By Mary Klingensmith
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Extra info for The Washington Manual of Surgery, 6th Edition
Example text
Table 2-1 Vitamins Vitamin Function Deficiency State Fat Soluble A (Retinol) Rhodopsin synthesis Xerophthalmia, keratomalacia D (Cholecalciferol) Intestinal calcium absorption, Rickets (children), bone remodeling osteomalacia (adults) E (α-Tocopherol) Antioxidant Hemolytic anemia, neurologic damage K Ï -Carboxylation of glutamate in Coagulopathy (Naphthoquinone) clotting factors (deficiency in factors II, VII, IX, and XI) Water Soluble B1 (Thioamide) Decarboxylation and aldehyde Beriberi, neuropathy, transfer reactions fatigue, heart failure B2 (Riboflavin) Oxidation-reduction reactions Dermatitis, glossitis B5 (Niacin) Oxidation-reduction reactions Pellagra (dermatitis, diarrhea, dementia, death) B6 (Pyridoxal Transamination and Neuropathy, glossitis, phosphate) decarboxylation reactions anemia B7 (Biotin) Carboxylation reactions Dermatitis, alopecia B9 (Folate) DNA synthesis Megaloblastic anemia, glossitis 45 46 B12 DNA synthesis, myelination Megaloblastic anemia, (Cyanocobalamin) Neuropathy C (Ascorbic acid) Hydroxylation of hormones, Scurvy hydroxylation of proline in collagen synthesis, antioxidant Adapted from Atluri P, Karakousis GC, Porrett PM, Kaiser LR.
Protein absorption can effectively occur at every level of the small intestine; therefore, clinically significant protein malabsorption is relatively infrequent, even after extensive intestinal resection. The 20 amino acids are divided into essential and nonessential groups, depending on whether they can be synthesized de novo in the body. 44 43 44 ◊ Major roles of amino acids include the following: ⋅ Synthesis and recycling of proteins. ⋅ Catabolic reactions, resulting in energy generation and CO2 production.
The patient should be maintained in a euvolemic state. 29 acidosis, and hyperphosphatemia are common problems in patients with ARF and should be managed as discussed in Chapter 4. Medication doses should be adjusted appropriately and potassium removed from maintenance IV fluids. ◊ Dialysis. Indications for dialysis include intravascular volume overload, hyperkalemia, severe metabolic acidosis, and complications of uremia (encephalopathy, pericarditis). ♦ Infectious Complications ◊ Management of infection and fever ⋅ Evaluation of fever should take into account the amount of time that has passed since the patient's most recent operation.