Transcript water and minerals required for oral soft tissues AND SALIVARY

WATER AND MINERALS
REQUIRED FOR ORAL SOFT
TISSUES AND SALIVARY GLANDS
CHAPTER 12
Copyright © 2015, 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc.
Water
 Most abundant component of the body
 At birth 75% to 80% of body weight
 In an adult 50% to 60% of body weight
 Adipose tissue contains less water than lean body
mass (LBM)
 Body fluids
 Intracellular fluid (ICF)
 Extracellular fluid (ECF)
 Osmotic pressure equalizes the
From Thibodeau GA, Patton KT: Anatomy &
Physiology, ed 6. St. Louis: Mosby, 2007.
solute concentration of ICF and ECF
Copyright © 2015, 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc.
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Physiological Roles: Water
 Solvent enables chemical reactions to occur by entering
into some reactions, such as hydrolysis
 Maintains stability of all body fluids, as the principal
component and medium for fluids (blood and lymph),
secretions (saliva and gastrointestinal fluids), and
excretions (urine and perspiration)
 Enables transport of nutrients to cells and provides
medium for excretion of waste products
 Acts as lubricant between cells to permit movement
without friction
 Regulates body temperature by evaporating as
perspiration from skin and vapor from mouth and nose
Copyright © 2015, 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc.
3
Requirements: Water
 AI for total fluid (beverages, water, and food)
 Men = 3.7 L (15 to 16 cups) per day
 Women = 2.7 L (11 to 12 cups) per day
 Water is lost via a variety of routes
1. Urination
2. Perspiration
3. Expiration
4. Defecation
 When as little as 2% of body water is
Fro Patton KT, Thibodeau
GA: Anatomy & Physiology,
ed 8. St. Louis: Mosby,
2013.
lost, osmoreceptors are stimulated, creating a
physiological desire to ingest liquids
Copyright © 2015, 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc.
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Sources: Water
 Plain tap water is the most natural source
of fluids
 EPA regulates the levels of contaminants allowed
in drinking water in public water systems
 Use of bottled water has increased
Redrawn from Popkin BM et al: A
new proposed guidance system for
beverage consumption in the United
States. Am J Clin Nutr 2006 Mar;
83(3):529-542.
 Other sources of water include soft drinks, sports and
energy drinks, vitamin water, and other drinks
 Energy drinks containing high kilocalorie and caffeine levels are
the fastest growing beverage category
 Beverages containing acidic flavorings may result in erosion
 Americans consume 21% of their daily kilocalories (approx. 500
calories) from caloric beverages
Copyright © 2015, 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc.
5
Hyperstates: Water
 Fluid volume excess (FVE)
 Occurs in ECF compartments secondary to an
increase in total body sodium
 Results in rapid weight gain, puffy eyelids, distended
neck veins, and elevated blood pressure
 At risk if:




