dh31, wwa#8, ch. 12

sodium requirements: no RDA

- AI for sodium is 1500 mg/day with the upper limits being 2300 mg/day for adults; - Minimum intake 500 mg/day

Classic signs of FVD are:

- Dry tongue with longitudinal fissures, - Xerostomia, - Shrinkage of oral mucous membranes, - Decreased skin turgor, - Dry skin, - Decreased urinary output

causes of hyperkalemia

- Impaired renal excretion, - Increased shift of potassium out of cells, - Increased potassium intake

sodium physiological role

- Maintain normal ECF concentration by affecting the concentration, excretion, and absorption of potassium and chloride and water distribution; - Regulate acid-base balance; - Facilitate impulse transmission in nerve and muscle fibers

chloride: physiological role

- Maintains ECF balance, osmotic equilibrium, and electrolyte balance; - In gastric secretions to aid protein digestion and creating acidic environment to inhibit bacterial growth and enhance iron, calcium, and vitamin B12 absorption

hyperstates: water; Fluid volume excess (FVE): relatively equal gain of water and sodium in relation to their losses

- Occurs in ECF compartments secondary to an increase in total body sodium. - Results in rapid weight gain, puffy eyelids, distended neck veins, and elevated blood pressure.

patients with hypertension

1500 mg or less of sodium daily

chloride: requirements

AI = 2300 mg/day for adults

potassium: requirements no RDA or UL

AI = 4700 mg/day for all adults; Equivalent to approximately 10 servings of fruits and vegetables daily

requirements for water

AI: men 3.7 L, or 15-16 cups. women: 2.7 L, or 11-12 cups.

hypostate: fluid volume deficit/FVD: occurs secondary

Associated with excessive loss of fluids from: Gastrointestinal tract (vomiting, diarrhea, drainage tubes) Urinary tract (diuretics, polyuria, or excessive urination) Skin (sweating)

chloride: hyperstate

At-risk groups include those with: Excessive intakes of salt (NaCl), Dehydration, Renal failure, Diarrhea, Cushing's syndrome

How do electrolytes affect hydration status? Cations and anions must be equally balanced, Electrolytes are important in water and acid-base balance, Electrolyte distribution differs in ICF/ECF compartments, All of the above, None of the above

Cations and anions must be equally balanced,

Electrolyte distribution differs in ICF/ECF compartments. The principle anion in plasma and interstitial fluid is: Chloride Bicarbonate Phosphate All of the above None of the above

Chloride

anion: negative charge

Chloride, bicarbonate, and phosphate

zinc: physiological roles

Component in >200 enzymes affecting cell growth and replication (DNA/RNA synthesis); Collagen synthesis, bone resorption, and remodeling; Sexual maturation, Night vision, Immune defenses Taste, smell, and appetite

iron: physiological roles

Component of hemoglobin, Catalyzes many oxidative reactions within cells, Conversion of beta-carotene to vitamin A, Formation of purines as part of nucleic acid, Removal of lipids from the blood, Detoxification of drugs in the liver, Synthesis of collagen, Production of antibodies

electrolytes:

Compounds or ions that dissociate in solution; important in water balance and acid-base (pH) balance

at risk for hyperstate if

Congestive heart failure Chronic renal failure Chronic liver disease High levels of steroids

Consume less than 2300 mg (approximately 1 tsp salt) of sodium per day by choosing and preparing foods with little added salt

Consume lean meats, whole grains, fruits, vegetables, and low-fat dairy to meet nutritional needs

potassium: sources

Dairy Meat Grains Fruits Vegetables Processed foods Potassium supplements and salt substitutes

iron hypostates

Deficiency: Microcytic anemia, Angular cheilosis, Pallor of lips and gingiva, Sore, burning tongue; glossitis, Atrophy of filiform papillae Risk of candidiasis Possible increased caries susceptibility

causes of hypokalemia

Drugs, such as diuretics furosemide, hydrochlorothiazide Cushing's syndrome Hyperaldosteronism Hypomagnesemia Alcoholism

nutritional directions

Encourage water as beverage of choice to fulfill daily water needs over consumption of caloric beverages

other sources include soft drinks, sports and energy drinks, vitamin water, and other drinks

