MNT for Individuals III

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Author:
rpeders
ID:
198092
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MNT for Individuals III
Updated:
2013-02-06 19:38:25
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Dietetics Review
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Renal system, Endocrine & metabolic disorders
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  1. What does the nephron consist of?
    • 1. Glomerulus: produces ultrafiltrate, blocks passage of large molecules
    • 2. Proximal Convoluted tubule: nutrient reabsorption
    • 3. Loop of Henle: water & sodium balance
    • 4. Distal Tubule: acid-base balance
  2. Renal Functions
    • 1. Filtration: RBC & pro stay in blood, filters everything else
    • 2. Absorption: 100% glucose, AA, 85% h2o, NA, K+
    • 3. Excretion: wastes, urea, excess ketones
    • 4. Secretion: blood pressure control hormones, ions that control acid-base balance
  3. Vasopressin
    • f-from hypothalamus
    • -elevates blood pressure
    • -increases water reabsorption from distal and collecting tubules
  4. SIADH
    • Syndrome of inappropriate antidiuretic hormone
    • 1. hyponaturemia caused by hemodilution, treat with FR
  5. Renin
    • -Vasoconstricter
    • -secreted by glomerulus when blood volume decreases
    • -stimulates aldosterone to increase sodium absorption and return blood pressure to normal
  6. EPO (erythropoietin)
    • -Produced by kidney
    • -stimulates bone marrow to produce RBC
  7. Lab Tests in Renal Disease
    • 1. Decreased GFR, creatinine clearance
    • 2. Increased serum creatinine, BUN
    • 3. BUN:creatinine ratio of >20:1 indicates a "pre-renal state" in which BUN reabsorption is increased due to acute kidney damage
    • 4. BUN:creatinine ratio <10:1 suggested reduced BUN reabsorption due to renal damage--needs dialysis
    • 5. Renal Solute Load (excreted 1L in urine)
    • -meausres nitrogen and electrolytes
  8. Manifestations of Renal Disease
    • 1. anemia from decr EPO
    • 2. upset in BP
    • 3. decr activation of Vit D (kidney produces active form)
  9. Renal Calculi
    • Caclium Stone (calcium oxalate)
    • 1.5-2L of fluid
    • adequate Ca (dark leafy greens, chocolate, nuts, beets, tea)
  10. Acute Kidney Injury
    • -sudden shutdown, decr GFR
    • -due to burns, accidents, obstruction, dehydration
    • 1st: IV glucose, lipids, pro
    • 2nd: If dialysis not needed--.6-.75 g/kg pro, until GFR returns then 1.2-1.5 g/kg
    • -25-35 cals/kg
    • -restrict sodium
    • -8-15 mf/kg phos, 2-3 g potassium
    • hydration
  11. Nephrosis-nephrotic syndrome
    • -deficit in capillary basement-permits large amns of protein into filtrate through tubules
    • -albuminuria, edma, malnutrition, hyperlipidemia
    • -moderate protein, high cal (35 cal/kg)
    • -sodium, phos and maybe fluid restriction
    • -protein loss=abnormalities in iron, copper, zinc, calcium
  12. Chronic Kidney Disease
    • -anorexia, wgt loss, nausea
    • -anemia from low EPO
    • -protein restrict when GFR falls
    • stage 1,2,3: .8g
    • state 4,5: .6g
    • -Calcium 1200-1500
    • -Phos
    • Stage 1,2:800-100; Stage 3-5: 8-12 mg
  13. End Stage Renal Disease (ESRD)
    • -BUN >100, & Cr 10-12 mg/dl
    • -retention of nitrogen metabolites
    • -May use Giovanetti diet
  14. Giovanetti Diet
    • 20 g protein (HBV)
    • Increase cals
    • Control edema
    • Prevent deficiencies
  15. Chronic Renal Failure
    Hemodialysis or Peritoneal Dialysis
  16. Hemodialysis
    • 1.2 g/kg Pro
    • 30-35 cals/kf
    • <30% fat; <300mg chol
    • 40 mg/kg ibw (2-3g) potassium
    • Vit C, b6, folate, b12, E supplements
  17. Peritoneal Dialysis
    • 1.2-1.3 g/kg pro
    • <60 yo=35 cals/kg; >60yo=30-35 cals/kg
    • 2-4 g Na
    • Potassium unrestricted
    • <2000 mg Ca including diet and binders
    • 800-1000mg phos
    • 1-3 L of fluid
    • *CAPD: continuous ambulatory peritoneal dialysis 4-5x/day
  18. Diabetes
    • Type 1: insulin deficient (juvenile)
    • Type 2: insulin-resistant
  19. Normal Blood Glucose:
    Impaired Fasting Glucose:
    Impaired Glucose Tolerance:
    Diabetes FPG:
    Diabetes GTT:
    • Normal Blood Glucose: 70-100
    • Impaired Fasting Glucose: 100-125
    • Impaired Glucose Tolerance:140-199
    • Diabetes FPG:>126
    • Diabetes GTT: >200
    • HgA1c >6.5%
  20. HgA1c
    • Measures the % of hemoglobin that has glucose attached
    • 60-90 days
    • high concentration of glucose forms chemical bonds to hemoglobin
  21. Goals for all diabetics
    • maintain normal blood glucose (PreP (70-130, PostP peak <180)
    • prevent and treat chronic complications
    • BP < 130/80
  22. Strategies for Type 1 Diabetics
    • CHO consistency
    • Adjustment of insulin and CHO
    • Monitor BG