Congestive heart failure
Chronic renal failure
Chronic liver disease
High levels of steroids
From Patton KT, Thibodeau GA: Anatomy &
Physiology, ed 8, St. Louis: Mosby, 2013.
Copyright © 2015, 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc.
6
Hypostates: Water
 Fluid volume deficit (FVD)
 Associated with excessive loss of fluids from:
 Gastrointestinal tract (vomiting, diarrhea, drainage tubes)
 Urinary tract (diuretics, polyuria, or excessive urination)
 Skin (sweating)
 Classic signs are:
 Dry tongue with longitudinal fissures (slits or wrinkles that
extend lengthwise on the tongue)
 Xerostomia
 Shrinkage of oral mucous membranes
 Decreased skin turgor
 Dry skin
 Decreased urinary output
Copyright © 2015, 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc.
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Electrolytes
 Compounds or ions that dissociate in
solution
 Cation (positive charge)
 Sodium, potassium, calcium, and magnesium
 Principal cation in plasma and interstitial fluid
is sodium
 Anion (negative charge)
 Chloride, bicarbonate, and phosphate
 Principal anion in plasma and interstitial
fluid is chloride
 Electrolytes are important in water
balance and acid-base (pH) balance
Copyright © 2015, 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc.
From Patton KT, Thibodeau GA:
Anatomy & Physiology, ed 8. St.
Louis: Mosby, 2013.
8
Physiological Role and
Requirements: Sodium
 Physiological roles
 Maintain normal ECF concentration by affecting the
concentration, excretion, and absorption of potassium and
chloride and water distribution
 Regulate acid-base balance
 Facilitate impulse transmission in nerve and muscle fibers
 Requirements
 AI for sodium is 1500 mg/day with the upper limits being
2300 mg/day for adults
 Minimum intake 500 mg/day
Copyright © 2015, 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc.
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Sources: Sodium
 Natural constituent of most foods, including:
 Meat
 Saltwater fish
 Eggs
 Dairy products
 Some vegetables
Copyright © 2015, 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc.
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Hyperstates and Hypostates:
Sodium
 Hyperstates
 Hypernatremia (elevated serum sodium level)
 Signs are extreme thirst; dry, “sticky” tongue and oral mucous
membranes; fever; and convulsions
 Hypostates
 Hyponatremia (low serum sodium level)
 Water intoxication or hyponatremia can occur when individuals
drink too much water
 Early symptoms of hyponatremia are nausea and abdominal
cramps, headache, confusion, lethargy, and coma
Copyright © 2015, 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc.
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Overview: Chloride
 Physiological roles
 Maintains ECF balance, osmotic equilibrium, and
electrolyte balance
 In gastric secretions to aid protein digestion and
creating acidic environment to inhibit bacterial growth
and enhance iron, calcium, and vitamin B12 absorption
 Requirements
 AI = 2300 mg/day for adults
 Sources
 Salt
Copyright © 2015, 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc.
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Hyperstates and Hypostates:
Chloride
 Hyperstates
 At-risk groups include
those with:





Excessive intakes of salt
(NaCl)
Dehydration
Renal failure
Diarrhea
Cushing’s syndrome
 Hypostates
 Hypochloremia
 Conditions placing at
risk include:



Persistent heavy sweating
Chronic diarrhea, vomiting
Chronic renal failure
Copyright © 2015, 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc.
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Overview: Potassium
 Physiological roles
 Maintain cellular (ICF) concentration
 Directly affects muscle contraction (especially cardiac)
and electrical conductivity of the heart
 Transmission of nerve impulses
 Regulates acid-base balance
 Requirements
 AI = 4700 mg/day for all adults
 Equivalent to approximately 10 servings of
fruits and vegetables daily
From Patton KT, Thibodeau GA: Anatomy &
Physiology, ed 8. St. Louis: Mosby, 2013.
Copyright © 2015, 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc.
14
Sources: Potassium
 Dairy
 Meat
 Grains
 Fruits
 Vegetables
 Processed foods
 Potassium supplements and salt substitutes
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Hyperstates and Hypostates:
Potassium
 Hyperstates
 Hypostates
 Hyperkalemia (elevated
serum potassium) is
life-threatening

Causes
 Impaired renal
excretion
 Increased shift of
potassium out of cells
 Increased potassium
intake
 Hypokalemia
 Causes
 Drugs, such as
diuretics furosemide,
hydrochlorothiazide
 Cushing’s syndrome
 Hyperaldosteronism
 Hypomagnesemia
 Alcoholism
Copyright © 2015, 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc.
16
Physiological Roles: Iron
 Component of hemoglobin
 Catalyzes many oxidative reactions within cells
 Conversion of beta-carotene to vitamin A
 Formation of purines as part of nucleic acid
 Removal of lipids from the blood
 Detoxification of drugs in the liver
 Synthesis of collagen
 Production of antibodies
From Patton KT, Thibodeau GA: Anatomy &
Physiology, ed 8. St. Louis: Mosby, 2013.
Copyright © 2015, 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc.
17
Requirements: Iron
 RDA
 Men and postmenopausal women: 8 mg/day
 Women: 19 to 50 yr: 18 mg/day
 UL
 45 mg/day
From Mahan LK, Escott-Stump S: Krause’s Food and Nutrition
Therapy, ed 13. St. Louis: Elsevier, 2011.
Copyright © 2015, 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc.
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Sources: Iron
 Heme iron
 Organ meats, meat, fish, poultry
 Non-heme iron
 Eggs
 Milk
 Whole grains, enriched cereals
 Green vegetables
 Dried fruit
Copyright © 2015, 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc.
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Hyperstates and Hypostates: Iron
 Toxicity
 Deficiency
 Hemochromatosis
 Microcytic anemia
 Organ damage
 Angular cheilosis
 Coronary heart disease
 Pallor of lips and gingiva
 Skin pigmentation
 Sore, burning tongue;
 Cirrhosis of the liver
glossitis
 Atrophy of filiform
papillae
 Risk of candidiasis
 Possible increased
caries susceptibility
Courtesy of Robert W. McKenna, Department
of Pathology, University of Texas Southwestern
Medical School, Dallas. In Kumar V, Abbas AK,
Fausto N: Robbins and Cotran Pathologic
Basis of Disease, ed 7. Philadelphia: Saunders,
2005.
Copyright © 2015, 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc.
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Physiological Roles: Zinc
 Physiological roles
 Component in >200 enzymes affecting cell growth and





