term
| Calcium is the ___________ mineral, where is it mostly? |
|
Definition
predominant
-with a 700 mg turnover daily, it is mostly in the bones |
|
|
Term
| How is a balance of calcium achieved? Via what 3 substances? |
|
Definition
with a constant turnover of calcium in the bone
-Vitamin D (calcitrol) calcifies bone
-PTH increases absorption, mobilizes bone Ca, controls Phos excretion
-Calcitonin regulates serum Ca by drawing it from the bone. |
|
|
Term
| What are the metabolic fxns of calcium? |
|
Definition
tooth and bone formation
blood clotting
nerve impulse transmission
muscle relaxation and contraction
enzyme activation |
|
|
Term
| What are some problems related to poor calcium intake? |
|
Definition
rickets (most commonly from vitamin D deficiency)
osteoporosis
tetanus
hypocalcemia-irritability, parasthesias, tetany, convulsions |
|
|
Term
| What are some problems related to calcium toxicity? |
|
Definition
hypercalciuria
-dehydration, lethargy, nausea, vomiting, anorexia and possible death
- the upper limit of clacium intake is 2500mg/day |
|
|
Term
| __________ occurs in bone and teeth in conjunction with Ca. |
|
Definition
|
|
Term
| Whay are the metabolic fxns of phosphorus? |
|
Definition
bone and tooth formation
absorption of glucose
transport of amino acids, fatty acids
energy metabolism
buffer system |
|
|
Term
| WHAT are 2 clinical problems regarding phosphorus? |
|
Definition
needed during growth
needed during recovery |
|
|
Term
| How does hypophosphatemia manifest? |
|
Definition
intestinal dz
bone dz
hyperparathyroidism
occurs mostly in alcoholics during withdrawal
symptoms include: anorexia, bone pain, proximal myopathy |
|
|
Term
| When is the only time you'll see hyperphosphatemia? |
|
Definition
| during renal insufficiency |
|
|
Term
| What are the food sources of phosphorus? |
|
Definition
| meat, milk, veggies, fruits. |
|
|
Term
| Where is magnesium found in the body? |
|
Definition
|
|
Term
| What are the metabolic fxns of magnesium? |
|
Definition
CHO and protein metabolism
cell reproduction and growth
smooth muscle action |
|
|
Term
| Magensium deficiency is rare, but can occur in people who have what? |
|
Definition
absorption or excretion problems
indications of magnesium deficiency include low levels of calcium and potassium in the blood, changes in the GI, neuromuscular and cardiovascular systems
-fatigue, lehtargy, weakness, poor appetite, impaired speech, anemia, irregular heartbeat, tremors and failure to thrive |
|
|
Term
| Is magnesium easy to replete in the body? |
|
Definition
|
|
Term
| Magnesium toxicity usually occurs in which type of pts? What may high blood levels result in? |
|
Definition
renal failure pts
changes in mental status, muscle weakness, nausea, extremely low blood pressure, difficulty breathing and an irregular heartbeat. |
|
|
Term
| Sodium is a major ___ ______. |
|
Definition
|
|
Term
| Is sodium easily absorbed? |
|
Definition
| yes, lost with diarrhea and vomiting |
|
|
Term
| What are the metabolic fxns of sodium? |
|
Definition
fluid balance
acid-base balance |
|
|
Term
| What are the clinical problems associated with sodium levels? |
|
Definition
|
|
Term
| Potassium is a major ______ in ___. |
|
Definition
cation
ECF.
-the predominant intracellular cation, even small doses of extracellular potassium affect the extracellular:intracellular ratio and thereby affect neural transmission, muscle contraction, and vascular tone |
|
|
Term
| where is potassium absorbed? excreted? |
|
Definition
|
|
Term
| What are the metabolic fxns of potassium? |
|
Definition
Fluid/electrolyte balance
Acid-base balance
Muscle activity
CHO metabolism (glycogen storage)
Protein synthesis
kidney and adrenal fxn |
|
|
Term
| What are the clinical problems associated with potassium? |
|
Definition
Hyperkalemia
Hypokalemia
-from vomitting, diarrhea, kidney dz, sweating
-muscle weakness to resp failure, fatigue, constipation, impaired renal fxn
-Worst diet in the world, really decreases pt’s intake???
