2Nd Trimester--A&p Nutrition, Metabolism, And Fluid, Electrolyte, And Acid-Base Balance

Front 1

Minerals constitute about __% of the total body weight and concentrate mostly ______.

Back 1

4%
in the skeleton.

Front 2

Major role of minerals

Back 2

Help regulate reaction of enzymes, such as in: calcium, iron, magnesium, and manganese helping to convert ADP to ATP.

Sodium & phosphorus: work in buffer system to control pH in body fluid.
Sodium: also helps regulate osmosis of body fluid, with other ions like potassium, is involved in the generation of nerve impulses and muscle contraction.
Some like Selenium work as an antioxidant and may play a role in preventing some cancers.

Front 3

Typical diets supply adequate amounts of potassium, sodium, chlorine, and magnesium. Some attention must be paid to eating foods that provide enough what?

Back 3

calcium, phosphorus, iron, and iodine.

Front 4

Vitamins are?

Back 4

organic substances requires in small amounts to maintain growth and normal metabolism. Most work as coenzymes. They can't be synthesized by the body and must be ingested.

Front 5

Fat-Soluble vitamins

Back 5

A, D, E, K.
Absorbed along with dietary lipids in the small intestine, and may be stored in cells, particularly in the liver.

Front 6

Vitamin A is essential for ? Its deficiency can cause ?

Back 6

Light-sensitive pigments in photoreceptors of the retina.
Its deficiency can cause night blindness.

Front 7

Vitamin D is essential for ? Its deficiency causes ?

Back 7

Essential for absorption and utilization of calcium and phosphorus.
Its deficiency causes rickets or osteomalacia.

Front 8

Vitamin E is essential for ? Its deficiency causes?

Back 8

Involved in formation of DNA, RNA, and RBCs.
Its deficiency may cause hemolytic anemia (vit B deficiency).

Front 9

Vitamin K is essential for? Its deficiency causes?

Back 9

A coenzyme essential for synthesis of several clotting factors.
Its deficiency may delay clotting time during bleeding.

Front 10

Water-Soluble vitamins

Back 10

B, C.
Not stored in the body and must be taken in regularly with food.

Front 11

B1 is essential for/ its xu could cause?

Back 11

essential for production of ATP for muscle and nerve cells and synthesis of neurotransmitters.
Its deficiency may cause beriberi and polyneuritis.

Front 12

B2 is essential for / its xu could cause?

Back 12

Involves oxidation of nutrients.
Deficiency may cause skin and tongue disorders.

Front 13

B3 is essential for / its xu could cause?

Back 13

(nicotinic acid) essential for metabolism of lipid including inhibition of cholesterol production and breakdown of triglycerides.
Its deficiency may cause pellagra characterized by dermatitis, diarrhea, and psychological disturbance.

Front 14

B6 is essential for / its xu could cause?

Back 14

Involved in metabolism of amino acids and triglycerides.
Its deficiency may cause dermatitis of eyes, nose, and mouth.

Front 15

B12 and folate are essential for / deficiencies could cause?

Back 15

Essential for production RBCs.
Deficiency may cause macrocytic anemia.

Front 16

Vitamin C is essential for / its deficiencies could cause?

Back 16

Promotes synthesis of collagen and wound healing; its deficiency can cause many disorders, such as scurvy, anemia, poor wound healing, etc.

Front 17

The antioxidant effects / free radicals:

Back 17

Almost all vitamins are medicines, which are used to treat any vitamin deficiency conditions or to prevent some diseases. Some vitamins, including C, E, and beta carotene (a provitamin of Vit A) may have antioxidant effects. They inactivate oxygen free radicals, which damage cell membranes, DNA, and other cellular structures and contribute to the formation of atherosclerotic plagues. Some free radicals arise naturally in the body, and others derive from environmental hazards such as tobacco smoke and radiation. Antioxidant vitamins are thought to play a role in protecting against some kind of cancer, reducing the buildup of ahterosclerotic plaque, delaying some effects of aging, and decreasing the chance of cataract formation. However, over dose and long term administration of vitamins may also present some side effects. Ex: Vit D may cause hypercalcemia and KD stone, and vit E may induce prolonged clotting time and bleeding tendency.

