Assessment of Micronutrient Status in Critically Ill Children: Challenges and Opportunities
Abstract
:1. Introduction
2. Water Soluble Vitamins
2.1. B Vitamins
2.1.1. Introduction
2.1.2. Assessment
2.1.3. Vitamin B in Critical Illness
2.2. Vitamin C
2.2.1. Introduction
2.2.2. Assessment
2.2.3. Vitamin C in Critical Illness
3. Fat Soluble Vitamins
3.1. Vitamin A
3.1.1. Introduction
3.1.2. Assessment
3.1.3. Vitamin A in Critical Illness
3.2. Vitamin D
3.2.1. Introduction
3.2.2. Assessment
3.2.3. Vitamin D in Critical Illness
3.3. Vitamin E
3.3.1. Introduction
3.3.2. Assessment
3.3.3. Vitamin E in Critical Illness
3.4. Vitamin K
3.4.1. Introduction
3.4.2. Assessment
3.4.3. Vitamin K in Critical Illness
4. Trace Elements
4.1. Iron
4.1.1. Introduction
4.1.2. Assessment
4.1.3. Iron in Critical Illness
4.2. Zinc
4.2.1. Introduction
4.2.2. Assessment
4.2.3. Zinc in Critical Illness
4.3. Selenium
4.3.1. Introduction
4.3.2. Assessment
4.3.3. Selenium in Critical Illness
4.4. Copper
4.4.1. Introduction
4.4.2. Assessment
4.4.3. Copper in Critical Illness
5. Conclusions
Acknowledgments
Author Contributions
Conflicts of Interest
References
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Vitamin | Name | Function and Enzyme Co-Factor |
---|---|---|
B1 | Thiamine | Aerobic and carbohydrate metabolism |
B2 | Riboflavin | Oxidation-Reduction reactions: FAD and FMN |
B3 | Niacin | Oxidation-Reduction reactions: NAD and NADP |
B5 | Pantothenic acid | Acylation and acetylation: coenzyme A |
B6 | Pyridoxal Phosphate | Metabolism of proteins, carbohydrates, and fats |
B7 | Biotin | Carboxylase enzymes |
B9 | Folate | DNA and RBC synthesis |
B12 | Cobalamin | DNA, RBC, and myelin synthesis |
Test | Purpose | |
---|---|---|
Vitamin B1 | Erythrocyte thiamine pyrophosphate | Quantification of thiamine pyrophosphate in erythrocytes |
Erythrocyte transketolase | Functional assessment of coenzyme activity | |
Vitamin B2 | Erythrocyte glutathione reductase activity coefficient assay | Functional assessment of coenzyme activity |
Erythrocyte FAD | Measurement of the active form of riboflavin | |
Vitamin B3 | Erythrocyte NAD and NADP | Measurement of active coenzymes of niacin |
Urinary 1-MN and 2-PYR | Measurement of niacin metabolites | |
Vitamin B5 | Urine pantothenic acid | Direct quantification of vitamin B5 |
Vitamin B6 | Plasma pyridoxal phosphate | Direct quantification of the active form of vitamin B6 in plasma |
Erythrocyte pyridoxal phosphate | Direct quantification of the active form of vitamin B6 in erythrocytes | |
Plasma PA:(PL+PLP) ratio | Measurement of vitamin B6 catabolism in plasma | |
Vitamin B7 | Urinary 3-HIA and 3-HIAc | Indirect measurement of biotin-dependent mitochondrial carboxylase activity |
Holo-PCC and holo-MCC | Quantification of vitamin B7-dependent enzymes in lymphocytes | |
Vitamin B9 | Plasma 5-methyltetrahydrofolate | Measurement of the primary active form of folate |
Plasma homocysteine | Measurement of a precursor substrate for an enzyme that requires vitamin B9 | |
Vitamin B12 | Plasma cobalamin | Direct quantification of vitamin B12 |
Plasma homocysteine | Measurement of a precursor substrate for an enzyme that requires vitamin B12 | |
Plasma MMA | Measurement of a precursor substrate for an enzyme that requires vitamin B12 | |
Urine MMA | Measurement of a precursor substrate for an enzyme that requires vitamin B12 | |
Vitamin C | Plasma ascorbic acid | Direct quantification of vitamin C |
