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sensation.\tIngestion\tof\tfluids\treturns\tNa\n+\n\tlevels\tto\tnormal.\tUnder\tcertain\tcircumstances\tNa\n+\n\tand\nfluid\tregulation\tcan\tbe\tdisrupted,\tresulting\n\tin\tabnormal\tblood\tNa\n+\n\tlevels.\tSIADH\tis\tcharacterized\tby\nconcentrated,\tlow-volume\turine\tand\tdilutional\thyponatremia\tas\twater\tis\tretained.\tSIADH\tcan\tresult | [
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from\tcentral\tnervous\tsystem\tdisorders,\tpulmonary\tdisorders,\ttumors,\tand\tcertain\tmedications.\nCommon\tdrug\tclasses/medications\tinclude\tantidepressants,\tanticonvulsants,\tantipsychotic\tagents,\ncytotoxic\tagents,\tand\tpain\tmedication\tare\tthe\tcommon\n\tmedications\t(\nShepshelovich\tet\tal,\t2017\n). | [
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medications\t(\nShepshelovich\tet\tal,\t2017\n).\nEstrogen,\twhich\tis\tslightly\tsimilar\tto\taldosterone,\talso\tcauses\tNa\n+\n\tand\twater\tretention.\tChanges\tin\nwater\tand\tNa\n+\n\tbalance\tduring\tthe\tmenstrual\tcycle,\tduring\tpregnancy,\tand\twhile\ttaking\toral\ncontraceptives\tare\tattributable\tpartially\tto\tchanges\tin\tprogesterone\tand\testrogen\tlevels. | [
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Dietary\treference\tintake\nThe\tdietary\treference\tintakes\t(DRIs)\tgive\tan\n\tupper\tlimit\tof\t2.3\tg\tof\tNa\n+\n\tper\tday\t(or\t5.8\tg\tsodium\nchloride\tper\tday).\tThe\tmean\tdaily\tsalt\tintake\tin\tthe\tUnited\tStates\tis\tapproximately\t6\tto\t12\tg/day\n(\nInstitute\tof\tMedicine\tof\tthe\tNational\tAcademies,\t2005\n),\twhich\texceeds\tthe\tadequate\tintake\t(AI)\tfor\nNa\n+ | [
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] |
),\twhich\texceeds\tthe\tadequate\tintake\t(AI)\tfor\nNa\n+\n\tof\t1.2\tto\t1.3\tg\tper\tday\tfor\tadult\tmales\tand\tfemales\t(see\t\nTable\t3.4\n).\nHealthy\tkidneys\tare\tusually\table\tto\texcrete\texcess\tNa\n+\n\tintake;\thowever,\n\tpersistent\texcessive\tNa\n+\nintake\thas\tbeen\timplicated\tin\tdevelopment\tof\thypertension.\tIn\taddition\tto\tits\trole\tin\thypertension, | [
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excessive\tsalt\tintake\thas\tbeen\tassociated\twith\tincreased\turinary\tCa\n++\n\texcretion,\tkidney\tstones,\tand\nsome\tcases\tof\tosteoporosis.\tHigher\tNa\n+\n\tconsumption\thas\tbeen\tassociated\twith\thigher\tweight\tstatus,\nand\ta\tpositive\trelationship\thas\tbeen\tobserved\tbetween\tNa\n+\n\tintake\tand\tobesity\n\tindependent\tof\nenergy\tintake\t(\nSong\tet\tal,\t2013\n;\t\nYoon,\t2013\n; | [
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independent\tof\nenergy\tintake\t(\nSong\tet\tal,\t2013\n;\t\nYoon,\t2013\n;\t\nZhu\tet\tal,\t2014\n).\tIn\taddition,\ta\tpositive\tassociation\thas\nbeen\tidentified\tbetween\tNa\n+\n\tintake\tand\tincreased\tcirculation\tof\tleptin\t(secreted\tby\tfat\tcells\tand\ninfluences\tinflammatory\tresponse\tand\tNa\n+\n\texcretion)\tand\ttumor\tnecrosis\tfactor\talpha\t(plays\ta\trole\nin\tinflammation)\t( | [
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in\tinflammation)\t(\nZhu\tet\tal,\t2014\n).\nSources\nThe\tmajor\tsource\tof\tNa\n+\n\tis\tsodium\n\tchloride,\tor\tcommon\ttable\tsalt,\tof\twhich\tNa\n+\n\tconstitutes\t40%\tby\nweight.\tProtein\tfoods\tgenerally\tcontain\tmore\tnaturally\texisting\tNa\n+\n\tthan\tdo\tvegetables\tand\tgrains, | [
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however,\tabout\t70%\tof\tserum\tmagnesium\tis\tfree\tor\tionized.\tThe\tremainder\tis\tbound\tto\tproteins\tand\nis\tnot\tactive.\nFunction\nMagnesium\t(Mg\n2+\n)\tis\tan\timportant\tcofactor\tin\tmany\tenzymatic\treactions\tin\tthe\tbody,\tbone\nmetabolism,\tcentral\tnervous\tsystem,\tand\tcardiovascular\tfunction.\tMany\tof\tthe\tenzyme\tsystems\nregulated\tby\tMg\n2+ | [
