Carbohydrate and Potein Metabolism Lecture Outlines | Course Shedule | Main Menu | Resources Carbohydrate (starch, sugar, milk, maltose
etc) accounts for at least 50% of the American diet The liver stores extra glucose in the form of GLYCOGEN. With excess glucose intake, glucose is not stored as glycogen but is converted to adipose tissue. 4 major hormones influence serum glucose levels
A fasting blood sugar greater than 126
mg/dL two times indicates diabetes. Plasma glucose levels are higher than whole
blood because the RBCs are not as rich in glucose as in the plasma. FBG across the lifespan
Blood glucose finger sticks common method to monitor blood sugar trends. A non invasive method using a laser device maybe a possibility in the future. Excellent way to diagnose diabetes mellitus The patient must eat a “normal” diet for several days before testing. Have the pt. fast during the night except for H2O. At the start of the test a FBG may be drawn then have the pt. drink 75 -100 g of glucose dissolved in H2O. Fingerstick Glucose are taken at 1,2,& 3 hrs and plotted on a graph. Too long to return to baseline or never returning to fasting levels (reference values p. 195) With prolonged hyperglycemia, the Hbg
remains saturated with glucose by glycohemoglobin (GHB). The test is weighted average of
glucose level over the last few months.
Most common reason for persistently
elevated blood glucose is diabetes mellitus and lead to acidosis and coma Glucose levels
Many causes: diabetes, stress, pregnancy, drugs. 3 Levels of glucose intolerance - hyperglycemia, ketosis, ketoacidosis Signs and Symptoms
Develops when there is a problem with usage
or amount of insulin (Glucose 300-750 mg/dL) Free fatty acids in HHNKS are lower than
those in DKA. Lack of ketosis. Glucose levels are considerably higher in HHNKS than DKA.
Maybe due to lack of ketonemia in HHNKS permits greater synthesis of glucose and thus more
severe hyperglycemia (600-2000 mg/dL) If there is not enough glucose to the cells
the body will mobilize fat and proteins for energy, KETONE bodies (acetoacetic acid,
acetone and hydroxybutyric acid) are the by-products Negative < 2 mg/dL is normal Purpose of test to distinguish between
diabetic ketoacidosis and HHNK Caused by in diabetic clients
Is always a potential problem for pregnant women and infants Nondiabetic clients – there are 2 groups
Sign and Symptoms (pg 200, Table 8-3) Diaphoresis, tachycardia, dizziness, tremors due to increase surge of epinephrine to try to increase blood sugar levels. Pts. on beta blockers will not have tachycardia or shakiness Nursing should assess early if possible and provide treatment (4 oz O.J. = 10 g simple carbo., other sugar containing beverage or treat) Can’t swallow, honey or cake gel can be put under the tongue. After 30 mins be sure to give protein and complex carbo. Lactase is an enzyme that is in the small
intestine use to digest lactose the sugar that is in milk products. Inherited disorder in which galactose
cannot be converted to glucose because of a missing enzyme. Galactose is wasted in the
urine. It can be detected in urine. Protein intake varies but a person needs 44
- 56 g of protein per day. Albumin is produced by the liver and is
needed to maintain oncotic pressure in the vascular system Globulins in general are either immunologic agents or enzymes Very complex and diversified group of serum proteins
Broad indicator of the quantity and
concentration of all plasma proteins except fibrinogen. Range: adult = 6-8 g/dL, newborn = 4.6-7.4 g/dL Low value less than 4.0 g/dL together with a low serum albumin level cause EDEMA Decreased – prolonged malnutrition, starvation, GI cancer, ulcerative colitis, Hodgkin’s disease, seer liver disease, chronic renal failure, water intoxication, malabsorption syndrome Smallest molecule yet is the largest component of plasma proteins responsible for 80% of colloidal osmotic pressure Normal value – Adult > 60 = 3.4 – 4.8 g/dL, Adult 18-60 years 3.5-5 g/dL, newborn 2.8-4.4 g/dL Decreased – many reasons, acute & chronic inflammation disease, liver disease, inflam. bowel syndrome, malnutrition, peritonitis, ascites Increased – Loss of vascular fluid because a reduction in volume of fluids the albumin levels will rise because they are more concentrated in the blood 2.5 times bigger than albumin, Many drugs affect this value –
aspirin, bicarbonates, corticosteriods, salicylates, estrogen, testosterone etc. Normal globulin is 2.8-4.4 g/dL Decreased: Hypogammaglobulemia, multiple myeloma Increased: Inflammatory disease, cirrhosis, chronic active hepatitis, sarcoidosis Albumin/globulin ratio (A/G ratio) – normal > 1.0, used to identify the proportional amts. of these 2 proteins in the blood. Low in if pt. has cirrhosis, severe infections, ulcerative colitis, chronic nephritis etc. Caused by increase loss of protein in
urine, burns, inadequate intake, decreased production (liver failure), malabsorption, true
protein def (Kwashiorkor) Ammonia is a byproduct of protein catabolism and is made during the process of deamination of amino acids. It is made by metabolizing tissues in the body and by bacterial activity on protein in the intestine. When ammonia enters the bloodstream the liver removes it from the portal vein circulation. Pts. with hepatic problems, ammonia is converted to urea then the kidneys remove the urea from the circulation and it is excreted in the urine. Elevated ammonia level is an indication of the failure of hepatic cells to function in the conversion of ammonia to urea & portal vein circulation problems which prevents ammonia from reaching the liver Purpose of the test is to evaluate or
monitor liver failure or impair portal vein circulation Use green topped tube & collect 7-10 ml venous blood
In severe liver disease blood urea nitrogen
(BUN) drops as ammonia level rises Preparation of pt. Fasting, water allowed, 1 ml of venous or
arterial blood. Blood must be heparinized and packed in ice & rotated immediately to
chill the specimen |