Front 18

Each gram of dietary protein or carbohydrate provides about __ Calories; a gram of fat = ___ calories.

Back 18

4 calories
9 calories

Front 19

Generalities about caloric needs: women/older people = ? children, teenage girls, active women, and most men need ?

Back 19

1600
2200
2800

Front 20

Expert recommendation of distribution of calories:

Back 20

1. 50-60% from carbs, with less than 15% from simple sugars
2. Less than 30% from fats, triglycerides are the main type of dietary fat, but no more than 10% as saturated fats.
3. 12-15% from proteins.

Front 21

Anabolism

Back 21

Chemical reactions that combine simple and smaller molecules into more complex and larger molecules, such as the formation of peptide bonds between amino acids, combining them into proteins.
REQUIRES ENERGY.

Front 22

Catabolism

Back 22

Chemical reactions that break down complex organic compounds into simple ones, such as the process of chemical digestion.
RELEASE ENERGY.

Front 23

Enzymes

Back 23

Serve as catalysts to speed up chemical reactions. Some enzymes requires presence of one ion such as Ca, Fe, Zn, etc., and some enzymes work together with coenzymes such as vitamins.

Front 24

Oxidation and reduction

Back 24

Removal of electrons and Hydrogen ions from a molecule is called oxidation, and the addition of electrons and Hydrogen to a molecule is called reduction. Both reactions are always coupled.
Ex: Removing 2H from lactic acid will convert into pyruvic acid (oxidation); Adding 2H to pyruvic acid will convert into lactic acid (reduction).

Front 25

Carbohydrate metabolism

Back 25

During digestion, polysaccharides and disaccharides are converted to monosaccharides (glucose, fructose, and galactose), which are absorbed by intestine and transported to the liver. Some glucose is oxidized to provide energy (glycolysis), excess glucose can be stored by the liver and skeletal muscle as glycogen (glycogenesis) or converted into fat.

Front 26

Lipid Metabolism

Back 26

Most lipids combine with proteins to form lipoproteins, which transport lipids in the bloodstream.

Some triglycerides may be oxidized to produce ATP, wherease others are stored in adipose tissue. Other lipids are used as structural molecules or to synthesize essential molecules. Glucose and amino acids can be converted into lipids (lipogenesis). Clinically, the levels of serum lipids and lipoproteins are significant to determine the risk of coronary artery disease.

Front 27

Lipoprotein: Chylomicron

Back 27

Carries dietary lipids to adipose tissue

Front 28

Very-low-density lipoprotein (VLDL)

Back 28

carries triglycerides from the liver to the adipose tissue

Front 29

Low-density Lipoprotein (LDL)

Back 29

Delivers cholesterol to body cells

Front 30

High-density lipoprotein (HDL)

Back 30

Removes excess cholesterol from body cells and transports to the liver for elimination.

Front 31

Protein metabolism

Back 31

During digestion, proteins are converted into amino acids, which are absorbed and enter the body cells. Inside the cells, amino acids are reassembled into proteins that function as enzymes, hormones, structural elements, and so forth; stores as fat or glycogen; or used for energy. Amino acids can also be converted into glucose, fatty acids.

Front 32

Measuring heat:

Back 32

Heat is a form of energy that can be measured as temperature and expressed in units called Calories.

Front 33

A Calorie is ?

Back 33

the amount of energy required to raise the temperature of 1 gram of water 1 degree Celsius.

Front 34

Metabolic rate

Back 34

Most heat is produced from oxidation of nutrients. The rate at which this heat is produced from nutrients in the cells is metabolic rate.

