Care of patients with metabolic diseases and nutrition

Metabolic diseases are due mainly factors abnormal metabolism of nutrients. These disorders have endogenous causes (eg, lack of insulin) or exogenous causes mixed-constitutional and hereditary factors.

Endocrine dysfunctions have influence on nutrient metabolism of the body, as some risk factors such as sedentary lifestyle, smoking, stress.
In some conditions, there is a mismatch between food consumed, burning in or ¬ rity and energy expenditure in the sense of increased consumption over expenditure (obesity), or a low intake in relation to combustion and expenses (malnutrition).

GETTING Physiology
The body is an open system that exchanges matter and energy with its surroundings. This change is permanent, so metabolismul.Metabolismul begins with ingestion of food and excretion ends with unused product.

Carbohydrate metabolism
Carbohydrates are the body energetic role. after digestion in the small intestine they come in the form of monosaccharides and absorbed.
Blood glucose – blood sugar – is constant (0.80 to 1.20 g/1000) by glucosemetabolism mechanism, which is the functional balance between the action of the hypoglycaemic and hyperglycaemic factors.
Hyperglycaemic factors:
-Glucagon – hormone alpha cells of the pancreas
Glucocorticoid hormones of the adrenal-
-Hormone of pituitary somatotrope
Hypoglycemic factors:
-Insulin – hormone beta cells of the pancreas.
By the complete degradation of 1 g glucose to C02 and water, are released 680 calories.

Lipid metabolism
Lipids were energetic role in the body, plastic and functional. They are absorbed in the small intestine as fatty acids, monoglycerides, cholesterol, phospholipids. In the body, are converted as follows:
Being submitted as rezerver-lipogenesis
-Catabolism – leads to the release of energy
-Ketogenesis – produce ketone bodies
-Gluconeogenesis – glucose synthesis from glycerol.
Lipid adjustment is made for the energy needs of the body, the central nervous system, pituitary, liver.

Protein metabolism
Proteins serve plastic, energetic and functional. They are absorbed as amino acids about port in the liver and then in the general circulation. From this level of protein synthesis pathway are – continuous renewal of the cell components, and the way catabolic degradation. childhood, renewal – protein anabolism – is very intense, however, elderly, degradation reactions – catabolism increases.
Products of catabolism nitrogen: urea, uric acid, creatinine, it is excreted in urine.
Regulation of protein metabolism hormone testosterone is made, glicocorticoizi and thyroid hormones, liver, kidney, central nervous system.

1.Examene Laboratory
a) blood:
Uric acid
: Creatinine
-Test oral glucose tolerance OGTT
-Lipemia, triglycerides
b) Urine:
-Examination of urine, for the determination of uric acid
Urea urinară/24 h
-glicozurie/24 h
, The synovial fluid:
Biochemical-in the case of gout, reveal the presence of sodium urate crystals
February. Determination of basal metabolism-indicated in cases of malnutrition and obesity
Three. Radiological examination the bone in gout, osteoporosis and highlights the periarticular deposition of urate (geodes)
April. ¬ Electro cardiogram – highlighted heart problems that occur with obesity or weight loss (sinus bradycardia)
5.Măsurarea weight – to determine the degree of obesity, using different formulas for calculating ideal weight:
• Broca G = T-100
• Lorentz G = T-T-50/4
G = weight in kg T = size in cm

Health education and disease prevention Nutrition and Metabolism
Primary Prevention
-Educating the entire population to avoid overeating and lack of exercise, obesity risk factors
-Dispensary persons (young) the constitutional risk
-Ensuring a balanced diet without excess protein, carbohydrates or lipids
Secondary Prevention
-Obese patients will be educated to respect calorie diet, use movement as a means of preserving normal body weight
-Malnourished patients will be educated to consume enough food to prevent disease complications
, Avoiding excess proteins (meat) in patients with gout
Dispensary patients, nutritional and metabolic diseases, the clinical and biological complications refer to
Prevention education is addressed:
– Obese cardiac complications, respiratory, prevent worsening of these conditions
– Patients with gout and / or kidney complications, pre ¬ come to chronic renal failure

Signs and symptoms Possible nutritional and metabolic diseases

1.Durere joint-in gout: access-gouty pain occurs suddenly, usually at night, it is violent, is localized in the big toe, often unilateral, being triggered by excessive consumption of alcohol, protein, micro traumatisms; pain subsides spontaneously or post-therapeutic after 4-8 days, is repeated at varying intervals
February. Tophi – uric deposits in joints and skin (elbows, fingers, pinna)
Three. Changes to Corpo ¬ ral ideal weight:
, In obesity, are exceeded ideal weight by 10-20% grade I, grade II 20-30%
and 30% grade III
-Uniform (common obesity)
-Localization in certain regions of the body
– Hips, thighs, abdominal flanks, knees, calves (gynoid type obesity, common in women)
-In the region of the neck, neck, shoulders, upper abdomen (android type obesity, found
, The weight loss, body weight decreased by more than 15% of the ideal skin fold is less than 4 mm,
in men and 6 mm, in women, the upper arm
April. Characteristic appearance of the face – thin lips, cheeks emaciated, sunken eyes (general problem in malnutrition)
May. Circulatory changes:
– Hypotension and bradycardia in patients malnourished
-Hypertension, varicose veins of the legs, found in obese patients


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