Laboratory Assessment of Nutritional Status: Bridging Theory & Practice

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MARY LITCHFORD. Laboratory Assessment of Nutritional Status: Bridging Theory & Practice

Greensboro, NC

Table of Contents

Introduction & Objectives

Overview

Implications of Selected Laboratory Tests

Changes in Nutritional Status

Impact of Inflammation

Reference Standards

Equipment

Considerations for Requesting Laboratory Tests

Communication of Results

Clinical Laboratory Values

Table 3. Abbreviations & Units of Measurement

Implications for Practice

Biochemical Assessment of Nutritional Status

Blood

Urine

Assessment of Hydration Status

Assessment of Protein Status

Nutritional Anemias

Classification of Anemias

Deficient Erythropoiesis

Excessive Hemolysis

Categories of Nutritional Anemias

Review Questions for Critical Thinking

Laboratory Reference. Alanine Aminotransferase (ALT)

Alkaline Phosphatase (ALP)

Ammonia, Blood

Apolipoprotein A & B, (Apo A-I, Apo B, Apo A-I/ Apo B ratio), Lipoprotein (a [Lp(a)], Apolipoprotein E (Apo E)

Arterial Blood Gases (ABGs) (pH, Bicarbonate (HCO3), Carbon Dioxide (CO2), PCO2, PO2, O2 saturation)

Aspartate Aminotransferase (AST) (formerly SGOT)

Bilirubin, Blood & Urine

Blood Urea Nitrogen (BUN)

C- Reactive Protein (CRP); High Sensitivity- C-Reactive Protein

Calcium (Ca), Blood

Calcium (Ca), Urine

Chloride

Cholesterol, Total Serum, LDL, HDL & VLDL

Cortisol, Blood & Urine

Creatine Kinase (CK) (formerly Creatine Phosphokinase CPK)

Creatinine Clearance

Creatinine, Serum

Creatinine, Urine

Erythrocyte Sedimentation Rate (ESR)

Ferritin

Fibrinogen (Factor I, Quantitative Fibrinogen)

Folate, Serum & Red Cell Folate (RBC Folate)

Glucose, Blood

Glucose, Blood, Post Prandial (PPG)

Glucose Tolerance Test, Oral (GTT)

Glucose, Urine

Glucose-6-Phosphate Dehydrogenase (G-6-PD)

Glycosylated Hemoglobin (A1C)

Hematocrit (HCT) or Packed Cell Volume (PCV)

Hemoglobin (HGB) Normal Values

Homocysteine (Hcy)

Iron Level (Serum Fe, Total Iron Binding Capacity (TIBC), Transferrin, Transferrin Saturation)

Serum Fe

Lactic Dehydrogenase (LDH)

Magnesium (Mg++), serum & Urine

Methyl Malonic Acid (MMA), serum & Urine

Natriuretic Peptides (Atrial Natriuretic Peptide, Brain Natriuretic Peptide, N-terminal fragment of Pro-Brain Natriuretic Peptide)

Osmolality, Serum

Osmolality, Urine

Phosphate (PO4, Phosphorus)

Potassium (K+), Serum

Potassium (K+), Urine

Protein, Blood (Retinol Binding Protein, Prealbumin, Serum Albumin, Serum Globulin & Total Protein)

Globulin

Protein, Urine (Total Protein, Albumin, Microalbumin)

Prothrombin Time (PT) & International Normalized Ratio (INR)

Red Blood Cell Indices (Mean Corpuscular Volume, Mean Corpuscular Hemoglobin, Mean Corpuscular Hemoglobin Concentration, Red Cell Distribution Width)

Reticulocyte Count (Retic Count), Reticulocyte Index

Schilling Test; Vitamin B12 Absorption Test

SODIUM (NA+), SERUM

Sodium (na+), Urine

Specific Gravity, Urine

Thiamin (B1)

Thyroid Function Tests (Thyroid-Stimulating Hormone (TSH), Thyrotropin-Releasing Hormone (TRH), Thyroxine-Binding Globulin (TBG), Thyroxine (T4), Free Thyroxine (T4), Free Thyroxine Index (FTI), Triiodothyronine(T3), Free Triiodothyronine (Free T3)

Triglycerides

Troponin (Cardiac-specific Troponin [cTnT], Cardiac-Specific I [cTnI]

Vitamin A, Retinol

Vitamin B6

Vitamin B12

Vitamin D, 25(OH)D

Vitamin E

White Blood Cell(WBC) Count & Differential Count

Neutrophils

Lymphocytes

Monocytes

Basophils & Eosinophils

Zinc (Zn), Plasma

References

Отрывок из книги

New technologies and innovative processes generate new information giving the practitioner a greater understanding of the cascade of events from diagnosis through treatment and outcomes. The Nutrition Care Process (NCP) is an innovative process in which nutrition care indicators are clustered together to identify nutrition diagnoses. Laboratory data remains one of the key components of the assessment section and is often incorporated into the PES statements.

Changes in laboratory values reflect changes in medical condition, but not always nutritional status. Be alert to all the factors that contribute to changes in laboratory values. Changes in nutritional status mean the plan of care is achieving the expected outcomes or it is not achieving the expected outcomes. Improving nutritional status usually means shorter hospital stays, fewer complications and speedier wound healing after surgery. Using laboratory assessment to document the positive impact of the medical nutrition therapy demonstrates the benefits of our professional expertise to the medical team.

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Key: WNL= within normal limits

Assessment FOR Overhydration

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