This document discusses various methods for nutritional assessment, including anthropometric, clinical, biochemical, and dietary assessments. It focuses on anthropometric methods such as measuring height, weight, body mass index, skin fold thickness, waist circumference, and waist-to-hip ratio. Clinical assessment involves taking a medical history and physical examination including checking for loss of subcutaneous fat and muscle wasting. The document also discusses using a subjective global assessment to classify a patient's nutritional status as severely, moderately, or well-nourished based on combining various assessment elements.
Examination of Swelling in a patient is always a task for MBBS students. This PPT provides the students, how to elicit a history & also the easy way to examine a swelling.
Brief Presentation on clinical examination of Cardio Vascular System with Report of Normal case
references:
macleod's clinical examination 13th edition
hutchinson clinical methods
Brief Presentation on clinical examination of Respiratory System with Report of Normal case
references:
macleod's clinical examination 13th edition
hutchinson clinical methods
R Alagappan - Manual of Practical Medicine, 4th Edition
Examination of Swelling in a patient is always a task for MBBS students. This PPT provides the students, how to elicit a history & also the easy way to examine a swelling.
Brief Presentation on clinical examination of Cardio Vascular System with Report of Normal case
references:
macleod's clinical examination 13th edition
hutchinson clinical methods
Brief Presentation on clinical examination of Respiratory System with Report of Normal case
references:
macleod's clinical examination 13th edition
hutchinson clinical methods
R Alagappan - Manual of Practical Medicine, 4th Edition
Explanation of what splenomegaly is in relation to its dimension deviation from normal spleen.Classification of splenomegaly according to it's size in adult and pediatric. The causes of splenomegaly along with the symptom that would manifest as a result of this anomaly. Lastly, diagnosis of splenomegaly
Explanation of what splenomegaly is in relation to its dimension deviation from normal spleen.Classification of splenomegaly according to it's size in adult and pediatric. The causes of splenomegaly along with the symptom that would manifest as a result of this anomaly. Lastly, diagnosis of splenomegaly
Obesity is a chronic, debilitating, life long disease giving rise to many other diseases. Severe obesity is
associated with co-morbidities including type 2 DM, hypertension, dyslipidemia, obstructive sleep apnoea,
obesity hypoventilation syndrome, polycystic ovarian syndrome, stateohepatosis, asthma, back and lower
limb degenerative problem, cancer and premature death. Morbid obesity has acquired epidemic proportions in the west. Traditional approaches to weight loss including diet, exercise and medication achieve no more than 5-10 % reduction in body weight with high relapse rates. So far, there was no effective remedy for morbid obesity. Bariatric surgery is the only effective means of achieving long term weight loss in the severely obese. The international guideline for bariatric surgery are BMI > 40 kg/m2 BMI > 35 kg/m2 together with obesity related disease. Bariatric surgery can achieve sustained weight loss durable to at least 15 years and causes marked improvement in co-morbidities.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
263778731218 Abortion Clinic /Pills In Harare ,sisternakatoto
263778731218 Abortion Clinic /Pills In Harare ,ABORTION WOMEN’S CLINIC +27730423979 IN women clinic we believe that every woman should be able to make choices in her pregnancy. Our job is to provide compassionate care, safety,affordable and confidential services. That’s why we have won the trust from all generations of women all over the world. we use non surgical method(Abortion pills) to terminate…Dr.LISA +27730423979women Clinic is committed to providing the highest quality of obstetrical and gynecological care to women of all ages. Our dedicated staff aim to treat each patient and her health concerns with compassion and respect.Our dedicated group ABORTION WOMEN’S CLINIC +27730423979 IN women clinic we believe that every woman should be able to make choices in her pregnancy. Our job is to provide compassionate care, safety,affordable and confidential services. That’s why we have won the trust from all generations of women all over the world. we use non surgical method(Abortion pills) to terminate…Dr.LISA +27730423979women Clinic is committed to providing the highest quality of obstetrical and gynecological care to women of all ages. Our dedicated staff aim to treat each patient and her health concerns with compassion and respect.Our dedicated group of receptionists, nurses, and physicians have worked together as a teamof receptionists, nurses, and physicians have worked together as a team wwww.lisywomensclinic.co.za/
HOT NEW PRODUCT! BIG SALES FAST SHIPPING NOW FROM CHINA!! EU KU DB BK substit...GL Anaacs
Contact us if you are interested:
Email / Skype : kefaya1771@gmail.com
Threema: PXHY5PDH
New BATCH Ku !!! MUCH IN DEMAND FAST SALE EVERY BATCH HAPPY GOOD EFFECT BIG BATCH !
