By L. Lee. Angelo State University. 2018.
Nitrogen Balance blood vitamin B12 level can be caused by decreased intake best cozaar 50mg, absorption generic cozaar 25mg mastercard, or transport discount 25 mg cozaar overnight delivery, Positive Nitrogen Balance Growth (e order cozaar 25 mg otc. His Nitrogen Balance Normal healthy adult Dietary N Excreted N serum albumin was 3. VITAMINS a Dietary Reference Intakes (DRI) Consequences Females (F) of Deficiency Males (M) Some Common (Names of deficiency Vitamin (18–30 yrs old) Food Sources diseases are in bold) Water-soluble vitamins Vitamin C RDA Citrus fruits; potatoes; peppers, broccoli, spinach; Scurvy: defective collagen formation leading to subcuta- F: 75 mg strawberries neous hemorrhage, aching bones, joints, and muscle in M: 90 mg adults, rigid position and pain in infants. UL: 2 g Thiamin RDA Enriched cereals and breads; unrefined grains; Beri-beri: (wet) Edema; anorexia, weight loss; apathy, F: 1. F: 15 mg green leafy vegetables M: 15 mg UL: 1 g Dietary Reference Intakes (DRI): Recommended Dietary Allowance (RDA); Adequate Intake (AI); Tolerable Upper Intake Level (UL) aInformation for this table is from Dietary Reference Intakes for Thiamin, Riboflavin, Niacin, Vitamin B , Folate, Vitamin B , Pantothenic Acid, Biotin, and Choline 6 12 (1998); Dietary Reference Intakes for Vitamin C, Vitamin E, Selenium, and Carotenoids (2000); Dietary Reference Intakes for Calcium, Phosphorus, Magnesium, Vita- min D, and Fluoride (1997), Dietary Reference Intakes for Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine, Iron, Manganese, Molybdenum, Nickel, Silicon, Vanadium, and Zinc (2001). Washington, DC: Food and Nutrition Board, Institute of Medicine, National Academy Press. Niacin can be synthesized in the human from tryptophan, and this term takes into account a conversion factor for dietary tryptophan. CHAPTER 1 / METABOLIC FUELS AND DIETARY COMPONENTS 15 riboflavin is 0. The largest requirements occur during lac- tation (1. Vitamins, by definition, cannot be synthesized in the body, or are synthesized from a very specific dietary precursor in insufficient amounts. For example, we can synthesize the vitamin niacin from the essential amino acid tryptophan, but not in sufficient quantities to meet our needs. Excessive intake of many vitamins, both fat-soluble and water-soluble, may cause deleterious effects. For example, high doses of vitamin A, a fat-soluble vita- min, can cause desquamation of the skin and birth defects. High doses of vitamin C cause diarrhea and gastrointestinal disturbances. One of the Reference Dietary Intakes is the Tolerable Upper Intake Level (UL), which is the highest level of daily nutrient intake that is likely to pose no risk of adverse effects to almost all individ- uals in the general population. As intake increases above the UL, the risk of adverse effects increases. Intake above the UL occurs most often with dietary or pharmacologic supplements of single vitamins, and not from foods. They are generally divided into the classifi- cations of electrolytes (inorganic ions that are dissolved in the fluid compartments of the body), minerals (required in relatively large quantities), trace minerals (required in smaller quantities), and ultratrace minerals (Table 1. Sodium (Na ), potassium (K ), and chloride (Cl–) are the major electrolytes (ions) in the body. They establish ion gradients across membranes, maintain water balance, and neutralize positive and negative charges on proteins and other molecules. Calcium and phosphorus serve as structural components of bones and teeth 2 A dietary deficiency of calcium can and are thus required in relatively large quantities. Calcium (Ca ) plays many lead to osteoporosis, a disease in other roles in the body; for example, it is involved in hormone action and blood which bones are insufficiently min- clotting. Phosphorus is required for the formation of ATP and of phosphory- eralized and consequently are fragile and lated intermediates in metabolism. Magnesium activates many enzymes and easily fractured. Osteoporosis is a particu- also forms a complex with ATP. Iron is a particularly important mineral larly common problem among elderly because it functions as a component of hemoglobin (the oxygen-carrying pro- women. Deficiency of phosphorus results in tein in the blood) and is part of many enzymes. Other minerals, such as zinc or bone loss along with weakness, anorexia, molybdenum, are required in very small quantities (trace or ultra-trace malaise, and pain.