Front 35

Basal Metabolic Rate (BMR)

Back 35

The measurement of metabolic rate under the basic condition. Affected by exercise, hormones, nervous system, body temperature, ingestion of food, age, gender, climate, etc. BMR measurement is also used clinically for diagnosis of some diseases like hyperthyroidism.

Front 36

Heat loss:

Back 36

More than 80% of heat loss occurs thru the skin; the remaining 15-20% is dissipated by the respiratory system and with the urine and feces.

Front 37

The principle routs of heat loss to the environment includes: (4 things)

Back 37

1. radiation
2. Conduction
3. convection
4. evaporation

Front 38

Radiation

Back 38

transfer of heat in the form of infrared between a warm object and a cooler one without physical contact

Front 39

Conduction

Back 39

heat exchange between two materials that are in direct contact

Front 40

Convection

Back 40

transfer of heat by the movement of a gas or liquid between the areas of different temperature

Front 41

evaporation

Back 41

the conversion of a liquid to a vapor

Front 42

Measuring heat:

Back 42

Heat is a form of energy that can be measured as temperature and expressed in units called Calories.

Front 43

A Calorie is ?

Back 43

the amount of energy required to raise the temperature of 1 gram of water 1 degree Celsius.

Front 44

Metabolic rate

Back 44

Most heat is produced from oxidation of nutrients. The rate at which this heat is produced from nutrients in the cells is metabolic rate.

Front 45

Basal Metabolic Rate (BMR)

Back 45

The measurement of metabolic rate under the basic condition. Affected by exercise, hormones, nervous system, body temperature, ingestion of food, age, gender, climate, etc. BMR measurement is also used clinically for diagnosis of some diseases like hyperthyroidism.

Front 46

Heat loss:

Back 46

More than 80% of heat loss occurs thru the skin; the remaining 15-20% is dissipated by the respiratory system and with the urine and feces.

Front 47

The principle routs of heat loss to the environment includes: (4 things)

Back 47

1. radiation
2. Conduction
3. convection
4. evaporation

Front 48

Radiation

Back 48

transfer of heat in the form of infrared between a warm object and a cooler one without physical contact

Front 49

Conduction

Back 49

heat exchange between two materials that are in direct contact

Front 50

Convection

Back 50

transfer of heat by the movement of a gas or liquid between the areas of different temperature

Front 51

evaporation

Back 51

the conversion of a liquid to a vapor

Front 52

Most important center of body temperature regulation

Back 52

Hypothalamus

Front 53

Hypothalamus & temperature regulation

Back 53

The neurons in the hypothalamus control the production and release of heat in response to the body temperature thru the impulses from thermoreceptors in the skin. If the body temperature fals, thermoreceptors send more impulses to the hypothalamus, which produces thyrotropin-releasing hormone (TRH) and TRH in turn stimultaes TSH secretion.

Front 54

TSH increases body temperature thru 3 mechanisms:

Back 54

1. sympathetic nerves cause vasoconstrition in the skin to prevent heat loss, and stimuate secretion of epinephrine and norepinephrine to elevate the cellular metabolism.
2. The hypothalamus stimultes parts of the brain to increase muscle tone, which raises heat production
3. they thyroid gland responds to TSH by releasing thyroid hormone sto increase metabolic rate. If the body temp rises, which stimulates hypothalamus. The impulses from hypothalamus cause vasoldilation in the skin. The skin turns warm and the excess heat is lost to the environment by radiation and conduction. At the same time, metabolic rate decreases, sweat gland stimulated by sympathetic nerves evaporates more sweat from the surface of the skin. All these responses help turn body temperature to normal.

Front 55

Hypothermia

Back 55

<35 C or 95 F
Commonly seen in overwhelming cold stress, metabolic diseases (hypothyroidism, hypoglycemia, adrenal insufficiency), drugs (alcohol, antidepressants, sedatives), malnutrtion, and shock, etc.