Contact me on Threema or skype to start big business!!
Hot-sale products:
NEW HOT EUTYLONE WHITE CRYSTAL!!
5cl-adba precursor (semi finished )
5cl-adba raw materials
ADBB precursor (semi finished )
ADBB raw materials
APVP powder
5fadb/4f-adb
Jwh018 / Jwh210
Eutylone crystal
Protonitazene (hydrochloride) CAS: 119276-01-6
Flubrotizolam CAS: 57801-95-3
Metonitazene CAS: 14680-51-4
Payment terms: Western Union,MoneyGram,Bitcoin or USDT.
Deliver Time: Usually 7-15days
Shipping method: FedEx, TNT, DHL,UPS etc.Our deliveries are 100% safe, fast, reliable and discreet.
Samples will be sent for your evaluation!If you are interested in, please contact me, let's talk details.
We specializes in exporting high quality Research chemical, medical intermediate, Pharmaceutical chemicals and so on. Products are exported to USA, Canada, France, Korea, Japan,Russia, Southeast Asia and other countries.
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Evaluation of antidepressant activity of clitoris ternatea in animals
Built and nutrition
1. C H A I R P E R S O N - D R . B A S A V A R A J B A L I G A R
M D D M C A R D I O L O G Y
S T U D E N T - D R . C H E T H A N . Y
BUILT AND NUTRITIONAL
ASSESSMENT
2. INTRODUCTION
Nutritional assessment is defined by the American Society for
Parenteral and Enteral Nutrition as “a comprehensive approach to
diagnosing nutrition problems that uses a combination of the following:
medical, nutrition, and medication histories; physical examination;
anthropometric measurement; and laboratory data
3. Nutritional Assessment Methods
Four different methods are used to collect data used in assessing a
person’s nutritional status:
Anthropometric
Clinical
Biochemical
Dietary
4. Importance of Nutritional Assessment
Nutrition can have a profound influence on health,
affecting growth and development of infants, children, and
adolescents; immunity against disease; morbidity and
mortality from illness or surgery; and risk of such diseases
as cancer, coronary heart disease, and diabetes.
5. Nutritional assessment is important in identifying persons
at nutritional risk, in determining what type of nutrition
intervention, if any, may be appropriate to alter nutritional
status, and in monitoring the effects of nutrition
intervention.
6. ANTHORPOMETRY
Anthropometry is the measurement of body size, weight,
and proportions
Anthropometric measures can be used to evaluate
nutritional status, whether it be obesity caused by
overnutrition or emaciation resulting from protein-energy
malnutrition
7. HEIGHT :
Stature, or standing height, can be measured for
subjects 2 to 3 years of age and older who are cooperative
and able to stand without assistance
In nonambulatory persons (those unable to walk) or
those who have such severe spinal curvature that
measurement of height would be inaccurate, stature can
be estimated from knee height.
8.
9.
10. SHORT STATURE
Height below 3rd centile or more than 2SD below the median height
for age and sex.
Normal variant
Familial short stature
Constitutional growth delay
Pathological
Proportionate
Prenatal
1. Intrauterine growth retardation
2. Antenatal infection in mother (TORCH*, syphilis, AIDS)
3. Antenatal consumption of alcohol, tobacco, heroin
4. Chromosomal disorders (Down’s syndrome, Turner’s syndrome).
14. WEIGHT
Body weight, though not an accurate measure of fat, is a widely used index.
Diurnal variations (cyclical changes occurring throughout the day) in
weight of about 1 kg in children and 2 kg in adults are known to occur. For
this reason, it is a good practice to also record the time weight was
measured.
Ideally, children and adults should be weighed after voiding and dressed in
an examination gown of known weight or in light underclothing with the
scales placed where adequate privacy is provided
15. For the age interval 2 to 20 years, the charts give percentile
curves for stature-for-age, weight-for-age, body mass
indexfor- age, and weight-for-stature.
16.