Hypertension & drug therapy
--Also caused by low K intake |
|
|
Term
| Where is potassium mainly found? |
|
Definition
| fruits and non-grain vegetables |
|
|
Term
| Chloride is the major _____ of ___. |
|
Definition
|
|
Term
| Cholride is a major component of what? |
|
Definition
|
|
Term
| Where is almost all of chloride absorbed? excreted? |
|
Definition
in the small intestine
in the urine (lost with vomiting and diarrhea)
-so if pull out large volumes via NG tube, try to put it back in by IV |
|
|
Term
| What are the metabolic fxns of chloride? |
|
Definition
fluid-electrolyte balance
acid-base balance
gastric acidity |
|
|
Term
| What clinical problems can arise with chloride? |
|
Definition
GI disorders
alkalosis
endocrine disorders |
|
|
Term
| Where do most people ge their chloride? |
|
Definition
|
|
Term
| What are major sources of sulfur? |
|
Definition
| amino acids such as methionine and cysteine |
|
|
Term
| What are the metabolic fxns of sulfur? |
|
Definition
protein structure
enzyme activity
energy metabolism |
|
|
Term
| What is a clinical problem that can manifest with high sulfur levels? |
|
Definition
cysinuria (treated with low methionine diet)
-stones?? |
|
|
Term
| What are the essential trace elements required for life? Do people with normal diets have to worry about these? |
|
Definition
IRON -SELENIUM
IODINE -MOLYBDENUM
ZINC -FLUORIDE
COPPER
MANGANESE
CHROMIUM
NO! |
|
|
Term
| Iron is bound to ___________. The stored/ measured form is ________. |
|
Definition
|
|
Term
| What are the fxns of iron? |
|
Definition
| plays key roles in hemoglobin/myoglobin synthesis and in cytochrome protein synthesis |
|
|
Term
| Iron deficiency is one of the most prevalent nutritional problems in the world. Seen with poor absorption and inadequate diet (vegetarians). What are the symptoms? |
|
Definition
pale mucosa, fatigue, SOB, susceptibility to infections
poor capillary bed refill,cold or abn sensations in extremities |
|
|
Term
| Clincial problems that may lead to an iron deficiency include what? |
|
Definition
blood loss
Fe deficiency anemia- most common nutrient deficiency in US |
|
|
Term
| What is the source of heme-iron? non-heme iron? |
|
Definition
beef
plants, beets
absorbed in an acid medium better than an alkaline medium (orange juice |
|
|
Term
| iron can be toxic at levels not much higher than the therapeutic range. what are the S/S? |
|
Definition
|
|
Term
| What is the fxn of iodine? what clinical problems are concerning? |
|
Definition
synthesis of thyroid hormone
goiter (iron deficiency) or toxicity |
|
|
Term
| What are symptoms of iodine deficiency besides goiter? |
|
Definition
| lethargy, dry skin, thick lips, enlarged tongue, reduced muscle and skeletal growth and mental retardation |
|
|
Term
| Will a goiter form with iodine toxicity? |
|
Definition
| yes- due to reduced iodine absorption |
|
|
Term
| Zinc is important bc of its role in what? |
|
Definition
wound healing
- when see a pt with a huge wound, think zinc and vitamin C |
|
|
Term
| In peole with high ostomies or fistulas, with a significant amt of drainage, for every ml of drainage, add ______ mg of zinc. |
|
Definition
|
|
Term
| What are the fxns of zinc besides wound healing? |
|
Definition
-sexual maturation, fertility and reproduction
-maintenance of normal taste and smell
-plays an important role in carbohydrate, fat and protein metabolism |
|
|
Term
|
Definition
| levels are determined by a balance of absorption by the intestine and secretion of endogenous reserves |
|
|
Term
|
Definition
| in the liver via ceruloplasmin |
|
|
Term
| What are the fxns of copper? |
|
Definition
production of skin, hair and eye pigment (melanin)
synthesis of CT (development of healthy bones, teeth and vascular structures)
protection of cells from oxygen damage (antioxidant compinent)
maintenance of myelin sheath around nerve fibers
essential for iron metabolism |
|
|
Term
| What are the genetic diseases associated with copper? |
|
Definition
wilson's dz
menkes syndrome |
|
|
Term
| What does chromium help to maintain? |
|
Definition
|
|
Term
| What is cobalt a part of? |
|
Definition
|
|
Term
| How is manganese absorbed? what clinical problems are associated with it? |
|
Definition
|
|
Term
| What is the absorption of selenium dependent on? |
|
Definition
|
|
Term
| Selenium controls cell damage that may lead to cancer how? |
|
Definition
| boosts the body's antioxidant capacity |
|
|
Term
| With selenium and molybdenum do you worry about deficiency diseases? |
|
Definition
|
|
Term
| What does molybdenum fxn as? |
|
Definition
|
|
Term
| Where are trace amts of fluoride founf? |
|
Definition
bones and teeth
can have clinical problems with this |
|
|
Term
| What is the source of flouride? |
|
Definition
|
|
Term
| What are the ultra trace elements? |
|
Definition
SILICON -ALUMINUM
VANADIUM -BORON
NICKEL
TIN
CADMIUM
ARSENIC |
|
|
Term
| What is the source of flouride? |
|
Definition
|
|
