Biological Markers - Nutritional Status of an Individual - Essay Example

?Biological markers-nutritional status of an individual Blood Mixed up case files A case presented before me contains complaints of fatigue, weakness, dizziness, cold feet, weight loss, itchy ear, skin infections, decreased vision, change in bowel movements and sexual dysfunction. The blood report that I received showed that the sample had a hematocrit level of 47.8 percent and a glucose level of 5.0 mmol/L. The normal range of hematocrit is between 38.8-50 percent for men and 34.9-44.5 percent for women (Mayo Clinic Staff, 2010). Thus it is clear that the hematocrit in the sample is within normal range. Hematocrit signifies the component of the blood that is made up of red blood cells only. Thus any condition that increases the oxygen demand of the body will increase this percentage. These conditions include living at high altitudes and pregnancy. Other conditions that might increase this value are a recent blood transfusion or severe dehydration. A low value of hematocrit signifies a failure to synthesize red blood cells or blood loss. Conditions such as bone marrow failure, intestinal malignancies and menorrhagia lead to decreased hematocrit levels. The data shows that the hematocrit level is within normal range and therefore the sample does not belong to this particular patient. Also the patient does not show any symptoms related to the increase or decrease in the hematocrit level. The second piece of information that is given in the report is the glucose level. The sample has a glucose level of 5.0 mmol/L. The normal range of glucose level in blood is between 5.6 mmol/L - 6.9 mmol/L (WebMD, 2011). A glucose level of 5.0 mmol/L indicates hypoglycaemia which shows with symptoms like sweating, shortness of breath, dizziness and fainting. Although the given patient does present these symptoms, some of the symptoms presented by patient are in sharp contrast to these test results. Thus it is safe to say that the report of the sample given to does not belong to this patient. The symptoms of the patient reveal certain things about the underlying disease. Symptoms like fatigue, dizziness, weight loss and weakness are general signs of underlying pathology that puts extra stress on the body and the patient ends up showing these symptoms. However, other symptoms like decreased vision, cold feet, altered bowel movements and sexual dysfunction point towards compromised circulation of blood. Skin infections and itchy ear point towards an increased propensity to develop infections. Some of the conditions that could show as these symptoms are the immunological disorders and cardiac diseases. If the patient is suffering from immunological disorders, the patient would show decreased immunological markers in the blood. If the patient was to have a cardiac disease, his blood sample would show cardiac enzymes. However, when one patient shows signs of both diseases, it is a strong indication of it being due to diabetes. The given sample shows normal hematocrit with hypoglycaemia. In a diabetic, the hematocrit would either be normal or elevated and would be coupled with hyperglycaemia. The hematocrit would be normal if the patient is taking adequate liquids and it would be elevated if the patient is severely dehydrated as is mostly the case. The glucose level would be elevated in a diabetic patient because the body is unable to utilize glucose and it stays in the blood. When considering symptoms, it is important to keep in mind the effects of diabetes on multiple systems of the body in order to explain the symptoms of the patient. Any disease can manifest with symptoms like fatigue, dizziness and weakness. Every disease process involves increased catabolic activity at all levels in the body with increased demands for nutrients and oxygen. When these demands are not met, their levels in the blood oscillate and result in symptoms like fatigue and weakness. When this process continues for too long and the demands are not met perpetually, the body starts to consume its own nutrient reserves in the liver and fat and once they are exhausted, it starts to use muscle mass to cope with these demands. As a result, weight loss occurs and the patient starts to look cachexic. One of the most important effects of diabetes is on the circulatory system. Diabetes causes increased artheroma formation and resultant decreased luminal diameter of the blood vessels. This impedes the blood flow to the peripheries and to areas that rely on blood supply through intricate networks such as the intestines. This results in altered thermoregulation, bowel movements and sexual function. Patients complain about having cold feet, altered bowel habits and loss of penile erection. Another aspect of this disease is the increased level of sugars in the blood which changes the