Energy drinks containing high kilocalorie and caffeine levels are the fastest growing beverage category; Beverages containing acidic flavorings may result in erosion; Americans consume 21% of their daily kilocalories (approx. 500 calories) from caloric beverages

iodine: hypostates

Goiter (enlargement of the thyroid gland), Spontaneous abortions and congenital anomalies, Delayed eruption of primary and secondary teeth, Enlarged tongue, Endemic cretinism

iron: sources

Heme iron: Organ meats, meat, fish, poultry; Non-heme iron: Eggs, Milk, Whole grains, enriched cereals Green vegetables Dried fruit

hyperstates: zinc

High levels of zinc cause: Vomiting and diarrhea, Epigastric pain, Lethargy, Fatigue, Renal damage, Pancreatitis, Death

chloride: hypostates

Hypochloremia; Conditions placing at risk include: - Persistent heavy sweating, - Chronic diarrhea, - vomiting, - Chronic renal failure

An imbalance in this nutrient can result in the following: delayed eruption of primary and secondary teeth, enlarged tongue, stillbirths, altered craniofacial growth, sensitivity to cold, dry skin, depression, and goiter. Zinc Iron Sodium Potassium Iodine

Iodine; Goiter is the main disorder resulting from low iodine intake.

Signs and symptoms of a deficiency of this nutrient include: microcytic anemia, fatigue, faulty digestion, blue sclerae, pale conjunctivae, and tachycardia. What nutrient is missing? Zinc Iron Sodium Potassium Iodine

Iron

zinc: sources --protein-rich foods

Lamb and beef Oysters Eggs

potassium: physiological role

Maintain cellular (ICF) concentration, Directly affects muscle contraction, especially cardiac, and electrical conductivity of the heart; Transmission of nerve impulses, Regulates acid-base balance

water

Most abundant component of the body; - At birth 75% to 80% of body weight; - In an adult 50% to 60% of body weight; Adipose tissue contains less water than lean body mass (LBM)

sources of sodium

Natural constituent of most foods, including: Meat Saltwater fish Eggs Dairy products Some vegetables

What term is used to describe the movement of water from an area of lower solute concentration to one of a higher solute concentration, across semipermeable membranes? Intracellular fluid Extracellular fluid Solvent Osmosis Solutes

Osmosis

Electrolyte distribution differs in ICF/ECF compartments. The principle anion in ICF is: Chloride Bicarbonate Phosphate All of the above None of the above

Phosphate; Anions include chloride, bicarbonate, and phosphate; the principal anion in ICF is phosphate.

Electrolyte distribution differs in ICF/ECF compartments. The principle cation in ICF is: Sodium Potassium Calcium Magnesium

Potassium

Chronic deficiency of this is often unrecognized; however, health problems include hypertension, heart attack, stroke, kidney stones, and loss of bone minerals, leading to osteoporosis. Patients may feel tired, weak, and irritable while being unable to pinpoint why. What nutrient is missing in their diet? Zinc Iron Sodium Potassium Iodine

Potassium; Potassium has the following important physiological roles: (1) maintains cellular (ICF) concentration, (2) directly affects muscle contraction (especially cardiac) and electrical conductivity of the heart, (3) facilitates transmission of nerve impulses, and (4) regulates acid-base balance. Potassium is important to maintain good muscle function for physically active individuals.

iodine: physiological role

Production of thyroxine

iodine: requirements

RDA =150 µg/day UL =1100 µg/day

iron: requirements

RDA: - Men and postmenopausal women: 8 mg/day - Women: 19 to 50 yr: 18 mg/day UL: 45 mg/day

Excesses of zinc also:

Reduces copper status Alters iron function Decreases immune function Decreases high-density lipoprotein (HDL)

iodine: sources

Seafood/plants grown near the ocean, Molasses, Yogurt and milk, Iodized salt

sodium hyperstate: Hypernatremia: elevated serum sodium level

Signs are extreme thirst; dry, "sticky" tongue and oral mucous membranes; fever; and convulsions

Electrolyte distribution differs in ICF/ECF compartments. The principle cation in plasma and interstitial fluids are: Sodium Potassium Calcium Magnesium

