Trace/Toxic elements, Vitamins, and Nutrition

if a deficiency impairs a biochemical or functional process and replacement of the element corrects this impairment is a characteristic of what?

essential element

What is measured in mg/dL concentration?

trace elements

What is measured in ug/dL concetrations?

ultratrace elements

What doe essential elements often have?

cofactors

What are trace elements of medical interest due to toxicity?

nonessential trace elemens

What is important in the clinical significance of disease states or toxicity?

absorption, transport, distribution, metabolism, and elimination of elements

What must be considered in sample collection?

anticoagulant

collection apparatus

specimen type

What collection tube is used for the testing of trace metals?

royal blue stopped with or without EDTA additive

What must be prevented during specimen collection?

environmental contamination

What uses the quantification of an element by measuring the intensity of emitted radiation from an aerosolized sample?

atomic emission spectroscopy

What is the order of atomic emission spectroscopy?

flame/inductively coupled plasma

monochromator

detector

What determines the element quantity through absorption of optical radiation by free atoms in the gas phase?

atome absorption spectroscopy

What is the order of atomic absorption spectroscopy?

light source

flame/graphite furnance

monochromator

detector

What measures the mass to charge ratio?

inductively coupled plasma mass spectrometry

What element is used in the manufacturing of stainless steel?

chromium

What form of chromium is easier to absorb and more toxic that Cr3+?

Cr6+

How is chromium transported?

bound is albumin and transferrin

What is the essential element for insulin action?

Cr3+

What form of chromium is an oxidizing agent?

Cr6+

What most commonly causes lung irritation and dermatitis and affects the liver, kidney, and immune system?

chromium

What is relatively soft yet tough metal and is used for electrical and heat conduction?

copper

What is an important cofactor and is critical for the reduction of iron in heme synthesis?

copper

What element is found in the cornea, spleen, intestine and lungs?

copper

Hepatic copper accounts for how much of total copper in the body?

10%

How is copper transported?

bound to proteins

Bile accounts for how much copper excretion? Urine/sweat?

bile: 98%

urine/sweat: <3%

What is important for many metalloenzymes?

copper

What disease causes copper rings in the eyes?

Wilson’s disease

What is an X linked recessive disease of copper metabolism and is usually fatal by age 3?

Menkes disease

What can toxic levels of copper cause?

hepatic and renal damage

neurologic symptoms

mucous membrane irritant

What element is used in the production of steel?

manganese

What element is primarily ingested and found mostly in fat and bone?

manganese

For manganese, what is the major way of excretion?

bile

What is manganese important for?

metalloenzymes and enzyme activation

Deficiency of what element causes clotting issues, dematitis, and elevated serum Ca, Phos, and ALP?

manganese

Toxicity of what element causes nausea, vomiting, headache, disorientation, anxiety, and compulsive laughing or crying?

manganese

What is used in electronic industry, nutritional supplements, pigments, pesticides, dandruff shampoos, and fungicides?

selenium

What accounts for most excretion of selenium?

urine is the most

some in sweat and exhalation

Selenium is important for the synthesis of what?

antioxidant

thyroid hormones

Deficiency of what causes cardiomyopathy?

selenium

Toxic levels of selenium causes what?

GI, tachycardia, CNS symptoms

What is a bluish-white lustrous metal, is stable in dry air, and has a white coating with moisture exposure?

zinc

What is the most common way of zinc absorption?

ingestion

What element if primarily found in muscle (60%) and bone (30%)?

zinc

How is zinc mostly excreted?

fecal

What takes up most of the zinc in the blood?

RBC

What is important for enzyme activity, DNA/RNA, and membrane structure?

zinc

Deficiency of what element causes growth inhibition and testicular atrophy?

zinc

What can zinc be used to treat?

wilson’s disease

What can zinc interfere with?

copper absorption

What is due to either inadequate diet, inadequate GI absorption or competing organism?

deficiency

What is due to increased metabolism that mandates intake and absorption of greater than normal levels?

insufficiency

What defines abnormally high intake that can lead to pathology?

toxicity

List all fat soluble vitamins

A, D, E, K

List all water soluble vitamins

ascorbic acid (C)

thiamine (B1)

riboflavin (B4)

pantothenic acid (B5)

pyridoxine (B6)

biotin (B7)

cyanocobalamin (B12)

folic acid

What vitamin is the coenzyme for energy metabolism?