natural flora of the body. Opportunistic infections such as yeast thrive on these increased sugars and show as recurrent fungal skin infections. Similarly, itchy ear is a common complaint. With the intricate fluid-filled crevices present in the ear and its constant connection with the oral cavity through the nasopharyngeal tube, the chances of lodging bacteria are increased due to a better nutrient environment. Extra sugars allow the bacteria to thrive and cause repeated infections. Thus understanding each of the symptoms of the patient in the light of the disease process brings us closer to the diagnosis that the patient might be suffering from diabetes. However, further investigations have to be undertaken in order to reach the final diagnosis. These tests include fasting blood sugar (FBS), random blood sugar (RBS), oral glucose tolerance test and glycohemoglobin A1c test. One of the first investigations carried out when suspecting diabetes is FBS. The blood sample for this test is taken after the patient has spent 8 hours fasting. It is done in order to test the body’s sensitivity to blood glucose and the release of appropriate amount of insulin in response to it. Oral glucose tolerance test is done keeping the same principle in mind but this is done to measure body’s sensitivity to high levels of glucose in the blood. A sample of blood is taken and the patient is asked to drink a liquid that usually contains 75g of glucose. The patient’s blood is sampled every 30 to 60 min over the next 3 hours and blood glucose levels are measured (Medline Plus, 2012). Minor deviations in blood glucose levels can occur such as immediately after food intake or exercise. However, blood glucose levels should be within the normal range under normal conditions and any major deviations are pathologic. These deviations are measured by RBS test. This test is done at any time of the day and the normal value is lower than 125 mg/dL (American Diabetes Association, 2012). Glycohemogobin A1c is a test that is indicated in patients who present with fatigue, increased urination, blurred vision and recurrent, non-healing infections ( American Association for Clinical Chemistry , 2013). This test measures the percentage of glucose that is bound to red blood cells and gives a measure of diabetes control. Ideally, this value should be less than 5.7% in non-diabetics and around 7% in diabetics. The higher this value is, the higher is the risk of diabetes related complications. Works Cited American Association for Clinical Chemistry AIc [Online] // Lab Tests Online. - American Association for Clinical Chemistry, May 9, 2013. - May 14, 2013. - www.labstestsonline.org. American Diabetes Association Standards of medical care in diabetes-- [Journal]. - New York : American Diabetes Association, 2012. - 63 : Vol. 1. Mayo Clinic Staff Hematocrit Test [Online] // Mayo Clinic website. - Mayo Foundation for Medical Education and Research, December 30, 2010. - May 14, 2013. - www.mayoclinic.com. Medline Plus Glucose Tolerance Test [Online] // Medline Plus. - US National Library of Medicine, February 6, 2012. - May 14, 2013. - www.nlm.nih.gov. WebMD Diabetes Health Center [Online] // Healthwise Incorporated. - Healthwise, July 5, 2011. - May 14, 2013. - www.diabetes.webmd.com. Biological markers-nutritional status of an individual Urine Referred by a nephrologist A patient has been referred in order to have advice on improving nutritional status based on a recent urine sample report that has been brought along. An assessment of the urine sample report shows that sample has been tested for several substances. All the substances that the sample was checked for are normal except that the patient shows slightly acidic urine with ketone presence of +1 urine value. A look at each of the substances is required for an affective advice. The sample shows that there is no sodium present in the urine. In a normal person, a random urine sample should have urinary sodium to be negative. This value signifies the tubular reabsorptive function in the kidneys and its negative value indicates normal kidney function. The specific gravity gives a measure of solutes present in a given urine sample. This in turn denotes the ability of the kidneys to concentrate or dilate the urine over that in plasma (RnCeus, 2006). In the given case, the specific gravity is within normal range which is 1.010-1.025. The pH of the urine can be anywhere between 4.8 to7.5. The given patient has a urinary pH of 6.5 which is slightly acidic. An acidic pH can be due to increased consumption of foods that produce acidic substances on catabolism which have to be excreted in urine. Approximately 150 mg of urinary proteins are excreted in urine by a normal person in 24 hrs. Thus normal urine contains only trace of proteins in a random sample. The presence of protein in urine indicates