17. Percentile Cut-Off Value( FOR 2-20 YEARS)
< 5th percentile
5th and < 85th percentile
85th and < 95th percentile
95th percentile or 30 kg/m 2 (whichever is smaller)
18. Classification of Overweight and Obesity by Body Mass Index
(BMI) in Adults
Underweight <18.5 <18.5
Normal weight 18.5-24.9 18.5-22.9
Overweight 25-29.9 23-24.90
Obesity Class 1 30-34.9 25-29.90
• (PRE OBESE)
Obesity Class 2 35-39.9 >30
(OBESE)
Extreme Obesity Class 3 >40
19. INDICATORS
Body mass index (Quetelet's index) = Weight (kg)/ Height(m)(2)
Ponderal index = Height (cm) /Cube root of body weight (kg)
Brocca index = Height (cm) -100
(For example, if a person's height is 160 cm, his idealweight
is (160-100) = 60 kg)
20. SKINFOLD THICKNESS
A large proportion of total body fat is located just under the skin.
Since it is most accessible, the method most used is the measurement of
skinfold thickness.
It is a rapid and "noninvasive“ method for assessing body fat.
Several varieties of callipers (e.g., Harpenden skin callipers) are
available for the purpose.
21.
22.
23. The measurement may be taken at all the four sites - mid-
triceps, biceps, subscapular and suprailiac regions.
The sum of the measurements should be less than 40 mm in
boys and 50 mm in girls
Further, in extreme obesity, measurements may be
impossible.
The main drawback of skinfold measurements is their poor
repeatability.
24. WAIST CIRCUMFERENCE AND WAIST :
HIP RATIO (WHR)
Waist circumference is measured at the mid point between the lower
border of the rib cage and the iliac crest.
It is a convenient and simple measurement that is unrelated to height.
Correlates closely with BMI
WHR and is an approximate index of intra - abdominal fat mass and
total body fat.
25. Changes in waist circumference reflect changes in risk factors for
cardiovascular disease and other forms of chronic diseases.
There is an increased risk of metabolic complications for men with a
waist circumference > 102 cm,and women with a waist circumference >
88 cm
High WHR (> 0.95 in men and > 0.80 in women) indicates abdominal
fat accumulation.
26. SL.N
O
ETHNICITY WAIST CIRCUMFERENCE
1
Europeans
Men >94 cm (>37 in)
Women >80 cm (>31.5 in)
2 South Asians
and Chinese
Men >90 cm (>35 in)
Women >80 cm (>31.5 in)
3 Japanese Men >85 cm (>33.5 in)
Women >90 cm (>35 in
27. TYPES OF OBESITY
Generalised obesity:Over eating is the most common cause. It is
characterised by the presence of a ‘double chin’.
Android obesity: It is a type of obesity, which is characterised by
excess deposition of fat over the region of the waist. (GREATER
RISK)
Gynoid obesity: It is a type of obesity, which is characterised by
excess deposition of fat over the region of the hips and thighs.
Superior or central type of obesity:
31. HISTORY
Ask about usual weight, peak weight, and deliberate weight loss.
A 4.5 kg (10-lb) weight loss over 6 months is noteworthy and a weight
loss of >10% of usual body weight is prognostic of clinical outcomes
32. Medical and surgical conditions; chronic disease
Look for medical or surgical conditions or chronic disease that can
place one at nutritional risk secondary to increased requirements, or
compromised intake or assimilation
Constitutional signs/ symptoms :Fever or hypothermia can indicate
active inflammatory response. Anorexia is another manifestation of
inflammatory response and is also often a side effect of treatments and
medications.
33. Eating difficulties/ gastrointestinal complaints : Poor dentition
or problems swallowing can compromise oral intake. Vomiting, nausea,
abdominal pain, abdominal distension, diarrhea, constipation, and
gastrointestinal bleeding can be signs of gastrointestinal pathology that
may place one at nutritional risk.
Medication use : Many medications can adversely affect nutrient
intake or assimilation. Review potential drug–drug and drug–nutrient
interactions.
34. Dietary practices and supplement use : Look for dietary practices
including therapeutic, weight reduction, vegetarian, macrobiotic, and fad
diets. Also record use of dietary supplements, including vitamins, minerals,
and herbals
Influences on nutritional status : Ask about factors such as living
environment, functional status (activities of daily living and instrumental
activities of daily living), dependency, caregiver status, resources, dentition,
alcohol or substance abuse, mental health (depression or dementia), and
lifestyle.
