Nitrogen content of protein
Nitrogen content = g protein x .16
AKA 16% of protein is nitrogen
Holliday Segar Method
First 10kg = 100ml/kg
Second 10kg = 50ml/kg
>20kg = 20ml/kg
If over 50, 15ml/kg
Cant use in those <14 days
Free Water Deficit
TBW x 1-(140/measured Na)
Total Body Water
Weight in kg x .6
Fluid Distribution
ICF = 66% of TBW
ECF = 33% of TBW
-Intravascular = 25% of ECF
-Interstitial = 75% of ECF
Respiratory Quotient
.7 = lipid oxidation
.82 = amino acid
.85 = mixed substrate
1 = carb breakdown
Corrected Calcium
Measured Calcium + .8 x (4-alb)
Corrected Sodium
Measured Na + [.016 x (BG-100)]
Nutrients Absorbed in the Stomach
Fluoride
Iodine
Nutrients Absorbed in the Duodenum
Fat soluble ADEK
Water soluble B vits (thia, ribo, nia, bio, fol) , except B12/B5/B6
Minerals Fe,Ca, Phos, Mg, Cu, Se, Io
All except choline, Zn, Mang, Chrom, Moly
Nutrients Absorbed in the Jejunum
AA
Monosaccharides
Lipids - glycerol, FFA
Fat soluble ADEK
Water soluble B vits (thia, ribo, nia, panto, bio, fol, pyrid, Vit C
MInerals Ca, Phos, Mg, Fe, Zn, Chro , Mang
Nutrients Absorbed in the Ileum
Bile salts and acids
Fat soluble - Vit D, Vit K
Vit C, Folate, B12
Mg
Nutrients Excreted by Bile/Stool
Fat soluble vits
Fe
Zn
Cu
Mang
Se
Nutrients Excreted in Urine
Water soluble except B12/folic acid
Choline
Cu (very little)
Se
Chrom
Iodine
Fluoride
Moly
Nutrients recycled by enterohepatic circulation
B12
Folic acid/B9
Vit A deficiency/toxicity
Deficiency - night blindness, follicular hyperkaratosis, impaired wound healing
Cause - fat malabsorption
Nutrient interactions: low ZN reduces Vit A
Toxicity - Alopecia, Ataxia, Prutitus
Vitamin D Deficiency/Toxicity
Deficiency - Tetany, Osteomalacia, hypoCa
Cause - fat malabsorption, renal disease,** LT PN support,** meds (steroids, isonizid, phenytoin)
Nutrient interactions: Excess vit D = excretion of vit K
Toxicity - Soft tissue calcification, confusion, tremor
Vitamin E Deficiency/Toxicity
Deficiency - Age spots, ataxia, hemolytic anemia
Causes - Fat malabsorption,** LT PN without supplementation**
Nutrient interactions: Excess supp interferes with Vit K and warfarin
Toxicity - Bruising, thrombocytopenia, cerebral hemorrhage
Vitamin K Deficiency/Toxicity
Deficiency - Bruising, prolonged bleeding, decreased bone density
Causes - Fat malabsorption, ABX, LT PN without ILE
Nutrient interactions: Excess vit A/E decreased Vit K absorption, excess vit D increases excretion
Toxicity - no toxicity
Vitamin C Deficiency/Toxicity
Deficiency - Capillary rupture, delated wound healing, corkscrew hairs
Causes - Older adults, cancer, alcohol/tobacco, hyper BG = less transport
Nutrient interactions: Vit C increases iron absorption
Toxicity - N/V/D, renal stone
Vitamin B1 Deficiency/Toxicity
Thiamine
Dry beriberi - muscle weakness
Wet beriberi - reduced cardiac output, encephalopathy, nystagmus
Causes - alcoholism, **LT PN **or HD, refeding, hyperemesis
Nutrient interactions: repletion only possible if Mg WNL, needed to activate
Toxicity - no toxicity
Vitamin B2 Deficiency/Toxicity
Riboflavin
Deficiency - dermatitis, cheilosis, normochromic normocytic anemia
Causes - critically ill
Nutrient interactions: Alcohol, Cu, Zn, Fe and mang can form chelates and prevent absorption
Toxicity - no toxicity
Vitamin B3 Deficiency/Toxicity
Niacin
Deficiency - Pellagra: dermatitis, diarrhea, dementia
Causes - older adult, alcohol, isonizaid/mercaptopurine
Nutrient interactions: needed for activation of folate
Toxicity - flushing, heat, GI upset, glucose intolerance
Vitamin B6 Deficiency/Toxicity
Pyridoxine
Deficiency - Microcytic anemia, seborrheic dermatitis, cheilosis
Causes - AUD, HD, older adults
Nutrient interactions: leads to alterations in AA
Toxicity - derm lesions, ataxia, sensory neuropathy