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Laboratory Data in nutrition assessment

89 hypocalcemia serum calcium 90 mgdl ionized ca 45

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Unformatted text preview: nized calcium: 4.5-5.6 mg/dL Normal levels maintained by hormonal Normal regulation using skeletal reserves regulation Ionized calcium is more accurate, especially Ionized in pt with hypoalbuminemia; evaluate before repleting Ca+ before Charney and Malone, 2004, p. 89 Hypocalcemia (serum calcium <9.0 mg/dL; ionized Ca+ <4.5 mg/dL) • • • • • Hypoalbuminemia Hypoparathyroidism Hypomagnesemia Renal failure, renal tubular necrosis Vitamin D deficiency or impaired Vitamin metabolism metabolism Hypercalcemia (serum calcium >10.5 mg/dL; ionized Ca+ >5.6 mg/dL) • • • • • Hyperparathyroidism Some malignancies, especially breast, lung, Some kidney; multiple myeloma, leukemia, lymphoma lymphoma Medications: thiazide diuretics, lithium, Medications: vitamin A toxicity vitamin Immobilization Hyperthyroidism Charney and Malone, 2004, p. 91 Serum Phosphorus (normal 3.0-4.5 mg/dL) • • Serum phos a poor reflection of body stores Serum because <1% is in ECF because Bones serve as a reservoir Hypophosphatemia (<3.0 mg/dL) • • • • • • Impaired absorption (diarrhea, Vitamin D Impaired deficiency, impaired metabolism) deficiency, Medications: phosphate binding antacids, Medications: sucralfate, insulin, steroids) sucralfate, Alcoholism, especially during withdrawal Intracellular shifts in alkalosis, anabolism, Intracellular neoplasms neoplasms Refeeding syndrome Increased losses: hyperparathyroidism, renal Increased tubular defects, DKA recovery, hypomagnesemia, diuretic phase of ATN Charney and Malone, 2004, p. 93 Hyperphosphatemia (>4.5 mg/dL) • • • • Decreased renal excretion: acute or chronic renal Decreased failure (GFR<20-25 mL/min); hypoparathyroidism hypoparathyroidism Increased cellular release: tissue necrosis, tumor Increased lysis syndrome lysis Increased exogenous phosphorus load or Increased absorption, phosphorus containing laxatives or enemas, vitamin D excess enemas, Acidosis Hypomagnesemia <1.3 mEq/L (normal 1.3-2.1 mEq/L) • • • • • • • Decreased absorption: prolonged diarrhea, intestinal or Decreased biliary fistula, intestinal resection or bypass, steatorrhea, ulcerative colitis; upper GI fluid...
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