Vitamin A | Plasma retinol | Direct quantification of one of the three forms of vitamin A |
Plasma retinol/RBP molar ratio | Measurement of proportion of a form of vitamin A and one of its circulating carrier proteins in plasma | |
Relative-dose-response of retinol | Measurement of a form of vitamin A in response to its administration | |
Changes in RBP following vitamin A administration | Measurement of one of the circulating carrier proteins of vitamin A in plasma in response to administration of vitamin A | |
Fasting plasma retinyl esters | Direct quantification for vitamin A toxicity | |
Vitamin D | Plasma 25(OH)D | Direct quantification of free vitamin D metabolite |
Plasma bioavailable 25(OH)D | Direct quantification of free plus albumin-bound vitamin D metabolite | |
Vitamin E | Plasma alpha-tocopherol | Direct quantification of the major isoform of vitamin E (consider adjusting to cholesterol or total lipids in critically ill patients) |
Vitamin K | Plasma phylloquinone | Direct quantification of the major form of vitamin K in plasma |
Coagulation function (INR and PT) | Functional assessment of vitamin K-dependent coagulation factors | |
PIVKA-II and uOC | Measurement of undercarboxylated prothrombin and osteocalcin | |
Iron | Serum iron | Direct quantification of iron levels in serum |
Ferritin | Measurement of iron storage | |
Transferrin/TIBC | Measurement of the capacity for iron transport | |
Transferrin saturation | Quantification of the percentage of iron-bound transferrin | |
ZnPP/H | Measurement of the proportion of protoporphyrin molecules associated with zinc vs. iron | |
Calcium | Serum total calcium | Direct quantification of total circulating calcium in serum |
Serum ionized calcium | Direct quantification of free circulating calcium in serum | |
Magnesium | Serum magnesium | Direct quantification of magnesium levels in serum |
Serum ionized magnesium | Direct quantification of ionized magnesium in serum | |
24-hour urinary magnesium | Measurement of magnesium levels in urine | |
Phosphorus | Serum phosphate | Direct quantification of phosphate levels in serum |
Zinc | Serum or plasma zinc | Direct quantification of zinc levels in serum or plasma |
Metallothionein | Measurement of zinc storage | |
ALP | Functional assessment of a zinc-dependent enzyme | |
Selenium | Serum selenium | Direct quantification of selenium levels in serum |
GSHpx activity | Functional assessment of the main selenium-dependent enzyme | |
Copper | Serum copper | Direct quantification of copper levels in serum |
Ceruloplasmin | Measurement of the main protein for copper transport | |
SOD activity | Functional assessment of a major copper-dependent enzyme |
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Dao, D.T.; Anez-Bustillos, L.; Cho, B.S.; Li, Z.; Puder, M.; Gura, K.M. Assessment of Micronutrient Status in Critically Ill Children: Challenges and Opportunities. Nutrients 2017, 9, 1185. https://doi.org/10.3390/nu9111185
Dao DT, Anez-Bustillos L, Cho BS, Li Z, Puder M, Gura KM. Assessment of Micronutrient Status in Critically Ill Children: Challenges and Opportunities. Nutrients. 2017; 9(11):1185. https://doi.org/10.3390/nu9111185
Chicago/Turabian StyleDao, Duy T., Lorenzo Anez-Bustillos, Bennet S. Cho, Zhilling Li, Mark Puder, and Kathleen M. Gura. 2017. "Assessment of Micronutrient Status in Critically Ill Children: Challenges and Opportunities" Nutrients 9, no. 11: 1185. https://doi.org/10.3390/nu9111185