    • Reduce insulin for exercise
  23. Strategies for Type 2 Diabetics
    • Achieve glucose, lipid and blood pressure goals
    • Weight loss
  24. Diabetic Nutrient Guidelines
    • Pro: .8g/kg
    • <200 mg chol
    • 60-70% MUS fats and CHO
  25. Gestational Diabetes
    • Risk Factors: BMI >30, history of GDM
    • Treatment: 40-45% CHO, 3 small-med meals, 204 snacks
    • DRI for CHO during pregnancy is 175g/day
    • 15-30g CHO w BF, less is tolerated
  26. Insulin Types
    • Rapid Acting: Novolog, Humalog, take 5-15 mins before eating, usualy duration 4 hours
    • Short-acting: Regular, take 30-45 minutes before meal (burst of insulin to cover the meal just about to be eaten) one unit covers 10-15 g of CHO, duration 3-6 hours
    • Intermediate-acting (NPH): onset 2-4 hrs, duration 10-18 hours, include bedtime snack of CHO & PRO
    • Long Acting: Lantus, Levermir, onset 2-4 hrs, duration 18-24 hours
  27. Common Insulin Regimens
    • Reg + NPH twice a day
    • Reg + NPH pre-BF, Reg-pres-supper, NPH bed
    • MDI (multiple daily injections)
    • Lantus basal insulin at bed, rapid for meals
    • insulin pump
  28. Oral-glucose lowering meds
    • insulin secretagogues: glucotrol-promotes insulin secreations
    • biguanides: metformin (glucophage)-enhance insulin action, suppress hepatic glucose production
    • alpha glucosidase inhibitors (acarbose, Precose)-inhibit ensymes that digest CHO, delaying absorption
    • Exenatide (byette): enhance insulin sectrions, suppresses postprandial glucagon
    • amylin agonist (smylin): decreases glucago production
  29. Dawn Phenomenon 
    • Natural increase in BG and insulin reqs bc of too much glucagon at dawn
    • *increased need for insulin @ dawn*
  30. Acute Ketoacidosis
    • Hyperglycemia bc dec insulin or too much CHO intake
    • Dehydration, fruity odor of ketones
    • Tx: insulin and hydration
  31. Acute Hypoglycemia (uncontrolled diabetes)
    • Treatment: 15g CHO from gluc tablets, fruit juice, sugar
    • wait 15 minutes; if still <70, give another 15g
    • repeat until BG is normal
  32. Long term complications of uncontrolled diabetes
    • Neuropathy: gastoparesis
    • Retinopathy: leads to blindess
    • Nepthropathy: leads to decreased kidney function
  33. Postprandial or reactive hypoglycemia
    • overstimulation of pancrease to increase insulin, BG falls below normal 2-5 hrs after meal
    • *Avoid simple sugars and eat 5-6 small meals/day*
  34. Addison's Disease (adrenal Cortex Insufficiency)
    • wasting of adrenal cortex
    • dec cortiol: glycogen depletion, hypoglycemia
    • dec aldosterone: sodium loss, potassium retention, dehydration
    • dec androgenic: tissue wasting, weight loss
    • *Diet: high protein, frequent feedings, high salt*
  35. Hyperthyroidism
    • Excess secretion of thyroid hormone
    • Elevated T3 &4
    • Increased BMR leading to weight loss
    • diet: increase calories
  36. Hypothyroidism
    • defiency of thyroid hormone
    • Low T4, sometimes 3
    • decreased BMR
    • Diet: weight reduction
  37. Goiter
    • Enlargement of thyroid gland bc insufficient thy hormones
    • Diet: iodized salt
  38. Gout
    • Disorder of purine metabolism
    • increased serum uric acid, causes joint pain & swelling
    • diet: weight reduction, low purine and fat
    • Meds: urate elminant, colchicine
  39. Galactosemia (inborn)
    • Missing ensyme that converts galactose-1-po4 to glucose-1-po4
    • Treat: soley by diet, galactose and lactose free
    • NO: Organ meats, MSG, milk
    • OKAY: soy, lactate, lactic acid, lactalbumin
  40. Urea Cycle Defects
    • unable to synthesize urea from ammonia resulting in ammonia accumulation
    • diet: protein restriction to lower ammonia, OTC (ornithine transcarbamylase deficiency)
  41. PKU (phenylketonuria-inborn)
    • Missing enzyme which converts phenylalanine to tyrosine
    • Detect with Guthrie blood test
    • Diet: restrict PHE, supplement with TYR; avoid aspartame
    • the need for phe decreases with age
    • low protein, high CHO--leads to dental caries
  42. Glycogen Storage Disease
    • defiency in G6P in liver, impairs gluconeogenesis and glycogenolysis
    • leads to hypoglycemia
    • diet: provide a consistent supply of exogenous glucose with raw cornstarch at regular intervals and a high CHO low fat diet
  43. Homocystinurias
    • Treatable inherited disorder of AA metabolism
    • severe elevations in methionine and homocysteine
    • low leverls of folate, bc and b12
    • supplement, if doesnt work low protein, low methionine diet
  44. Maple Syrup Urine Disease
    • Can't metabolize BCAA
    • restrict BCAA 45-62 mg/day
    • give adequate CHO and fat
    • small amounts of milk
    • avoid eggs, meat, nuts, dairy

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