35.
36.
37.
38. PHYSICAL EXAMINATION
The first of the three elements of the physical examination
is LOSS OF SUBCUTANEOUS FAT.
The four anatomic areas (shoulders, triceps, chest, and
hands) should be checked for loss of fullness or loose-fitting
skin.
Loss of subcutaneous fat should be noted as normal (0),
mild loss (1+ ), moderate loss (2 + ), or severe loss (3 + )
39. The PRESENCE OF MUSCLE WASTING (the
second element of the physical examination) is best
assessed by examining the deltoid muscles (located
at the sides of the shoulders) and the quadriceps
femoris muscles (the muscles of the anterior thigh).
40. Loss of subcutaneous fat in the shoulders and deltoid
muscle wasting gives the shoulders a squared-off
appearance.
41. The presence of edema at the ankle or sacrum can also be
assessed as absent, mild, moderate, or severe. The
presence of “pitting” edema can be checked by
momentarily pressing the area with a finger and then
looking for a persistent depression (more than 5 seconds)
where the finger was.
When considerable edema or ascites are present, weight
loss is a less important variable.
42. SUBJECTIVE GLOBAL ASSESSMENT
SGA depends on the clinician’s subjectively combining
the various elements to arrive at an overall, or global,
assessment.
Patients with weight loss > 10% that is continuing, poor
dietary intake, and severe loss of subcutaneous fat and
muscle wasting fall within the severely malnourished
category (class C rank).
43. Patients with at least a 5% weight loss, reduced dietary
intake, and mild to moderate loss of subcutaneous fat and
muscle wasting fall within the moderately
malnourished category (class B rank).
A class A rank would be given to patients having a recent
increase in weight (that is not fluid retention), even if their
net loss for the past 6 months was between 5% and 10%.
44. It is regarded by many as the most reliable and efficient
method to assess nutritional status at the bedside and is
considered the gold standard for bedside assessment tools.
45.
46.
47. PROTEIN ENERGY MALNUTRITION
PEM is the disease caused by prolonged inadequate energy and protein
consumption— starvation—with consequent depletion of the BCM and
body fat.
The body normally adapts to starvation by reducing energy expenditure
and curtailing protein catabolism, partly by hormone- and nervous
system-regulated alterations in cellular metabolism, and partly by
reducing its muscle mass.
48. These adaptations enable prolonged survival during sub-lethal
starvation, but survival comes at a cost that includes lethargy, a
tendency to hypothermia, muscle atrophy (including of the cardiac and
respiratory muscles), skin thinning, and functional disability.
The cardinal diagnostic features of PEM—generalized muscle atrophy
and subcutaneous adipose tissue depletion—are easy to detect by
simple physical examination
49. Starvation-Related Malnutrition (Uncomplicated
Protein- Energy Malnutrition)
Chronic Disease-Related Malnutrition and
Cachexia
Acute Disease-Related Malnutrition
54. EATING DISORDERS
ANOREXIA NERVOSA
Anorexia nervosa is characterized by a refusal to maintain a
minimally normal body weight, an intense fear of gaining weight
that is not alleviated by losing weight, and a distorted perception
of body shape or size in which a person feels overweight (either
globally or in certain body areas) despite being markedly
underweight.
55. A prominent clinical feature of persons with anorexia
nervosa is marked weight loss, which in some instances
can become extreme and life threatening.
In postmenarcheal females, amenorrhea—i.e., the
absence of at least three consecutive menstrual cycles (a
woman is considered to have amenorrhea if her periods
occur only following hormone administration—e.g.,
estrogen)
56.
57. BULIMIA NERVOSA
BINGE Eating, in a discrete period (e.g., within any 2-hour
period), an amount of food that is definitely larger than
most people would eat during a similar period of time and
under similar circumstances
A sense of lack of control over eating during the episode
(e.g., a feeling that one cannot stop eating or control what
or how much one is eating)
58. Recurrent inappropriate compensatory behavior in order to
prevent weight gain, such as self-induced vomiting; misuse
of laxatives, diuretics, enemas, or other medications;
fasting; or excessive exercise
The binge eating and inappropriate compensatory
behaviors both occur, on average, at least twice a week for 3
months.
59.