Front 56

Fever

Back 56

Body temp higher than normal. Usually due to an infection of bacteria or viruses, or some other causes, such as malignancies, toxic reactions, reactions to vaccines, ovulation, excessive secretion thyroid hormones, and diseases or injuries involving the central nervous system.
When the phagocytes ingest certain bacteria, they are stimulated to secrete a pyrogen, a fever producing substance. The pyrogen circulates to the hypothalamus and induces neurons of the preoptic area to secrete prostaglandins (PGs). Some PGs can reset the hypothalamic thermostat to make the temperature higher.

Front 57

PGs stands for?

Back 57

Prostaglandins

Front 58

Antipyretics such as ?

Back 58

aspirin, tylenol, advil, etc. reduce fever by inhibiting synthesis of certain PGs.

Front 59

Obesity

Back 59

Obesity is defined as being 20% or more above ideal body weight.

Affects 1/3 of the adult population in the US. Causes are complex and include personal, social, psychological, and hereditary components, and it is linked with hyperlipidemia, atherosclerosis (CAD and stroke), hypertension, type II diabetes, pulmonary disease, arthritis, gallstones, certain cancers (breast, uterus, colon) etc. Effort to lose weight is more difficult. For more people, an adequate diet control and exercise are the surest ways to avoid obesity.

Front 60

Body Mass Index:

Back 60

Weight (kg) / height (m2)
BMI > or = 27.3 for women and > or = 27.8 for men is OVERWEIGHT.

Front 61

Ideal Body Weight

Back 61

Height (cm) - 100
> 10% of ideal body weight is overweight
> 20% of that is obesity

Front 62

1 Kg = ? lbs?

Back 62

2.2 lbs

Front 63

1 in = ? cm

Back 63

2.54 cm

Front 64

Know how to calculate BMI and Ideal body weight

Back 64

Weight in lbs = 115
115/2.2 = 52.27 kg
61.5 inches * 2.54 = 156.21 cm

21.4 BMI

Ideal weight: 156.21 - 100 = 56 * 2.2 = 123.67

??

Front 65

Fluid compartments

Back 65

Body fluid includes water and dissolved solutes, which constitute about 55-60% of total body mass and is partitioned into two main compartments: intracellular fluid (ICF) and extracellular fluid (ECF)

Front 66

ICF

Back 66

Intracellular fluid. Within the cells of the body, makes 2/3 of body fluid

Front 67

ECF

Back 67

includes all body fluids outside the cells. About 80% of ECF is interstitial fluid, and about 20% of ECF is plasma. The ECF also includes lympth, cerebrospinal fluid, synovial fluid, etc.

Front 68

Water gain and regulation

Back 68

Under normal conditions, in an adult person, the amount of water taken in (about 2300 ml/day) and produced in chemical reaction during metabolism (200 ml/day) is equal to the quantity lost (2500 ml/day). This balance is regulated by the nervous mechanism; a thirst center in hypothalamus governs the urge to drink.

Front 69

When water loss is greater than water gain, this stimulates the thirst center in 3 ways:

Back 69

1. decreased secretion of saliva makes mouth dry
2. decreased volume of body fluids causes rennin secretion in kidney angiotensin II formation
3. Concentrated body fluids stimulate osmoreceptors.
All of them stimulate the thirst center in the hypthalamus to cause thirst and to increase water intake. When the body mass decreases by 2% due to fluid loss, mild dehydration exists. This happens often in elderly people, in infants, and in those who are in a confused mental state, or who have diarrhea or vomiting.

Front 70

The routes of water loss

Back 70

include kidneys (1500 ml/day)
skin (600 ml/day)
lungs (300 ml/day)
intestinal tract (100 ml/day)

Elimination of excess body water and solutes occurs mainly by controlling the amount lost in urine. The extent of urinary salt (NaCl) loss is the main factor that determines the body fluid volume. The reason i that in osmosis, "water follows solutes" and Na and Cl are the main solutes in extracellular fluid and urine

Front 71

Water follows ?