Sodium

Cation: positive charge

Sodium, potassium, calcium, and magnesium;

hypostates: zinc

Thickening of epithelium, Impaired keratinization of epithelial cells, Increased susceptibility to PD, Flattened filiform papillae, Loss of taste and smell acuity, Poor appetite, Impaired wound healing

hypostates: zinc; groups at risk for deficiency

Those whose zinc requirements are relatively high (such as during periods of rapid growth) Older adults Vegans Severe malabsorption (diarrhea) or other chronic health problems

iron: hyperstates

Toxicity: Hemochromatosis, Organ damage, Coronary heart disease, Skin pigmentation, Cirrhosis of the liver

Which is the most natural source of fluids for quenching thirst? Sports/energy drinks Carbonated beverages Green tea Water Cranberry extract Ginkgo biloba

Water

sodium hypostates: hyponatremia: low serum sodium level

Water intoxication or hyponatremia can occur when individuals drink too much water; Early symptoms of hyponatremia are nausea and abdominal cramps, headache, confusion, lethargy, and coma

absorption of heme iron parallels body's need

absorption of nonheme iron depends on intraluminal and meal composition and physiological need

RDA of iron based on consumption of at least 75% iron intake from heme sources

acidic conditions enhance iron absorption, but calcium and manganese interfere with its absorption

sea salt is not lower in sodium than table salt

also not foritified with iodine, which is important for thyroid health

every cell contains iron

approximately 4 g, or less than 1 tsp, is present in entire body

healthy intake would include at least 100 fl. oz. total intake of beverage

at least 50% from water, 16 oz unsweetened tea or coffee, 8 oz low fat milk, 24 oz of kilocalorie/nutrient beverage, 12 oz. of calorically sweetened and diet beverages

coliforms

bacterial indicator of sanitation; universally present in feces of animals

gastric iron is stomach helps promote iron absorption

binds to serum protein transferrin, and is continuously transported through body because transferrin functions to recycle iron

coffee not a significant source of vitamins and minerals

but does contain small amounts of magnesium, chromium, potassium; nutrients that many Americans lacking

sports drinks tested on endurance athletes, who may be able to benefit from a beverage that contains carbs and electrolytes, and sometimes protein

but for most people engaged in regular routine physical activity, sports drinks offer little to no advantage over plain water; can get the vitamins/minerals added to sports drinks in a well-balanced diet

water consumed with a meal does not affect caloric consumtion at mealtime

but water incorporated into food, like in soup, increases satiety, ultimately leading to less caloric intake;

oral manifestations of zinc deficiency include

changes in epithelium of tongue, increased cell numbers, susceptibility to PD, flattened filiform papillae

Principal anion in plasma and interstitial fluid is

chloride

sodium-potassium pump regulates potassium levels

constantly moving into or out of cells

dental erosion: sports/energy drinks have acidic pH 3-4.

damage to enamel evident after 5 days; energy drinks cause twice as much damage to teeth as sports drinks

RDA based on approximation that 10% of dietary iron is absorbed

demand for iron replenishment is constant because cells are continually being replaced; UL of iron: 45 mg/day

polyphenols in tea may have antioxidant and anti-inflammatory acitons; may be better alternative beverage to coffee

drawback to tea consumption: tannin content, which inhibits iron absorption, esp when tea and iron consumed at same time

potassium hyperstates: hyperkalemia

elevated serum potassium; is life-threatening

enamel erosion: most to least

energy drinks, sports drinks, regular soda, diet soda

direct measurement of total amount of body water is impossible

evaluation of physical signs of fluid deficit or excess is vital to diagnosis and treatment

Assess patients for electrolyte imbalances and nutrient deficiencies

excesses and refer to medical providers as needed

iodine hyperstate

excessive amounts result in thyroiditis, hypothyroidism, hyperthyroidism, sensitivity reactions

Normal fluid requriements are eight 8 oz. cups of total water daily. t/f

false; 15-16 cups/day for men; 11-12 cups/day for women

Potassium is principally found in extracellular fluid. t/f

false; intracellular

Oral pallor is associated with iodine deficiency. t/f

false; it is a sign of iron-deficiency anemia

The recommended dietary allowance (RDA) for sodium is 5000 mg/day. t/f

false; minimum requirement for sodium is 500 mg/day for adults, but no RDA has been established for sodium.