60. HEAD TO TOE EXAMINATION
FOR NUTRITIONAL STATUS
63. Non-cicatricial Alopecia:
Alopecia areata (most common)
Physiologic: Androgenic alopecia
Systemic diseases: SLE, hyperthyroidism, hypothyroidism,
ACRODERMATITIS ENTEROPATHICA, PERNICIOUS ANAEMIA and
Down’s syndrome.
Infection: Moth eaten type in syphilis and fungal infections.
Drugs: Antimetabolites, cytotoxics, heparin, carbimazole, iodine, bismuth, vitamin
A, allopurinol and amphetamines.
Telogen effluvium: Systemic illness (typhoid, measles, pneumonia) post-partum and
post-surgical, MALNUTRITION
Radiation.
64. VITAMIN B9
Recommende
d
Daily Enteral
Intake
Signs and
Symptoms
Populations
At Risk for
Deficiency
Signs and
Symptoms of
Toxicity
Status
Evaluation
400 mcg Bone marrow
suppression,
macrocytic
megaloblastic
anemia,
glossitis,
diarrhea Can be
precipitated by
Sulfasalazine
and
Phenytoin
Alcoholics,
celiac or tropical
sprue, chronic
sulfasalazine use
PO: May lower
seizure
threshold in
those taking
anticonvulsants
Folic
acid(serum),
RBC folic
acid(plasma)
65.
66. VITAMIN B12
Recommende
d
Daily Enteral
Intake
Signs and
Symptoms
Populations
At Risk for
Deficiency
Signs and
Symptoms of
Toxicity
Status
Evaluation
2.4 mcg Bone marrow
suppression,
macrocytic
megaloblastic
anemia,
glossitis,
diarrhea
posterolateral
column
demyelination,
AMS,
depression,
psychosis
Vegetarians,
atrophic
gastritis,
pernicious
anemia, celiac
sprue, Crohn's
disease, patients
postgastrectomy
or ileal resection
None Cobalamin
(B12)(serum),
methylmalonic
acids (plasma)
70. VITAMIN B7
Recommended
Daily Enteral
Intake
Signs and
Symptoms
Populations At
Risk for
Deficiency
Signs and
Symptoms of
Toxicity
Status
Evaluation
30 mcg Mental status
changes, myalgias,
hyperesthesias,
anorexia,(excessive
egg white
consumption
results
in avidin-mediated
biotin inactivation)
Alcoholics None Biotin(plasma),
methyl-
citrate(urine)
73. Colour of Hair
White - hair albinism (due to absence of pigment).
Grey hair is a sign of ageing.
Poliosis patchy loss of pigmentation of hair in the
region of an adjoining vitiligo.
Flag sign brownish discolouration of hair, with
interspersed normal colour of hair, is seen in protein
energy malnutrition.
ZINC DEFICINECY
74. ZINC
Nutrient Recommended
Daily Enteral
Intake
Signs and
Symptoms
Populations At
Risk for
Deficiency1,4
Signs and
Symptoms of
Toxicity4
Status
Evaluation4,5
Zinc 11 mg Poor wound
healing,
diarrhea (high
fistula risk),
dysgeusia,
hypogonadism,
infertility,
acro-oroficial
skin lesions
(glossitis,
alopecia),
behavioral
changes
Intrinsic:
Acrodermatitis
enteropathica
Chronic
diarrhea,
cereal-based
diets,
alcoholics, any
intestinal
malabsorptive
states, fistulas/
nephrotic
syndrome,
diabetes, post–
gastric bypass/
anorexia,
pregnancy
Intrinsic:
Acrodermatitis
enteropathica
PO: Nausea,
vomiting,
gastritis,
diarrhea, low
HDL, gastric
erosions,
Competition
with GI
absorption can
precipitate
Cu21 deficiency
Inhaled:
Hyperpnea,
weakness,
diaphoresis
Zinc,S,P,
alkaline
phosphatases
(good for those
on TPN, but in
general
Zincs,p, hair,
RBC, WBC
levels can be
misleading)
Zinc
radioisotope
studies (most
accurate tests
at present;
98. D/D OF BLEEDING GUMS:
Ill fitting Dentures and other dental appliances
Bleeding disorders
Improper flossing
Gingivitis
Leukemia
Vitamin c def
Use of anticoagulants
Vit k deficiency
99. Manifestations
Infancy and Childhood
Painful swelling over the long bones due to subperiosteal haemorrhage
Gingivitis, swollen, spongy gums if teeth have erupted
Lassitude, anorexia and pain in limbs
Inward sinking of sternum with sharp elevation of costochondral junctions
(scorbutic rosary)
Purpura and echymoses may appear in the skin
Painful joint swelling due to haemorrhage into the joint cavities.