B1 (thiamine)

What vitamin is the precursor for coenzymes FMN or FAD and is part of redox reactions?

B3 (niacin)

What vitamin is a component of coenzyme A?

B5 (pantothenic acid)

What vitamin is part of amino acid metabolism and transport and heme synthesis?

B6 (pyridoxine)

What vitamin is a coenzyme for carboxyl unit transfer?

B7 (biotin)

What vitamin is part of hematopoiesis and fatty acid metabolism?

B12 (cyanocobalamin)

What vitamin is a coenzyme for one-carbon transfer reactions and amino acid metabolism?

folate (folic acid)

What vitamin is part of H+ ion transfer, redox reactions, amino acid metabolism, and collagen synthesis?

vitamin C (ascorbic acid)

What vitamin is part of vision, cell differentiation, growth, reproduction, and immune system function?

vitamin A (retinol)

What vitamin controls calcium and phosphorus metabolism?

vitamin D

What vitamin is part of antioxidants, breakdown of peroxide, and integrity of cells?

vitamin E

What vitamin a cofactor for post-translational carboxylation of many proteins and clotting factors?

vitamin K

How are fat soluble vitamins absorbed? What does it require?

dissolve in fat before being absorbed into the blood stream

bile acids from the liver are needed

What can interfere with the absorption of fat-soluble vitamins?

lipase

What is carried by lipoproteins and stored in the intestines, liver, and fatty tissues?

fat soluble vitamins

What type of vitamin has a greater risk of toxicity?

fat soluble vitamins

What vitamin dissolves in water, is regularly eliminated in urine and feces, and needs constant re-supply?

water soluble vitamins

What is the major site for vitamin absorption?

small intestine

Where are vitamin B12 and vitamin K metabolized?

large intestine

How are vitamins metabolized?

nutrients enter at cellular levels

picked up and absorbed via blood capillaries and lymph fluids

How are vitamins absorbed?

by active transport, diffusion, and osmosis

What vitamins are most commonly assayed?

folate (B9)

B12

D

What vitamin is most commonly deficient and can lead to megaloblastic anemia?

folate

Increased likelihood of neural tube defects in infants can be due to what in the mother?

folate deficiency

Increased levels of atherosclerosis related to homocysteine turnover is dependent on what vitamin levels?

folate

How is folate measured?

serum and RBC hemolysate

Vitamin B12 absorption is dependent on?

intrinsic factor

What are transcobalamins?

specific serum transport proteins for transporting B12 to the tissues

Insufficient dietary B12 is associated with?

megaloblastic anemia

What is important for assessing PTH function, bone development, chronic renal failure, small bowel disease, pancreatic insufficiency, and drug-related hypovitaminosis?

vitamin D

What condition occurs when the diet is deficiency in protein and calories?

Marasmus

Marasmus lead to what?

general wasting

Which is more severe?

Marasmus

Kwashiorkor

Marasmus

What condition occurs when diet is adequate in calories but deficient in protein?

Kwashiorkor

What occurs in Kwashiorkor?

visceral muscle protein loss

What are the negative outcomes of malnutrition?

increased mortality and morbidity

impaired wound healing

increased rates of infection

increased length of hospital stay

What is part of anthropomorphic measurement?

height and weight

skinfold thickness

wrist and mid-arm muscular circumference

What is seen in hematology assays in deficiencies?

reduced Hgb, Hct, WBC, and lymphocytes

What is seen in immunology assays in deficiencies?

delayed or decreased immune function

increased TdT

cytokine levels

What is used to determine if malabsorption is present?

fecal fat

What does increased urine BUN/creatinine mean?

increased catabolism

What is used to measure inadequate dietary fat or malabsorption?

cholesterol/triglyceride

What is transthyretin?

pre-albumin

transports thyroxine (T4) and retinol binding protein bound to retinol

What is responsible for vitamin A transport?

retinol binding protein (RBP)

normal CRP and low transthyretin indicates

protein malnutrition