replication (DNA/RNA synthesis)
Collagen synthesis, bone resorption, and remodeling
Sexual maturation
Night vision
Immune defenses
Taste, smell, and appetite
Copyright © 2015, 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc.
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Requirements and Sources: Zinc
 Requirements
 RDA
 11 mg/day for men and 8 mg/day for women
 UL
 40 mg/day for adults
 Sources
 Lamb and beef
 Oysters
 Eggs
 Peanuts
Copyright © 2015, 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc.
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Hyperstates: Zinc
 High levels of zinc
cause:
 Excesses of zinc also:
 Reduces copper status
 Vomiting and diarrhea
 Alters iron function
 Epigastric pain
 Decreases immune
 Lethargy
function
 Decreases high-density
lipoprotein (HDL)
 Fatigue
 Renal damage
 Pancreatitis
 Death
Copyright © 2015, 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc.
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Hypostates: Zinc
 Signs and symptoms
 Thickening of epithelium
 Impaired keratinization of epithelial cells
 Increased susceptibility to periodontal disease
 Flattened filiform papillae
 Loss of taste and smell acuity
 Poor appetite
 Impaired wound healing
Copyright © 2015, 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc.
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Hypostates: Zinc
 Groups at risk of deficiency
 Those whose zinc requirements are relatively high (such as
during periods of rapid growth)
 Older adults
 Vegans
 Severe malabsorption
(diarrhea) or other chronic
health problems
Copyright © 2015, 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc.
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Overview: Iodine
 Physiological role
 Production of thyroxine
 Requirements
 RDA =150 µg/day
 UL =1100 µg/day
 Sources
 Seafood/plants grown near the ocean
 Molasses
 Yogurt and milk
 Iodized salt
Copyright © 2015, 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc.
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Hyperstates and Hypostates: Iodine
 Hyperstates: excessive amounts
result in thyroiditis, hypothyroidism,
hyperthyroidism, sensitivity reactions
 Hypostates
From Fehrenbach MJ, Herring SW: Illustrated Anatomy
of the Head and Neck, ed 4. St. Louis: Saunders, 2012
 Goiter (enlargement of the thyroid gland)
 Spontaneous abortions and congenital anomalies
 Delayed eruption of primary and secondary teeth
 Enlarged tongue
 Endemic cretinism
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Nutritional Directions
 Encourage water as beverage of choice to fulfill daily water
needs over consumption of caloric beverages
 Assess patients for electrolyte imbalances and nutrient
deficiencies/excesses and refer to medical providers as
needed
 Consume less than 2300 mg (approximately 1 tsp salt) of
sodium per day by choosing and preparing foods with little
added salt
 Consume lean meats, whole grains, fruits, vegetables, and
low-fat dairy to meet nutritional needs
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HEALTH APPLICATION
Hypertension
 Discuss the epidemiology & statistics of
Americans impacted by hypertension
 How is hypertension defined clinically?
 What are the health risks of having
hypertension?
 What are causes of hypertension?
 What treatment(s) or lifestyle changes can be
employed to reduce hypertension?
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