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regulated\tby\tMg\n2+\n\tare\tinvolved\tin\tnutrient\tmetabolism\tand\tnucleic\tacid\tsynthesis,\tleading\tto\tthe\nbody’s\tneed\tto\tcarefully\tregulate\tMg\n2+\n\tstatus.\nAs\twith\tCa\n++\n,\tsevere\thypo-\tor\thypermagnesemia\tcan\thave\tlife-threatening\n\tconsequences.\tPhysical\nsymptoms\tof\tMg\n2+\n\tabnormalities\tare\tsimilar\tto\tthose\tobserved\twith\tother\telectrolyte\tdeficiencies, | [
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and\tthe\tchallenges\twith\tserum\tmeasurements\tdiscussed\tearlier\tmake\tassessment\tof\tMg\n2+\n\tstatus\ndifficult.\tSymptoms\tof\thypomagnesemia\tinclude\tmuscle\tweakness,\ttetany,\tataxia,\tnystagmus,\tand,\tin\nsevere\tcases,\tventricular\tarrhythmia.\tFrequent\tcauses\tof\thypomagnesemia\tinclude\texcessive\n\tstool | [
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stool\nlosses\t(as\tseen\tin\tshort\tbowel\tsyndrome\tor\tmalabsorption),\tinadequate\tMg\n2+\n\tin\tthe\tdiet\t(oral,\nenteral,\tor\tparenteral\tnutrition),\tintracellular\tshifts\tduring\trefeeding\tsyndrome\t(\nBox\t3.1\n;\tsee\t\nChapter\n12\n),\tacute\tpancreatitis,\tburns,\talcoholism,\tdiabetic\tketoacidosis,\tand\tmedications\tcausing\tincreased\nMg\n2+ | [
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] |
presence\tof\tsignificant\tillness.\nDuring\tstarvation,\tthe\tbody’s\tmetabolism\tshifts\n\tfrom\tusing\tglucose\tto\tusing\tfat\tas\tthe\tmain\tfuel\nsource.\tWhen\tnutrients\tare\tprovided\tto\tthe\tbody,\tthere\tis\ta\tmetabolic\tshift.\tAn\tincrease\tof\tinsulin\nleads\tto\tthis\tintracellular\tshift,\tand\tthus\tconcentrations\tof\telectrolytes\tin\tthe\tserum\tfall.\tLow | [
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] |
levels\tof\tphosphorus,\tmagnesium,\tand\tpotassium\tcan\tbe\tseen,\tand\tthere\tare\tsignificant\trisks\tof\ncardiac\tarrhythmia,\tneurological\tconsequences\t(seizures,\n\tdelirium,\tneuropathy),\tand\trespiratory\nfailure.\tFluid\tretention\tand\tthiamin\tdeficiency\tcan\talso\toccur.\nPrevention\tof\tRefeeding\tSyndrome:\n1.\t\nPatient\tscreening\tfor\trisk\tof\trefeeding\tsyndrome\n2. | [
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1.\t\nPatient\tscreening\tfor\trisk\tof\trefeeding\tsyndrome\n2.\t\nSlow\treintroduction\tand\tadvancement\tof\tcalories\tprovided\tfrom\tenteral\tor\tparenteral\nnutrition\tto\tpatients\n3.\t\nClinical\tmonitoring\t(for\tcardiac,\tneuro,\trespiratory,\tfluid\tstatus,\tetc.)\n4.\t\nLaboratory\n\tmonitoring\tof\tserum\telectrolytes\tand\ttreatment\tof\tabnormalities | [
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monitoring\tof\tserum\telectrolytes\tand\ttreatment\tof\tabnormalities\nFrom\tCanada\tT,\tTajchman\tSK,\tTucker\tAM,\tet\tal,\teditors:\tA\nSPEN\tFluids,\telectrolytes\tand\tacid\tbase\ndisorders\thandbook\n,\tSilver\tSpring,\tMD,\t2015,\tASPEN,\tpp\t1–397;\tSkipper\tA:\tRefeeding\tsyndrome\tor\nrefeeding\thypophosphatemia:\ta\tsystematic\treview\tof\tcases,\t\nNutr\tClin\tPract | [
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Nutr\tClin\tPract\n\t27:34–40,\t2012;\tRhoda\tKM,\nPorter\tMJ,\tQuintini\tC:\tFluid\tand\telectrolyte\n\tmanagement:\tputting\ta\tplan\tin\tmotion,\t\nJPEN\tJ\tParenter\nEnteral\tNutr\n\t35:\t675–685,\t2011;\tKraft\tMD,\tBtaiche\tIF,\tSacks\tGS:\tReview\tof\tthe\trefeeding\tsyndrome,\t\nNutr\nClin\tPract\n\t20:625–633,\t2005. | [