Retrobulbar, subarachnoid and intracerebral hemorrhages
100.
101. ADULTS:
Swollen, spongy gums
Perifollicular hyperkeratosis with haemorrhage
Haemorrhage into the muscles of the arms and legs
Petechial haemorrhages in the viscera and echymoses
Delayed wound healing
Other clinical manifestations are icterus, oedema,
fever, convulsions and hypotension
Vitamin C deficiency causes normochromic
normocytic anaemia
102. Recommended
Daily Enteral
Intake
Signs and
Symptoms
Populations
At Risk for
Deficiency
Signs and
Symptoms of
Toxicity
Status Evaluation
90 mg
VIT C
Scurvy,
ossification
abnormalities
Tobacco
lowers plasma
and WBC
vitamin C
Sudden
cessation of
high dose
vitamin C
can
precipitate
scurvy
Fruit-deficient
diet, smokers,
ESRD
Nausea,
diarrhea,
increased
oxalate
synthesis
(theoretical
nephrolithiasis
risk)
Ascorbic
acid(plasma),
leukocyte ascorbic
acid
109. D/D for petichiae (<3mm)
Physical trauma :
repeated bout of coughing, vomitting
Asphyxiation
Sun burn
Hickey
NON INFECTIOUS
VIT C VIT K DEF
Thrombocytopenia
Leukemia
Von villebrands disease
Aplastic anemia
112. Recommended
Daily Enteral
Intake
Signs and
Symptoms Signs
and Symptoms
Populations At
Risk for
Deficiency
Signs and
Symptoms of
Toxicity
Status
Evaluation
120 mcg
VITAMIN K
Hemorrhagic
disease of
newborn,
coagulopathy
Any malabsorptive
state involving
proximal small
bowel, chronic
liver disease
In utero:
Hemolytic anemia,
hyperbilirubinemi
a, kernicterus IV:
flushing, dyspnea
hypotension
(possibly related to
dispersal agent)
Prothrombin time
(plasma)
129. D/D OF KOILONYCHIA
Iron deficiency Anemia
Hemochromatosis
Raynauds syndrome
Porphyria
Inherited
130. IRON
Recommended
Daily Enteral
Intake/
Parenteral
Intake
Signs and
Symptoms
Signs and
Symptoms
Populations At
Risk for
Deficiency
Signs and
Symptoms of
Toxicity
Status Evaluation
8 mg Fatigue,
hypochromic
microcytic
anemia
glossitis,
koilonychia
Reproductive age
females, pregnant
females, chronic
anemias,
hemoglobinopath
ies post–gastric
bypass/
duodenectomy,
alcoholics
PO or IV:
hemosiderosis,
followed by
deposition in liver,
pancreas heart and
glands Intrinsic:
Hereditary
hemochromatosis
Ferritins, TIBCs %
Transferrin saturation,
serum iron
131.
132. WHITE NAILS AND TRANSVERSE RIDGING
OF NAILS – HYPOALBUMINEMIA
133. D/D OF WHITE NAILS
Anemia
Hypoalbumunaemia
Diabetes
CCF
RA
Malignancy
136. VITAMIN D
Recommended
Daily Enteral
Intake
Signs and
Symptoms
Signs and
Symptoms
Populations At
Risk for
Deficiency
Signs and
Symptoms of
Toxicity
Status
Evaluation
5–15 mcg Rickets/osteomal
acia
Any malabsorptive
state involving
proximal small
bowel, chronic liver
disease Of note:
Those with higher
skin melanin
content (i.e., darker
skin) have low
baseline 25-OH
vitamin D levels; it
is unclear whether
this merits their
inclusion as an “at
risk” population
Hypercalcemia,
hyperphosphatemi
a, which can lead
to CaPO4
precipitation,
systemic
calcification +/-
AMS +/-AKI
25-OH vitamin D
serum levels is Of
note: lively debate
between IOM and
Endocrine Society
regarding
definitions of
deficiency, goal
serum 25-OH
levels, and at risk
populations
147. CHROMIUM
Recommende
d
Daily Enteral
Intake
Signs and
Symptoms
Signs and
Symptoms
Populations
At Risk for
Deficiency
Signs and
Symptoms
of Toxicity
Status Evaluation
30–3 5 mcg Glucose
intolerance
peripheral
neuropathy
None PO: gastritis
IV: skin
irritation
Cr61: (steel,
welding) lung
carcinogen if
inhaled
Chromium (serum)
148.
