Water & the Minerals

Fluids Females 50-55% water Males 55-60% Less water in older adults More in children More in persons who

exercise

Fluids Main functions

Shape and structure to cellsnormal turgor

Aids in digestion and absorption of nutrients

Transports/ lubricates Solvent/ chemical reactions Stabilizes body temperature

Fluids Adults metabolize 2.5-3

liters water/day Excrete 500-600 ml/day to

get rid of body wastes 7-9 liters secreted into GI

tract each day almost all reabsorbed

Approximate Total Volume of

Digestive Secretions Produced in 24

Hours by Adult of Average Size

Secretion Amount

Saliva 1500 mlGastric 2500Bile 500Pancreatic 700Intestinal 3000

TOTAL 8200 ml

Fluids Normal losses 2.5 liters/day Obligatory Facultative Thirst-not always accurate

diminished in elderly infants can’t tell you watch color of urine

Fluids ECF water outside

cell 1/3 body H20 blood plasma interstitial

fluids

ICF water inside

cells 2/3 body H20 site of basic

metabolic activity

Dehydration Fluid volume deficient or

hypovolemia Output exceeds water intake Shift of water from ECF to

ICF Lower blood volume Cellular edema

Dehydration Hypovolemia symptoms

intense thirst dry mucous membranes weak and rapid pulse orthostatic hypotension vomiting and confusion concentrated urine life threatening -10% weight

loss

Signs of dehydration

Headache/ lightheadness Fatigue Loss of appetite Flushed skin Heat intolerance Dry mouth and eyes Dark, scanty urine

Fluid overload Fluid volume excess or

hypervolemia Fluid intoxication

muscle cramps and low BP

excessive water intake renal failure or CHF water shifts from cell to ECF

Fluid overload Peripheral edema Rapid, bounding pulse Distended neck veins Pulmonary edema/SOB

Fluids Adequate water intake 30 ml/kg or 1-1.5 ml/1

kcalorie energy expenditure Urine should be pale yellow

Minerals

Inorganic elements Classified as macro and

trace elements by amount by need

Functions Structure Fluid Balance Vitamin, enzyme, and

hormone activity Nerve cell transmission Muscle contraction

Acid -Base balance Determined by pH Water regulates pH Normal pH 7.35-7.45 Acid base buffers

carbonic acid sodium bicarbonate

Acid -Base Balance Disturbances

respiratory acidosischronic lung disease

metabolic acidosisketosis

respiratory alkalosishyperventalating

metabolic alkalosisvomiting

Mineral salts NaCl in body water Movement directed by cells Water follows salt Separate into ions in

solution Conduct electricity Called electrolytes

Electrolytes Cations-NA+, K+

Anions-Cl-

Usually balanced

Sodium Principle electrolyte in ECF Primary regulator ECF volume Maintains acid base balance Muscular irritability Nerve impulse transmission Intestinal secretions 35-40% skeleton

Sodium 1 gram sodium in 1/5 t. of NaCl Salt is 39% sodium Use less with HTN, CHF, and

Kidney Failure Adjust depending on climate

and physical activity Suggested intake 2400 mg or

1000mg/1000 kcalories

Sodium Increased losses with

vomiting and diarrhea Replace both Na+ and water

Potassium Principle cation in ICF Maintains cell integrity Keeps heart beat steady Deaths from severe diarrhea

or dieresis Assists in CHO and protein

metabolism

Potassium High K foods associated

with decreased risk of stroke and lower blood pressure

Hypokalemia too low=death

Hyperkalemia too high =death

Lower Sodium Diet

Reduce sodium gradually Learn to read the food labels

and compare brands Fresh is best Balance high and low

sodium foods Experiment with herbs,etc.