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Nutr\nClin\tPract\n\t20:625–633,\t2005.\nOften\thypomagnesemia\tis\ttreated\twith\toral\tsupplementation\tif\tno\tphysical\tsymptoms\tare\tnoted.\nHowever,\tdietitians\tshould\tmonitor\tcautiously\tfor\tdiarrhea\twith\toral\tMg\n2+\n\tsupplements\tif\tthey\tare\nnot\tgiven\tin\n\tdivided\tdoses\t(such\tas\tmagnesium\toxide),\twhich\toften\tcan\tincrease\tMg\n2+\n\tlosses\tthrough | [
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2+\n\tlosses\tthrough\nthe\tstool.\tIncreased\tlosses\tthrough\tthe\tstool\tis\tavoided\twith\tsupplementation\tfrom\tsalts\tsuch\tas\nmagnesium\tgluconate,\tmagnesium\tcitrate,\tor\tmagnesium\tlactate.\tIntravenous\trepletion\twith\tMg\n2+\n\tis\nrequired\twith\tsymptomatic\tsigns\tof\tdeficiency\tor\tif\tserum\tlevels\tare\tbelow\t1\tmg/dL.\nHypermagnesemia,\ta\tserum\tvalue | [
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] |
Hypermagnesemia,\ta\tserum\tvalue\n\tgreater\tthan\t2.5\tmg/dL,\tcan\tbe\tdue\tto\texcess\tsupplementation\nor\tMg\n2+\n-containing\tmedications,\tsevere\tacidosis,\tor\tdehydration.\tTreatment\toptions\tinclude\tomission\nof\tMg\n2+\n-containing\tmedications\tand\tcorrection\tof\tthe\tfluid\timbalance.\nAbsorption/excretion\nApproximately\t30%\tto\t50%\tof\tMg\n2+ | [
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when\thypokalemia\tis\trefractory\tto\nrepletion\t(unable\tto\tregain\ta\tnormal\tlevel\tdespite\tdelivery\tof\tappropriate\trepletion\tdoses).\tThe\nkidneys\tincrease\tpotassium\texcretion\tin\tresponse\tto\thypomagnesemia.\nSources\nMg\n2+\n\tis\tfound\tin\ta\tvariety\tof\tfoods,\tmaking\tan\tisolated\tMg\n2+\n\tdeficiency\tunlikely\tin\totherwise\thealthy | [
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] |
2+\n\tdeficiency\tunlikely\tin\totherwise\thealthy\nindividuals.\tHighly\tprocessed\tfoods\ttend\tto\thave\tlower\tMg\n2+\n\tcontent,\twhereas\tgreen\n\tleafy\nvegetables,\tnuts,\tseeds,\tlegumes,\tand\twhole\tgrains\tare\tgood\tsources\t(see\t\nAppendix\t43\n).\nDietary\treference\tintakes\nThe\trecommended\tintake\tof\tMg\n2+\n\tin\tadults\tranges\tfrom\t310\tto\t420\tmg/day,\tdepending\ton\tage\tand | [
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] |
2+\n\tin\tadults\tranges\tfrom\t310\tto\t420\tmg/day,\tdepending\ton\tage\tand\ngender\t(see\tinside\tcover).\nPhosphorus\nPhosphorus\tis\tthe\tprimary\tintracellular\tanion,\tand\tits\trole\tin\tadenosine\ttriphosphate\t(ATP)\tis\tvital\tin\nenergy\tmetabolism.\tIn\taddition,\tphosphorus\n\tis\timportant\tin\tbone\tmetabolism.\tAbout\t80%\tof\tthe | [
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is\timportant\tin\tbone\tmetabolism.\tAbout\t80%\tof\tthe\nbody’s\tphosphorus\tis\tfound\tin\tbones.\tNormal\tlevels\tfor\tserum\tphosphorus\tare\tbetween\t2.4\tand\t4.6\nmg/dL\t(refer\tto\tthe\treference\tranges\tfor\teach\treporting\tlaboratory).\nFunctions\nLarge\tamounts\tof\tfree\tenergy\tare\treleased\twhen\tthe\tphosphate\tbonds\tin\tATP\tare\tsplit.\tIn\taddition\tto | [
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kidney\tdisease).\nSources\nPhosphorus\tis\tfound\tmainly\tin\tanimal\tproducts,\tincluding\tmeats\tand\tmilk;\tdried\tbeans,\tsoda,\nprocessed\tfoods,\tbaked\tgoods,\tand\tseafood\tor\tmeats\tsoaked\tin\tphosphate\tsolutions\tare\tcommon\ndietary\n\tsources\tin\tthe\tAmerican\tdiet.\nDietary\treference\tintakes | [
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dietary\n\tsources\tin\tthe\tAmerican\tdiet.\nDietary\treference\tintakes\nThe\trecommended\tintake\tof\tphosphorus\tis\tapproximately\t700\tmg/day,\tdepending\ton\tage\tand\tgender,\nwith\tan\tupper\tlimit\tof\t3500\tto\t4000\tmg\t(see\tinside\tcover).\nPotassium\nWith\tapproximately\t98%\tof\tpotassium\t(K\n+\n)\tin\tthe\tintracellular\tspace,\tK\n+\n\tis\tthe\tmajor\tcation\tof\tICF. | [
