Protein Status.ppt

Protein Status Anthropometric Biochemical Clinical physical exam medication information Dietary Protein Status Clinical physical exam Protein Status Two compartment model somatic protein is muscle visceral protein is organs, RBC, lymphocytes, serum proteins Protein Status Somatic protein stores Arm muscle circumference Arm muscle area Gender and age specific Protein Status Visceral protein organs rbc granulocytes lymphyocytes serum proteins Protein Status Guidelines interpreting AMA 5th percentile = wasted, no muscle stores 5th to 15th = below average 15th to 85th =average 85th to 95th = above average 95th = high muscle Protein Status Somatic protein stores 30% total body protein Visceral protein stores 50% total body protein Protein Status Visceral protein stores Albumin 3.5 - 5.0 g/dL or 35 - 50 g/L Half-life is 14 - 21 days Protein Status Alb Responds slowly to nutritional repletion Poor indicator of nutritional support in acute care Better for initial assessment Protein Status Prealbumin, thyroxine-binding pre-albumin, transthyretin 20 - 50 mg/dL Half-life is 2 to 3 days Protein Status Prealbumin More sensitive measuring nutritional therapy Decreased in trauma and infection Protein Status TLC Protein malnutrition causes decrease in TLC Do not use in immunocompromised pt. Protein Status CBC with differential count WBC X %lymphocytes 12,300 X .25 = 3,075 cells/mm3 Protein Status Normal WBC 4,500 - 11,000 cells/mm3 Normal %lymphocytes 20 - 40% Normal TLC 2,000 cells/mm3 Protein Status TLC severe delpletion is 800 cells/mm3 moderate is 800 - 1199 cells/mm3 mild is 1,200 - 1,800 cells/mm3 Protein Status TLC Practice looking at a CBC form Protein Energy Malnutrition No risk Alb 3.2 g/dL Prealb 17 mg/dL Moderate risk Alb 2.5 - 3.2 g/dL Prealb 10 to 17 mg/dL PEM Severe risk Alb 2.5 g/dL Prealb 10 mg/dL PEM Using Alb and weight loss Criteria grid, Funk Ayton, JADA, 1995 PEM Using Diagnostic Related Groups of the International Disease Classification system PEM Case