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Protein Status

Protein Status. Anthropometric Biochemical Clinical physical exam medication information Dietary. Protein Status. Clinical physical exam. McClaren 41. Hair is dull, dry, lacks lustre. Kwashiorkor and marasmus. McClaren 42. ‘Flag-sign’ of marasmus and kwashiorkor.

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Protein Status

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  1. Protein Status • Anthropometric • Biochemical • Clinical • physical exam • medication information • Dietary

  2. Protein Status • Clinical • physical exam

  3. McClaren 41. Hair is dull, dry, lacks lustre. Kwashiorkor and marasmus.

  4. McClaren 42. ‘Flag-sign’ of marasmus and kwashiorkor.

  5. McClaren 40. Moon face of kwashiokor.

  6. Protein Status • Two compartment model • somatic protein is muscle • visceral protein is organs, RBC, lymphocytes, serum proteins

  7. Protein Status • Somatic protein stores • Arm muscle circumference • Arm muscle area • Gender and age specific

  8. McClaren 1. Cachexia.

  9. Protein Status • Visceral protein • organs • rbc • granulocytes • lymphyocytes • serum proteins

  10. 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

  11. Protein Status • Somatic protein stores • 30% total body protein • Visceral protein stores • 50% total body protein

  12. Protein Status • Visceral protein stores • Albumin • 3.5 - 5.0 g/dL or 35 - 50 g/L • Half-life is 14 - 21 days

  13. Protein Status • Alb • Responds slowly to nutritional repletion • Poor indicator of nutritional support in acute care • Better for initial assessment

  14. Protein Status • Prealbumin, thyroxine-binding pre-albumin, transthyretin • 20 - 50 mg/dL • Half-life is 2 to 3 days

  15. Protein Status • Prealbumin • More sensitive measuring nutritional therapy • Decreased in trauma and infection

  16. Protein Status • TLC • Protein malnutrition causes decrease in TLC • Do not use in immunocompromised pt.

  17. Protein Status • CBC with differential count • WBC X %lymphocytes • 12,300 X .25 = 3,075 cells/mm3

  18. Protein Status • Normal WBC • 4,500 - 11,000 cells/mm3 • Normal %lymphocytes • 20 - 40% • Normal TLC • 2,000 cells/mm3

  19. Protein Status • TLC • severe delpletion is < 800 cells/mm3 • moderate is 800 - 1199 cells/mm3 • mild is 1,200 - 1,800 cells/mm3

  20. Protein Status • TLC • Practice looking at a CBC form

  21. 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

  22. PEM • Severe risk • Alb <2.5 g/dL • Prealb <10 mg/dL

  23. PEM • Using Alb and weight loss • Criteria grid, Funk & Ayton, JADA, 1995

  24. Criteria grid for determining malnutrition dx. Funk & Ayton, JADA, 1995

  25. PEM • Using Diagnostic Related Groups of the International Disease Classification system

  26. PEM • Case 1 • wt is 75% of wt/ht • Alb 4.0 g/dL • Case 2 • wt is 93% of wt/ht • TLC 1,000 cells/mm3

  27. PEM • Case 3 • wt is 80% of wt/ht • Alb 3.0 g/dL

  28. Summary Protein Status • Somatic protein • Visceral protein • Dietary intake • Physical exam or clinical • Anthropometrics

  29. END • Questions on protein status?

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