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balance.\tIn\taddition\tto\tCa\n++\n,\tK\n+\n\tis\timportant\tin\tthe\tregulation\tof\tneuromuscular\tactivity.\nConcentrations\tof\tNa\n+\n\tand\tK\n+\n\tdetermine\tmembrane\tpotentials\tin\tnerves\tand\tmuscle.\tK\n+\n\talso\npromotes\tcellular\tgrowth.\tThe\tK\n+\n\tcontent\tof\tmuscle\n\tis\trelated\tto\tmuscle\tmass\tand\tglycogen\tstorage; | [
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in\trenal\timpairment\tbecause\tK\n+\n\tis\texcreted\tby\tthe\n\tkidneys.\nHyperkalemia\tcan\tbe\tcritical,\tespecially\twhen\tlevels\texceed\t6.5\tmEq/L\tand\tare\taccompanied\tby\nsymptoms\tof\tmuscle\tweakness,\tparalysis,\trespiratory\tfailure,\tand\tarrhythmias/ECG\tchanges.\tCauses | [
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+\n\tunder\tthe\tinfluence\tof\n\taldosterone.\tIn\tthe\nsetting\tof\thypokalemia,\taldosterone\tsecretions\tare\tlower,\tand\tthe\tkidneys\tshift\tto\treabsorb\tK\n+\n\tand\nexcrete\tNa\n+\n.\nSources\nK\n+\n-rich\tfood\tsources\tinclude\tfruits,\tvegetables,\tlegumes,\tfresh\tmeat,\tand\tdairy\tproducts.\tSalt\nsubstitutes\tcommonly\tcontain\tK\n+\n.\t\nBox\t3.2 | [
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] |
substitutes\tcommonly\tcontain\tK\n+\n.\t\nBox\t3.2\n\tcategorizes\tselect\tfoods\taccording\tto\ttheir\tK\n+\n\tcontent.\nWhen\tevaluating\tK\n+\n\tsources\tand\tlosses,\tclinicians\tmust\tconsider\n\tother\tnonfood\tsources\tof\tK\n+\n,\tsuch\nas\tintravenous\tfluids\twith\tadded\tK\n+\n,\tcertain\tmedications\tcontaining\tK\n+\n,\tand\tmedications\tthat\tmay\ncause\tthe\tbody\tto\texcrete\tK\n+\n.\nBOX\t3.2 | [
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] |
+\n,\tand\tmedications\tthat\tmay\ncause\tthe\tbody\tto\texcrete\tK\n+\n.\nBOX\t3.2\nClassification\tof\tSelect\tFoods\tby\tPotassium\tContent | [
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Low\t(0-100\nmg/serving)\n*\nMedium\t(100-200\nmg/serving)\n*\nHigh\t(200-300\nmg/serving)\n*\nVery\tHigh\t(>300\tmg/serving)\n*\nFruits\nApplesauce\nBlueberries\nCranberries\nLemon,\t½\nmedium\nLime,\t½\nmedium\nPears,\tcanned\nPear\tnectar\nPeach\tnectar\nVegetables\nCabbage,\traw\nCucumber\nslices\nGreen\tbeans,\nfrozen\nLeeks\nLettuce,\niceberg,\t1\tcup\nWater\nchestnuts,\ncanned\nBamboo | [
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] |
frozen\nLeeks\nLettuce,\niceberg,\t1\tcup\nWater\nchestnuts,\ncanned\nBamboo\nshoots\tcanned\nFruits\nApple,\t1\tsmall\nApple\tjuice\nApricot\tnectar\nBlackberries\nCherries,\t12\tsmall\nFruit\tcocktail\nGrape\tjuice\nGrapefruit,\t½\nsmall\nGrapes,\t12\tsmall\nMandarin\toranges\nPeaches,\tcanned\nPineapple,\tcanned\nPlum,\t1\tsmall\nRaspberries\nRhubarb\nStrawberries\nTangerine,\t1\tsmall | [
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Plum,\t1\tsmall\nRaspberries\nRhubarb\nStrawberries\nTangerine,\t1\tsmall\nWatermelon,\t1\tcup\nVegetables\nAsparagus,\tfrozen\nBeets,\tcanned\nBroccoli,\tfrozen\nCabbage,\tcooked\nCarrots\nCauliflower,\tfrozen\nCelery,\t1\tstalk\nCorn,\tfrozen\nEggplant\nGreen\tbeans,\nfresh,\traw\nMushrooms,\tfresh,\nraw\nOnions\nPeas\nRadishes\nTurnips\nZucchini,\tsummer\nsquash\nFruits\nApricots,\tcanned | [