Back 71

Solutes

Front 72

What are the main solutes in extracellular fluid and urine?

Back 72

Na + and Cl-

Front 73

Aldosterone & water/solute loss/regulation

Back 73

Promotes re-absorption in Na, Cl, and water in renal tubules, and increases excretion of K+. As the blood volume decreases, increased rennin and angiotensin II levels stimulate aldosterone formation and elevate blood volume; high blood volume will inhibit aldosterone formation

Front 74

Atrial Natriuretic Peptide & water/solute loss/regulation

Back 74

ANP from heart promotes urinary excretion in Na, Cl and water (natriuresis) and decreases blood volume; increased blood volume stretches the atria of the heart and promotes release of ANP to make natriuresis and reduce the blood volume.

Front 75

Antidiuretic Hormone (ADH) and water/solute loss/regulation

Back 75

ADH increases water absorption in renal tubules to decrease urine excretion, and it is the main hormone to regulate water loss. Increased osmotic pressure stimulates release of ADH, and decreased osmotic pressure inhibits ADH release. If excess sodium ions remain in the body because kidneys fail to excrete, the result is increased blood volume, increased blood pressure, and edema.

Front 76

General functions of electrolytes: The ions formed when the electrolytes break apart serve 4 general functions in the body.

Back 76

1. Certain ions control the osmosis of water between fluid compartments.
2. ions help maintain the acid-base balance required for normal cellular activities
3. Ions carry electrical current, which allows production of action potentials and controls secretion of some hormones and neurotransmitters
4. Several ions serve as factors for optimal activity of enzymes.

Front 77

Sodium (Na)

Back 77

Sodium ions (Na +) represent 90% of extracellular cations. Normal plasma concentration is 136-148 mEq/L. Na play important role in fluid and electrolyte balance and maintain the osmotic pressure in extracellular fluid. Na is necessary for the generation and conduction of action potentials in neurons and muscle fibers.

Front 78

Hypernatremia (sodium)

Back 78

may be dehydration, intravenous fluids. a;dpsterpmos,. etc. Excess of sodium may cause intense thirst, hypertension, edema, agitation, and convulsions.

Front 79

Hypnatremia

Back 79

may result from vomiting, diarrhea, and Addison's disease, etc. Sodium deficiency may cause muscular weakness, dizziness, headache, hypotension, tachycardia, shock, mental confusion, stupor, and coma.

Front 80

Potassium (K)

Back 80

Potassium ions (K+) are the major cations in intracelular fluid, normal plasma concentration is 3.5-5.0 mEq/L. K plays a key role in producing action potentials in neurons and muscle fibers, abnormal plasma K level affects neuromuscular and cardiac function. K moving in or out of cells is exchanged for H. Same condition also occurs in renal excretion. The shift of H helps regulate pH

Front 81

Hyperkalemia (K)

Back 81

is seen in acute and chronic renal failure, metabolic acidosis, Addison's disease, hemolysis or tissue injury, etc. Excess of potassium may cause muscular weakness, decreased or absent reflex, cardiac arrhythmias, even death by inducing ventricular fibrillation or cardiac arrest.

Front 82

Hypokalemia

Back 82

may occur with aldosteronism, congestive heart failure, periodic paralysis, thiazide diuretic therapy. Potassium deficiency may cause muscle fatigue, flaccid paralysis, mental confusion, increased urine output, abdominal flatulance, and changes in ECG.

Front 83

Calcium (Ca)

Back 83

About 98% of Ca combined with phosphate is in bone and teeth. Normal plasma Ca2 level is 4.5-5.5 mEq/L. Parathyroid hormone (PTH), calcitonin, and Vitamin D control the ionized Ca in extracellular fluid. Ca 2+ plays important roles in blood clotting, muscle contraction, and nervous impulse transmission.

Front 84

Hypercalcemia

Back 84

occurs with primary hyperparathyroidism, bone tumor, etc. Excess of calcium may cause weakness, itching, polyuria, cardiac arrhythmia, confusion, lethargy, and coma.