Chloride Principle anion of ECF Not usually treated

separately from sodium problems

Calcium Most abundant 99% bone and teeth 1% serum Bound with P04

-3 and Mg++

Calcium Bones replete serum Serum Ca++

bone and teeth formation controls muscle contractions transmits nerve impulses blood clotting secretion of hormones

Calcium Calcium Regulated very tightly 30-40% dietary calcium

absorbed bound to oxalates &

phytates in plant foods New recommendations

Calcium Serum levels kept constant Vitamin D and parathyroid

hormone raises Ca++ levels PRN

Calcium travels with Albumin in blood-need to do corrected Ca++ calculation if Albumin low

Calcium Deficiencies Means less bone density

Osteoporosis- thin, white or Asian women most at risk

Rickets- malabsorption of Ca++

Calcium Deficiencies Sedentary lifestyle

less absorption Low calcium diet

increased blood pressure ETOH and smoking

increases losses

Calcium Supplements Carbonate Citrate Acetate NO oyster shell

Supplements

No more than 2500mg per day

Count amounts from food Smaller divided doses Do not take iron and

calcium at the same time Plenty of fluids

Calcium Excesses Constipation Kidney Stones

Calcium Sources Milk Cheese Yogurt Soy & other legumes Whole grains Green Leafy Vegetables

Phosphorous Combined with Ca++ in

bone and teeth 85% in bones Major body buffer Important in energy

transfers-ATP

Phosphorous Absorption regulated by

parathyroid hormone Excesses excreted in urine Renal insufficiency =

high serum levels

Phosphorous Deficiencies Malnutrition ETOH abuse Starvation

Phosphorous Sources Meats Poultry Fish Eggs Legumes Milk and Dairy Products Soft drinks

Magnesium Small amount in body Critical to operation of

hundreds of enzymes Smooth muscle relaxation Necessary for release of

energy Holds calcium in tooth

enamel

Magnesium Deficiency Vomiting and diarrhea ETOH abuse Protein malnutrition Causes hallucinations in

ETOH withdrawal Prolonged muscle

contractions

Magnesium Sources Green leafy vegetables Nuts Legumes Whole grains Seafood

Iron 3-5 g stored in body 2/3 as heme in hemoglobin 1/3 as ferritin RBC carries O2 to tissues Needed for new cells

Iron 10-15% dietary iron

absorbed Amount increases in

deficiency Nonheme Fe+++ ferric

plant source Nonheme and heme Fe++

ferrous animal source

Iron Toxicity Repeated transfusions Polycystic disease Iron poisoning Symptoms

N&V shock convulsions and coma

Iron Deficiencies Most deficient nutrient in US Nutritional Anemias Hemorrhagic Anemias Postgastrectomy anemia Malabsorption anemia Chronic disease anemia

Iron Deficiencies Symptoms

weakness and fatigue headaches apathy

Pica-eating of non-nutrient substances ice, clay, paste, starch, kaolin

Iron Deficiency Anemia Increase food sources

Include iron fortified cereals

Know heme iron sources Add sources of Vitamin C Drink coffee & tea between

meals, not with meals Cook in iron pots

Iron Sources Liver Lean meat Dried beans Fortified cereals

Iodine Major source is iodized salt Thyroid hormones

body temperature metabolic rate reproduction/growth nerve and muscle

functions

Zinc Picked up by

albumin for transport Energy job Healing job Immune function

Zinc Deficiencies Mental disorders Abnormal dark adaptation

in vision Skin lesions Hair loss Strict vegetarians at risk

Iodine Deficiencies Goiter Weight gain Birth defects Cretinism

Selenium Antioxidant Sparing effect on Vitamin C Research area Toxicity

hair & nail loss skin lesions diarrhea

Selenium Rare deficiency in long

term parenteral nutrition

Other Trace Minerals Copper

wound healing hemoglobin help cells use FE++

sheaths around nerve fibers Deficiency

dementia, liver failure

Other Trace Minerals Manganese Fluoride

excess can mottle teeth Chromium

CHO/lipid metabolism works with insulin