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Peas\nRadishes\nTurnips\nZucchini,\tsummer\nsquash\nFruits\nApricots,\tcanned\nGrapefruit\tjuice\nKiwi,\t½\tmedium\nNectarine,\t1\tsmall\nOrange,\t1\tsmall\nOrange\tjuice\nPeach,\tfresh,\t1\nmedium\nPear,\tfresh,\t1\tmedium\nVegetables\nAsparagus,\tfresh,\ncooked,\t4\tspears\nBeets,\tfresh,\tcooked\nBrussels\tsprouts\nKohlrabi\nMushrooms,\tcooked\nOkra\nParsnips\nPotatoes,\tboiled\tor\nmashed | [
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] |
Kohlrabi\nMushrooms,\tcooked\nOkra\nParsnips\nPotatoes,\tboiled\tor\nmashed\nPumpkin\nRutabagas\nMiscellaneous\nGranola\nNuts\tand\tseeds,\t1\toz\nPeanut\tbutter,\t2\ttbsp\nChocolate,\t1.5-oz\tbar\nFruits\nAvocados,\t¼\tsmall\nBanana,\t1\tsmall\nCantaloupe,\t¼\tsmall\nDried\tfruit,\t¼\tcup\nHoneydew\tmelon,\t⅛\tsmall\nMango,\t1\tmedium\nPapaya,\t½\tmedium\nPrune\tjuice\nVegetables | [
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Mango,\t1\tmedium\nPapaya,\t½\tmedium\nPrune\tjuice\nVegetables\nArtichoke,\t1\tmedium\nBamboo\tshoots,\tfresh\nBeet\tgreens,\t¼\tcup\nCorn\ton\tthe\tcob,\t1\tear\nChinese\tcabbage,\tcooked\nDried\tbeans\nPotatoes,\tbaked,\n\t½\tmedium\nPotatoes,\tFrench\tfries,\t1\toz\nSpinach\nSweet\tpotatoes,\tyams\nSwiss\tchard,\t¼\tcup\nTomato,\tfresh,\tsauce,\tor\tjuice;\ntomato\tpaste,\t2\ttbsp\nWinter\tsquash | [
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Tomato,\tfresh,\tsauce,\tor\tjuice;\ntomato\tpaste,\t2\ttbsp\nWinter\tsquash\nMiscellaneous\nBouillon,\tlow\tsodium,\t1\tcup\nCappuccino,\t1\tcup\nChili,\t4\toz\nCoconut,\t1\tcup\nLasagna,\t8\toz\nMilk,\tchocolate\tmilk,\t1\tcup\nMilkshakes,\t1\tcup\nMolasses,\t1\ttbsp\nPizza,\t2\tslices\nSalt\tsubstitutes,\t¼\ttsp\nSoy\tmilk,\t1\tcup\nSpaghetti,\t1\tcup\nYogurt,\n\t6\toz | [
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Soy\tmilk,\t1\tcup\nSpaghetti,\t1\tcup\nYogurt,\n\t6\toz\n*One\tserving\tequals\t½\tcup\tunless\totherwise\tspecified\nDietary\treference\tintakes\nThe\tadequate\tintake\tlevel\tfor\tK\n+\n\tfor\tadults\tis\t4700\tmg/day.\tNo\tupper\tlimit\thas\tbeen\tset.\tK\n+\n\tintake\tis\ninadequate\tin\ta\tlarge\tnumber\tof\tAmericans,\tas\tmany\tas\t50%\tof\tadults.\tThe\treason\tfor\tthe\tpoor\tK\n+ | [
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] |
substance\tthat\ttends\tto\taccept\thydrogen\tions\tin\tsolution.\tThe\thydrogen\tion\tconcentration\t(H\n+\n)\ndetermines\tacidity.\tBecause\tthe\tmagnitude\tof\tH\n+\n\tis\tsmall\tcompared\twith\tthat\tof\tother\tserum\nelectrolytes,\tacidity\tis\texpressed\tmore\treadily\tin\n\tterms\tof\tpH\tunits.\tA\tlow\tblood\tpH\tindicates\ta\nhigher\tH\n+ | [
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terms\tof\tpH\tunits.\tA\tlow\tblood\tpH\tindicates\ta\nhigher\tH\n+\n\tand\tgreater\tacidity,\twhereas\ta\thigh\tpH\tvalue\tindicates\ta\tlower\tH\n+\n\tand\tgreater\talkalinity.\nAcid–base\tbalance\n\tis\tthe\tdynamic\tequilibrium\tstate\tof\tH\n+\n.\tMaintaining\tthe\tarterial\tblood\tpH\tlevel\nwithin\tthe\tnormal\trange\tof\t7.35\tto\t7.45\tis\tcrucial\tfor\tmany\tphysiologic\tfunctions\tand\tbiochemical | [
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the\tbody’s\tregulatory\tcapabilities\tor\twhen\tnormal\tregulatory\tmechanisms\tbecome\tineffective.\tThese\nregulatory\tdisturbances\tmay\tdevelop\tin\tassociation\twith\tcertain\tdiseases,\n\ttoxin\tingestion,\tshifts\tin\nfluid\tstatus,\tand\tcertain\tmedical\tand\tsurgical\ttreatments\t(\nTable\t3.5\n).\tIf\ta\tdisrupted\tacid–base | [
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Table\t3.5\n).\tIf\ta\tdisrupted\tacid–base\nbalance\tis\tleft\tuntreated,\tmultiple\tdetrimental\teffects\tranging\tfrom\telectrolyte\tabnormalities\tto\ndeath\tcan\tensue. | [
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] |