The most common pattern is anterior subluxation as the shoulder becomes pro- tracted and elevated discount 25 mg cozaar with mastercard. The humeral head becomes subluxated anteriorly to- ward the coracoid process cheap 25 mg cozaar with amex. These subluxations cause children no pain but are often accompanied by decreased range of motion buy generic cozaar 25 mg on line, especially external ro- tation and abduction generic cozaar 25 mg with amex. The increasing contracture may cause problems with dressing or cleaning the axilla. Complete acute dislocation of the shoulder, either in the anteroinferior direction or the posterosuperior direction, also occurs. For many children in middle childhood or adolescence, this event causes pain but the shoulder is easy to reduce. In a few children the shoulder becomes dislocated and is not painful. The fixed dislocations occur in individuals with severe involvement and they do not become painful over time. Because this was thought to be a always hung in front of him and bothered him, especially shoulder with useful function, we did not want to do ex- when he wanted to walk fast. Also, he was concerned tensive muscle lengthening; therefore, he had a derotation about the appearance of the limb. He was in 11th grade osteotomy of the humerus and a myofascial lengthening of a regular high school and did age-appropriate aca- of the biceps and brachialis (Figure C8. He used the extremity as a helper hand but tively, he had 30° of external rotation of the shoulder, and he was not concerned about improving the function of the the elbow came to −20° of extension. On physical examination he demonstrated the the result, and although the limb still tended toward inter- ability to raise the arm to 90° of forward flexion, maxi- nal rotation, it was better than fixed internal rotation. On physical examination the shoulder could be externally rotated to almost neutral passively (Figure C8. The elbow extended to a minimum of 15° with full flexion on passive motion. He stood and walked with the elbow flexed and the shoul- Figure C8. Upper Extremity 399 Natural History Very few fixed shoulder dislocations become painful. The painful acute dis- locations may slowly resolve over time as the shoulder is protected. A small group of individuals, usually late adolescents or young adults, develop se- vere instability with multiple recurrent dislocations. These dislocations may become progressively more painful as joint degeneration occurs. Treatment Fixed anterior subluxations and fixed dislocations of the shoulder with no pain seldom need any treatment. Acute dislocations should be reduced and the position causing the dislocation avoided, which may require the use of a sling but needs to be individualized to each child. Parents and therapists need to be advised to avoid moving the arm into the position where the insta- bility occurs. Caretakers need to be advised to avoid lifting the children by holding the arms and definitely never lift them by pulling the arms into the extended and flexed overhead position. If recurrent dislocations get worse and do not slowly resolve, which almost always happens in childhood and adolescence, surgical reconstruction should be considered using standard shoulder stabilization procedures. If reconstruction fails or if the joint has severe degenerative arthritis, fusion of the shoulder joint is a good option. Occasionally, athetoid or dystonic patients will have an unstable shoul- der.
The -ketoglutarate dehydrogenase complex One of Otto Shape’s tennis part- uses thiamine pyrophosphate 50mg cozaar with visa, lipoate and FAD as bound coenzymes discount cozaar 25 mg without a prescription, and NAD and ners told him that he had heard CoASH as substrates buy cozaar 50 mg visa. Each of these coenzymes has unique structural features that about a health food designed for enable it to fulfill its role in the TCA cycle cozaar 25 mg visa. The adver- tisement made the claim that succinate A. FAD and NAD would provide an excellent source of energy during exercise because it could be metabo- Both FAD and NAD are electron-accepting coenzymes. Why is FAD used in some lized directly without oxygen. Their unique structural features enable FAD and anything wrong with this statement? NAD to act as electron acceptors in different types of reactions, and play different physiological roles in the cell. FAD is able to accept single electrons (H•), and forms a half-reduced single electron intermediate (Fig. It thus participates in reactions in which single electrons are transferred independently from two different atoms, which occurs in double bond formation (e. When FAD and FMN accept single electrons, they are converted to the half-reduced semi- quinone, a semistable free radical form. They can also accept two electrons to form the fully reduced form, FADH2. However, in most dehydro- genases, FADH2 is never formed. Instead, the first electron is shared with a group on the protein as the next electron is transferred. Therefore, in this text, overall acceptance of two electrons by FAD has been denoted by the more general abbreviation, FAD(2H). CHAPTER 20 / TRICARBOXYLIC ACID CYCLE 365 – – The claim that succinate oxidation COO COO could produce energy without oxy- CH2 CH2 gen is wrong. It was probably Isocitrate CO2 α-Ketoglutarate – based on the fact that succinate is oxidized H C COO isocitrate CH2 to fumarate by the donation of electrons to H C H dehydrogenase C O FAD. However, ATP can only be generated – – from this process when these electrons are COO COO O H O donated to oxygen in the electron transport C NH2 C NH2 chain. The energy generated by the electron + H+ + transport chain is used for ATP synthesis in N N the process of oxidative phosphorylation. R R After the covalently bound FAD(2H) is oxi- + dized back to FAD by the electron transport NAD NADH chain, succinate dehydrogenase can oxidize Fig. The alcohol group (C—OH) is oxi- another succinate molecule. Subsequent electron shifts in the pyridine ring remove the positive charge. The H of the OH group dis- sociates into water as a proton, H. In contrast, NAD accepts a pair of electrons as the hydride ion (H ), which is attracted to the carbon opposite the positively-charged pyridine ring (Fig. This occurs, for example, in the oxidation of alcohols to ketones by malate dehydrogenase and isocitrate dehydrogenase. The nicotinamide ring accepts a hydride ion from the C-H bond, and the alcoholic hydrogen is released into the medium as a positively charged proton, H. The free radical, single-electron forms of FAD are very reactive, and FADH can lose its electron through exposure to water or the initiation of chain reactions. As a consequence, FAD must remain very tightly, sometimes covalently, attached to its enzyme while it accepts and transfers electrons to another group bound on the enzyme (Fig 20.