149. COPPER
Recommended
Daily Enteral
Intake
Signs and
Symptoms Signs
and Symptoms
Populations
At Risk for
Deficiency
Signs and
Symptoms of
Toxicity
Status
Evaluation
900 mcg Hypochromic
normocytic or
macrocytic anemia
(rarely microcytic)
neutropenia,
thrombocytopenia,
diarrhea,
osteoporosis
pathologic fractures
Intrinsic:
Menkes‘disease
Chronic
diarrhea high
zinc/low
protein diets
PO: gastritis, nausea,
vomiting, coma,
movement/
neurologic
abnormalities,
Wilsons disease.
Copper
,Ceruloplasmin
150.
151. IODINE
Recommended
Daily Enteral
Intake
Signs and
Symptoms
Signs and
Symptoms
Populations
At Risk for
Deficiency
Signs and
Symptoms of
Toxicity
Status Evaluation
150 mcg Thyroid
hyperplasia
(goiter)
functional
hypothyroidism
Intrinsic in utero:
cretinism, poor
CNS
development,
hypothyroidism
Those without
access to
fortified salt
grain, milk, or
cooking oil
Hypothyroidism
blocks thyroxine
synthesis OR
hyperthyroidism
Excess
supplementation
in severe
deficiency
TSH(serum),
iodine(urine) (24 hr
intake or iodine: Cr ratio
are more representative
than a single sample)
Thyroglobulins
154. MANGNESE
Nutrient Recommende
d
Daily Enteral
Intake/
Parenteral
Intake
Signs and
Symptoms
Signs and
Symptoms
Population
s At Risk
for
Deficiency
Signs and
Symptoms
of Toxicity
Status
Evaluation
Manganese 2.3 mg Hypercholes
terolemia,
dermatitis,
dementia,
weight loss
Chronic liver
disease, iron
deficient
populations
PO: None
Inhalation:
Hallucinatio
n,
Parkinsonian
-type
symptoms
No reliable
markers
Manganeses
does not
reflect bodily
stores,
especially in
the CNS
155.
156. SELENIUM
Nutrient Recommend
ed
Daily Enteral
Intake
Signs and
Symptoms
Signs and
Symptoms
Populations
At Risk for
Deficiency
Signs and
Symptoms of
Toxicity
Status
Evaluation
Selenium 55 mcg Myalgias
cardiomyopath
y Intrinsic:
Keshan's
disease
(Chinese
children),
Endemic areas
of low soil
content include
certain parts of
China and New
Zealand
PO: Nausea,
diarrhea, AMS,
irritability,
fatigue,
peripheral
neuropathy,
hair loss, white
splotchy nails,
halitosis
(garlic-like
odor)
Selenium(seru
m), glutathione
peroxidase
activity(blood)
159. MOLYBDENUM
Nutrient Recommende
d
Daily Enteral
Intake/
Parenteral
Intake
Signs and
Symptoms
Signs and
Symptoms
Populations
At Risk for
Deficiency
Signs and
Symptoms of
Toxicity
Status
Evaluation
Molybdenum 45 mcg/45 mcg CNS toxicity,
hyperoxypurine
mia,
hypouricemia,
low urinary
sulfate excretion
(also reported
with parenteral
sulfite infusion)
Intrinsic:
Molybdenum
cofactor
deficiency,
isolated sulfite
oxidase
deficiency
None PO or any
exposure:
Hyperuricemia
gout Inhaled:
Pneumoconiosi
s (industrial
exposure)
Molybdenum
160.
161. VITAMIN B5
Recommende
d
Daily Enteral
Intake
Signs and
Symptoms
Signs and
Symptoms
Populations
At Risk for
Deficiency
Signs and
Symptoms of
Toxicity
Status
Evaluation
5 mg Fatigue,
abdominal pain,
vomiting,
insomnia,
paresthesias
Alcoholics PO: Diarrhea Pantothenic
acid(urine)