TABLE\t3.5\nFour\tMajor\tAcid–Base\tImbalances\nAcid-base\nImbalance\npH\nPrimary\nDisturbance\nCompensation\nPossible\tCauses\nRespiratory\nRespiratory\nacidosis\nLow\nIncreased\npCO\n2\nIncreased\trenal\tnet\nacid\texcretion\twith\nresulting\tincrease\tin\nserum\tbicarbonate\nEmphysema;\tCOPD;\tneuromuscular\tdisease\nwhere\trespiratory\tfunction\tis\timpaired; | [
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] |
where\trespiratory\tfunction\tis\timpaired;\nexcessive\tretention\tof\tCO\n2\nRespiratory\nalkalosis\nHigh\nDecreased\npCO\n2\nDecreased\trenal\tnet\nacid\texcretion\n\twith\nresulting\tdecrease\tin\nserum\tbicarbonate\nHeart\tfailure,\tpregnancy,\tsepsis,\nmeningitis,\tanxiety,\tpain,\texcessive\nexpiration\tof\tCO\n2\nMetabolic\nMetabolic\nacidosis\nLow\nDecreased\nHCO\n3\n− | [
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expiration\tof\tCO\n2\nMetabolic\nMetabolic\nacidosis\nLow\nDecreased\nHCO\n3\n−\nHyperventilation\twith\nresulting\tlow\tpCO\n2\nDiarrhea;\turemia;\tketoacidosis\tfrom\nuncontrolled\tdiabetes\tmellitus;\nstarvation;\thigh-fat,\tlow-carbohydrate\ndiet;\tdrugs,\talcoholism,\tkidney\tdisease\nMetabolic\nalkalosis\nHigh\nIncreased\nHCO\n3\n−\nHypoventilation\twith\nresulting\tincrease\tin\npCO | [
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and\tsulfuric\tacids,\tare\tproduced\tfrom\tthe\tmetabolism\tof\tphosphate-containing\tcompounds\tto\tform\nphosphates\tand\tphosphoric\tacid\tand\tsulfur-containing\tamino\tacids\t(such\tas\tthe\tmetabolism\tof\nmethionine\tand\tcysteine).\n\tOrganic\tacids,\tsuch\tas\tlactic,\turic,\tand\tketo\tacids,\tcome\tfrom\tthe | [
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Organic\tacids,\tsuch\tas\tlactic,\turic,\tand\tketo\tacids,\tcome\tfrom\tthe\nincomplete\tmetabolism\tof\tcarbohydrates\tand\tfats.\tThese\torganic\tacids\ttypically\taccumulate\tonly\nduring\texercise,\tacute\tillness,\tor\tfasting.\tUnder\tnormal\tconditions,\tthe\tbody\tis\table\tto\tmaintain\nnormal\tacid–base\tstatus\tthrough\ta\twide\trange\tof\tacid\tintake\tfrom\tfoods.\nRegulation | [
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Regulation\nVarious\tregulatory\tmechanisms\tmaintain\tthe\tpH\tlevel\n\twithin\tvery\tnarrow\tphysiologic\tlimits.\tAt\tthe\ncellular\tlevel,\t\nbuffer\n\tsystems\tcomposed\tof\tweak\tacids\tor\tbases\tand\ttheir\tcorresponding\tsalts\nminimize\tthe\teffect\ton\tpH\tof\tthe\taddition\tof\ta\tstrong\tacid\tor\tbase.\tThe\tbuffering\teffect\tinvolves | [
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formation\tof\ta\tweaker\tacid\tor\tbase\tin\tan\tamount\tequivalent\tto\tthe\tstrong\tacid\tor\tbase\tthat\thas\tbeen\nadded\tto\tthe\tsystem\t(see\t\nFig.\t3.3\n).\nProteins\tand\tphosphates\n\tare\tthe\tprimary\tintracellular\tbuffers,\twhereas\tthe\tbicarbonate\tand\tH\n2\nCO\n3\nsystem\tis\tthe\tprimary\textracellular\tbuffer.\tThe\tacid–base\tbalance\talso\tis\tmaintained\tby\tthe\tkidneys | [
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and\tlungs.\tThe\tkidneys\tregulate\thydrogen\tion\t(H\n+\n)\tsecretion\tand\tbicarbonate\tresorption.\tThe\nkidneys\tregulate\tthe\tpH\tof\tthe\turine\tby\texcreting\tH\n+\n\tor\tHCO\n3\n−\n\tand\tcan\tmake\tbicarbonate.\tThe\nkidneys\tare\tthe\tslowest-responding\tmechanism\n\tto\tmaintain\tacid–base\tbalance.\tThe\tlungs\tcontrol\tH\n+\nthrough\tthe\tamount\tof\tCO\n2\n\tthat\tis\texhaled.\tWhen\tmore\tCO\n2 | [
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causes.\n\tThe\tevaluation\tof\tacid–base\tstaus\trequires\tanalysis\tof\tserum\telectrolytes\tand\tarterial\tblood\ngas\t(ABG)\tvalues\t(\nTable\t3.6\n).\tThere\tare\tfour\tmain\tacid–base\tabnormalities:\tmetabolic\tacidosis,\nmetabolic\talkalosis,\trespiratory\tacidosis,\tand\trespiratory\talkalosis.\tIt\tis\timportant\tto\tcharacterize\tthe | [