renal, more specifically glomerular function. Intact glomerular function gives only trace of protein in urine like in the given case. Urinary glucose should be negative in normal people. This value signifies the tubular reabsortive ability of the kidney and is only positive in diabetes or advanced renal disease. The presence of ketones in the urine should not exceed 0.29 mmol/l for healthy adults. This results in a urinary ketone value of 0. The results show a urinary ketone value of 0.5mmol/l which gives a urinary ketone value of +1. However, it is less than the value labelled as ketonuria (Taboulet, et al., 2007). Bilirubin is a by-product of breakdown of red blood cells and only traces are found in a 24 hr sample. Presence of bilirubin in urine indicates excessive breakdown of red blood cells such as in haemolytic anaemia. The given sample shows bilirubin to be negative. Haemoglobin in urine indicates blood loss through urine. Injuries to the genitourinary system or malignancies related to the genitourinary system result in the presence of haemoglobin in the urine. The given sample shows negative value for the urinary haemoglobin. Based on these test results, the patient appears to be healthy and the slight deviations in the urinary ketones and urinary pH can be treated with alterations in diet. However, the doctor should ask the patient to undergo blood investigations for glucose in order to rule out diabetes or any other metabolic disorder. For the same purpose, renal function tests and thyroid function tests should also be done in order to reach a final diagnosis. Ketones are end-products of fatty acid breakdown. Human body consumes glucose as its preferred source of energy. However, when glucose stores run low for instance during fasting or a high protein diet, the body starts to consume the fatty acids present in fat stores which result in the formation of ketones and water. Thus, the presence of ketones in urine denotes that the body is consuming fats as a primary source of energy. These ketones are excreted from the body in urine and urinary values of more than 0.9mmol/l are classified as ketonuria (Sekizawa, et al., 2001). Presence of ketones in the urine is not always pathologic. In fact, when ketonuria is associated with fasting, it has beneficial effects. Presence of ketones in the urine may be a sign of several underlying diseases. These include metabolic disorders such as uncontrolled diabetes, glycogen storage diseases and renal glycosuria. Urinary ketones may also be elevated as a result of conditions that increase metabolism such as pregnancy, lactation and hyperthyroidism. From a nutritional point of view, the most important thing is that the presence of ketones in the urine may denote decreased carbohydrate metabolism, high protein metabolism or starvation. Based on these results, the doctor should first of all ask the patient to find out their BMI. After assessing the patient’s physical appearance and objectively seeing his/her weight, it will be easier to say whether the patient is starving or whether this is due to nutritional deficiency. For a patient who has a low BMI, a gradual increase in diet starting from a diet rich in carbohydrates with a proportionate amount of protein based on the patient’s gender and body surface area is recommended. This would be possible if the patient would start to take wheat, meats and poultry. Dairy products, fruits and vegetables for vitamins, minerals and calcium are also recommended. However, complete elimination of fats from the diet of a starving patient is not recommended as his/her body might take time to switch over to alternate source of nutrition. For a patient who has a normal BMI, a diet rich in carbohydrates and low in proteins is recommended. This diet will have increased amount of wheat, grains and rice but smaller portions of meat, poultry and eggs. This will reduce the amount of proteins in the patient’s diet and push his body to utilize carbohydrates as tudies suggest that glucose is the sole oxidative fuel in fed animals (Ruderman, et al., 1974). These alterations in diet are enough to bring the slight deviations in the urinary biochemistry of this patient within normal range. Works Cited RnCeus Urine Specific Gravity [Online] // RnCeus Interactive. - RnCeus.com, 2006. - 013. - www.rnceus.com. Ruderman Neil, Ross Peter and Berger Micheal Regulation of glucose and ketone-body metabolism in brain of anaesthetized rats [Journal]. - Boston : Biochem J. , 1974. - 138 : Vol. 1. Sekizawa A [et al.] Cell-free fetal DNA is increased in plasma of women with hyperemesis gravidarum [Journal]. - [s.l.] : Clinical chemistry , 2001. - 12 : Vol. 47. Taboulet P [et al.] Correlation between urine ketones (acetoacetate) and capillary blood ketones (3-beta-hydroxybutyrate) in hyperglycaemic patients [Journal]. - 2007. - 2 : Vol. 33. Read More