iron most difficult mineral to obtain in adequate amounts in American diet

ferrous form is better absorbed than the ferric form

symptoms of hypernatermia are a result of

fluid moving from ICF to ECF in an attempt to equalize sodium and water balance

10% of sodium consumed comes from natural content of foods

goal is to slowly and without loss of consumers' acceptance, achieve safer levels of sodium that are consistent with public health recommendations

sodium deficiency many lead to a decreased salivary flow rate

high levels of sodium, greater than 2 g/day, cause calcium loss in the urine

aldosterone indirectly affects serum potassium levels

if aldo released, sodium is reabsorbed but potassium excreted; if aldo is inhibited, potassium is retained

amount of caffeine in a product not required on labels because it is not a nutrient

if energy drinks contain "natural" ingredients like ginkgo or guarana, FDA consideres them a dietary supplement rather than a food or medicaiton

body fluids

intracellular fluid/ ICF; extracellular fluid/ ECF; osmotic pressure equalizes the solute concentration of ICF and ECF

soda consumption decreasing among adolescents and young adults, whereas sports/energy drink consumption tripled

kilocalories may be a major contributor to alarming increase in obesity

potassium hypostates: hypokalemia

low serum potassium level; occurs through GI and renal tracts, and by excessive sweating

bottled water not healthier

most do not contain fluoride; does not have to be listed on label unless it is added

iron is poorly absorbed

most of iron in food is in oxidized form of ferric iron (Fe3+)

serum sodium concentration is an index of water deficit or excess

not an index of total sodium levels in body

When as little as 2% of body water is lost,

osmoreceptors are stimulated, creating a physiological desire to ingest liquids

most prominent oral sign of iron deficidncy include

pallor of lips and oral mucosa, swelling of tongue, angular cheilitis, atrophy of filiform papillae, glossitis

physiological roles of water: 1. Solvent enables chemical reactions to occur by entering into some reactions, such as hydrolysis. 2. Maintains stability of all body fluids, as the principal component and medium for fluids (blood and lymph), secretions (saliva and gastrointestinal fluids), and excretions (urine and perspiration)

physiological roles of water, cont. 3. Enables transport of nutrients to cells and provides medium for excretion of waste products. 4. Acts as lubricant between cells to permit movement without friction Regulates body temperature by evaporating as perspiration from skin and vapor from mouth and nose

sources of water

plain tap water is most natural source; - EPA regulates the levels of contaminants allowed in drinking water in public water systems; Use of bottled water has increased

chloride: sources

salt; also from processed foods and water

Principal cation in plasma and interstitial fluid is

sodium

salt recognition threshold is determined by

sodium concentration of saliva

dietary sodium restricion is rarely cause of hyponatremia

sodium depletion may occur in combination iwth excessive losses as a result of vomiting, diarrhea, sugary or profuse perspiration from exercise of fever

sodium level in blood are significantly higher than potassium levels because

sodium is major cation in intravascular fluid

chloride is primary anion connected with sodium in ECF

to help maintain ECF balance, osmotic equilibrium, and electrolyte balance

Heme iron is provided by meat sources and is more readily absorbed than iron from vegetable or grain products.

true

Meats are more than half water. t/f

true

Milk is a good source of potassium. t/f

true

Taste alteration is a symptom of zinc deficiency. t/f

true

Thirst is the primary regulator of fluid intake. t/f

true

Water is the most abundant component in the body. t/f

true

hemochromatosis

uncommon disorder in which ion is absorbed at a high rate despie elevated iron stores in liver

water lost through

urination, perspiration, expiration, defecation

B vitamins not little packets of energy

vitamins help body use energy from foods, but extra B vitamins do not provide additional energy boosts; most get adequate amounts of B vitamins in diets

foods that incorporate water appear larger;

volume provides greater oral stimulation, and water bound to food slows absorption and increases satiety

zinc defieciency also results in congenital defects, skeletal abnormalities, cleft palate and lip, collegen synthesis defeicts

when zinc deficiency diagnosed, zinc supplementation is vital

11 mg for men and 8 mg for women

zinc deficiencies have not been reported