Front 85

Hypocalcemia

Back 85

may be induced by primary hypoparathyroidism., chronic renal failure, and vitamin D deficiency, etc. Calcium deficiency may cause muscle cramps, tetany, bone fracture, convulsions, spasms of laryngeal muscle, even death by inducing asphyxiation.

Front 86

Chloride (Cl)

Back 86

Chloride ions (Cl) are the major anions in extracellular fluid. Normal Cl concentration is 95-105 mEq/L. Cl helps maintain osmotic pressure of blood, and effects acid-base balance.

Front 87

Hyperchloremia

Back 87

may be seen in chronic renal failure, heart failure, etc. Excess of chloride may cause weakness, metabolic acidosis, and lethargy.

Front 88

Hypochloremia

Back 88

may result from severe vomiting and diarrhea, etc. Chloride deficiency may cause muscle spasms and metabolic alkalosis.

Front 89

Acid-Base balance

Back 89

In a healthy person, the pH of arterial blood remains 7.35-7.45. From different diet, the cellular metabolism may produce more acids or more bases. The removal of hydrogen ions (H) or hydroxide ions (OH) from the body depends on three major mechanisms: buffer system, exhalation of CO2 and excretion of H in the urine.

Front 90

The removal of hydrogen ions (H) or hydroxide ions (OH) from the body depends on three major mechanisms:

Back 90

buffer system, exhalation of CO2 and excretion of H in the urine.

Front 91

Buffer system

Back 91

Buffers are substances that prevent sharp changes in acid-base balance and maintain a relatively constant pH.

Front 92

Protein buffer system

Back 92

Hemoglobin and albumin are good buffers, they can release both H and OH to buffer bases or acids.

Front 93

Carbonic acid (H2CO3) and bicarbonate (HCO3) buffer system

Back 93

They are weak acid and weak base. If the blood pH decreases, HCO3 can remove the excess H; if the blood pH increases, H2CO3 can provide H.

Front 94

Phosphate (H2PO4 and HPO3) buffer system

Back 94

Weak acid and weak base. Like carbonic and bicarbonate buffer system.

Front 95

Exhalation of CO2

Back 95

Breathing plays an important role in maintaining the pH of body fluids. Decreased or increased pH is detected by chemoreceptors in the medulla oblongata and in the aortic and carotid bodies, which stimulate the respiratory center to change the rate and depth of breathing and to affect the following reactions...

Front 96

Kidneys & acid/base balance

Back 96

The slowest mechanism for removal of acids is also the only way to eliminate most acids that form in th ebody. Cells of the renal tubules secrete H, which is secreted in urine. KD also can synthesize and reabsorb HCO3 to prevent buffer loss. Therefore, renal failure causes metabolic acidosis.

Front 97

Acidosis

Back 97

Is a condition in which arterial blood pH is below 7.35.

Front 98

Metabolic acidosis

Back 98

is caused by overproduction of acids during cellular metabolic causes, such as diabetic ketoacidosis or the kidneys fail to excrete acids, such as chronic renal failure.

Front 99

Respiratory acidosis

Back 99

results from respiratory disorders, such as respiratory failure and chronic restrictive lung disease, which leads to accumulation of CO2 in the blood circulation. Acidosis affects central nervous system, the patients present with fast and deep respiration, depression, lethargy, coma, and may die.

Front 100

Alkalosis

Back 100

Is a condition in which arterial blood pH is higher than 7.45.

The effect of alkalosis is overexcitability in both central and peripheral nervous systems. The result is nervousness, muscle spasms, even convulsions or death.

Front 101

Respiratory alkalosis

Back 101

commonly caused by hyperventilation, such as in central nervous disease, severe anxiety, or hysteria, etc.

Front 102

Metabolic alkalosis

Back 102

may result from severe vomiting and gastric juice loss, ingestion of excessive amount of sodium bicarbonate or other antacids, etc.