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TABLE\t3.6\nCommon\tArterial\tBlood\tGas\tValues\n*\nClinical\tTest\nABG\tValue\npH\n7.35-7.45\npCO\n2\n35-45\tmm\tHg\npO\n2\n80-100\tmm\tHg\nHCO\n3\n−\n\t(bicarbonate)\n22-26\tmEq/L\nO\n2\n\tsaturation\n>95%\n*\nCheck\texact\treference\trange\tat\tlaboratory\twhen\tinterpreting\tpatient\tresults\nABG,\n\tArterial\tblood\tgas.\nMetabolic\tacidosis\nMetabolic\tacidosis | [
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ABG,\n\tArterial\tblood\tgas.\nMetabolic\tacidosis\nMetabolic\tacidosis\n\tresults\tfrom\tincreased\tproduction\tor\taccumulation\tof\tacids\tor\tloss\tof\tbase\t(i.e.,\nHCO\n3\n−\n)\tin\tthe\textracellular\tfluids.\tSimple,\tacute\tmetabolic\tacidosis\tresults\tin\ta\tlow\tblood\tpH\t(or\nacidemia\n),\tlow\tHCO\n3\n−\n,\tand\tnormal\tpCO\n2\n.\tExamples\tof\tmetabolic\tacidosis\n\tinclude\tdiabetic | [
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,\tand\tnormal\tpCO\n2\n.\tExamples\tof\tmetabolic\tacidosis\n\tinclude\tdiabetic\nketoacidosis,\tlactic\tacidosis,\ttoxin\tingestion,\turemia,\tand\texcessive\tHCO\n3\n−\n\tloss\tvia\tthe\tkidneys\tor\nintestinal\ttract.\tMultiple\tdeaths\tpreviously\thave\tbeen\tattributed\tto\tlactic\tacidosis\tcaused\tby | [
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“routinely\tmeasured”\tanions\tin\tthe\tblood.\tThe\tanion\tgap\tis\nwhere\tNa\n+\n\tis\tsodium,\tK\n+\n\tis\tpotassium,\tCl\n−\n\tis\tchloride,\tand\tHCO\n3\n−\n\tis\tbicarbonate.\tNormal\tis\t12\tto\n14\n\tmEq/L\t(refer\tto\tthe\treference\tranges\tfor\teach\treporting\tlaboratory).\nAnion\tgap\tmetabolic\tacidosis\toccurs\twhen\ta\tdecrease\tin\tHCO\n3\n−\n\tconcentration\tis\tbalanced\tby | [
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3\n−\n\tconcentration\tis\tbalanced\tby\nincreased\tacid\tanions\tother\tthan\tchloride.\tThis\tcauses\tthe\tcalculated\tanion\tgap\tto\texceed\tthe\tnormal\nrange\tof\t12\tto\t14\tmEq/L.\tThis\tnormochloremic\tmetabolic\tacidosis\tmay\tdevelop\tin\tassociation\twith\ndiabetic\tketoacidosis,\tlactic\tacidosis,\n\turemia,\tingestion\t(e.g.,\tmethanol,\tparaldehyde,\tethylene\tglycol, | [
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uremia,\tingestion\t(e.g.,\tmethanol,\tparaldehyde,\tethylene\tglycol,\nalcohol),\tor\tbe\tiatrogenic\t(\nWilson,\t2003\n).\tNongap\tmetabolic\tacidosis\toccurs\twhen\ta\tdecrease\tin\nHCO\n3\n−\n\tconcentration\tis\tbalanced\tby\tan\tincrease\tin\tchloride\tconcentration,\tresulting\tin\ta\tnormal | [
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anion\tgap.\tThis\thyperchloremic\tmetabolic\tacidosis\tmay\tdevelop\tin\tassociation\tsmall\tbowel\tfistulae,\nexcess\tchloride\tingestion\t(from\tmedications\n\tor\tparenteral\tsources),\tdiarrhea,\tpancreatic\tfistulae,\nrenal\ttubular\tacidosis,\tureterosigmoidostomy,\tor\tadrenal\tinsufficiency\t(\nCanada\tet\tal,\t2015\n).\nMetabolic\talkalosis\nMetabolic\talkalosis | [
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Canada\tet\tal,\t2015\n).\nMetabolic\talkalosis\nMetabolic\talkalosis\n\tresults\tfrom\tthe\tadministration\tor\taccumulation\tof\tHCO\n3\n−\n\t(i.e.,\tbase)\tor\tits\nprecursors,\texcessive\tloss\tof\tacid\t(e.g.,\tduring\tgastric\tsuctioning),\tor\tloss\tof\tECF\tcontaining\tmore\nchloride\tthan\tHCO\n3\n−\n\t(e.g.,\n\tfrom\tvillous\tadenoma\tor\tdiuretic\tuse).\tSimple,\tacute\tmetabolic\talkalosis | [
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] |
results\tin\ta\thigh\tblood\tpH,\tor\t\nalkalemia\n.\tMetabolic\talkalosis\talso\tmay\tresult\tfrom\tvolume\tdepletion;\ndecreased\tblood\tflow\tto\tthe\tkidneys\tstimulates\treabsorption\tof\tNa\n+\n\tand\twater,\tincreasing\tHCO\n3\n−\nreabsorption.\tThis\tcondition\tis\tknown\tas\t\ncontraction\talkalosis\n.\tAlkalosis\talso\tcan\tresult\tfrom\nsevere\thypokalemia\t(serum\tK\n+\n\tconcentration | [
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] |
severe\thypokalemia\t(serum\tK\n+\n\tconcentration\n\t<2\tmEq/L).\tAs\tK\n+\n\tmoves\tfrom\tthe\tintracellular\tto\tthe\nextracellular\tfluid,\thydrogen\tions\tmove\tfrom\tthe\textracellular\tto\tthe\tintracellular\tfluid\tto\tmaintain\nelectroneutrality.\tThis\tprocess\tproduces\tintracellular\tacidosis,\twhich\tincreases\thydrogen\tion\nexcretion\tand\tHCO\n3\n−\n\treabsorption\tby\tthe\tkidneys. | [
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excretion\tand\tHCO\n3\n−\n\treabsorption\tby\tthe\tkidneys.\nRespiratory\tacidosis\nRespiratory\tacidosis\n\tis\tcaused\tby\tdecreased\tventilation\tand\tconsequent\tCO\n2\n\tretention.\tSimple,\nacute\trespiratory\tacidosis\tresults\tin\ta\tlow\tpH,\tnormal\tHCO\n3\n−\n\tand\televated\tpCO\n2\n.\tAcute\trespiratory | [
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neuromuscular\tdiseases,\tand\tstarvation\tcachexia.\tPrevention\tof\toverfeeding\tis\tprudent\tas\tit\tcan\nworsen\tacidosis\t(\nAyers\tand\tDixon,\t2012\n).\nRespiratory\talkalosis\nRespiratory\talkalosis\n\tresults\tfrom\tincreased\tventilation\tand\telimination\tof\tCO\n2\n.\tThe\tcondition\tmay | [
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2\n.\tThe\tcondition\tmay\nbe\tmediated\tcentrally\t(e.g.,\tfrom\thead\tinjury,\tpain,\tanxiety,\tcerebrovascular\taccident,\tor\ttumors)\tor\nby\tperipheral\tstimulation\t(e.g.,\n\tfrom\tpneumonia,\thypoxemia,\thigh\taltitudes,\tpulmonary\tembolism, | [
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4\nIntake:\tAssessment\tof\tfood-\tand\nnutrition-related\thistory\nCynthia\tBartok,\tPhD,\tRDN,\tCD,\tL.\tKathleen\tMahan,\tRDN,\tMS,\tCD\nKEY\tTERMS\n24-hour\trecall\nacceptable\tintake\t(AI)\nacceptable\tmacronutrient\tdistribution\trange\t(AMDR)\nbioactive\tcompound\ncalorie\tcount\ndietary\tintake\tdata\ndietary\treference\tintakes\t(DRIs)\nfood\tdiary | [
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] |
quantitative\tfood\tpatterns\nrecommended\tdietary\tallowance\t(RDA)\ntolerable\tupper\tlevel\t(UL)\nNutritional\tstatus\nNutritional\tstatus\n\tis\tthe\tphysiologic\tstate\tor\tcondition\tof\tan\tindividual\tbased\ton\tthe\tbalance\nbetween\tthe\tindividual’s\n\tintake\tand\tunique\trequirement\tfor\tnutrients\t(\nFig.\t4.1\n).\tNutrient\tintake | [
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] |
Fig.\t4.1\n).\tNutrient\tintake\nrepresents\tthe\tamount\tof\ta\tnutrient\tthat\tis\tabsorbed\tinto\tthe\tbody\tfrom\tfoods,\tbeverages,\nmedications,\tand\tsupplements\tconsumed.\tThus\tnutrient\tintake\tdepends\ton:\n•\t\nthe\tamount\tof\ta\tnutrient\tcontained\tin\tthe\tdiet,\n•\t\nthe\tbioavailability\tof\ta\tnutrient\tbased\ton\tits\tsource,\tand\n• | [
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FIG.\t4.1\nOptimal\tnutrition\tstatus:\ta\tbalance\tbetween\tnutrient\tintake\tand\tnutrient\trequirements.\nNutrition\tprofessionals\tsuch\tas\tregistered\tdietitian\tnutritionists\t(RDNs)\tand\tnutrition\tand\tdietetic\ntechnicians,\tregistered\t(NDTRs)\tserve\tas\tfood\tand\tnutrition\texperts\ton\thealth\tcare\tteams.\tThey\tare | [
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