LESSON 9 NDMU | College of Arts and Sciences | Nursing

Notre Dame of Marbel University

College of Arts and Sciences
Nursing Department

LESSON 9

WATER & MINERALS

LESSON 9 NDMU | College of Arts and Sciences | Nursing

LESSON 9: WATER AND MINERALS

Introduction
Water is an essential nutrient, more important to life than any of the others. The
body needs more water each day than any other nutrient. Furthermore, you can
survive only a few days without water, whereas a deficiency of the other nutrients
may take weeks, months, or even years to develop.
This course packet begins with a look at minerals, the aid of our body in maintaining ap-
propriate balance and distribution of bodily fluids. In addition to introducing the minerals
that help regulate body fluids, this course packet describes many of the other important
functions minerals perform in the body.

Intended Learning Outcomes

At the end of this course packet, the student-nurses can:
1) Explain the classifications of micronutrients - fat soluble vitamins
2) Recognize the roles of these micronutrients in the diet

Kickstart!
Activity: Use the nutritional tool 24 hour recall. Instead of recalling food intake, try to
recall the number of times you drank water for the last 24 hours. Do you think you have
met the required amount of daily water intake? Why or why not? Answer in a paragraph
form of not more than 7 sentences.
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LESSON 9 NDMU | College of Arts and Sciences | Nursing

MINERALS
•Pertain to the elements in their simple inorganic form.
•They are commonly referred to as mineral elements or trace minerals if required in
small amounts

MAJOR MINERALS

SODIUM
ROLES
•Involved in fluid balance via antidiuretic hormone and aldosterone secretion
•Nerve transmission and neurological function (THINK BRAIN!)
•Maintain acid base balance in conjunction with chloride
•MAJOR CATION OF ECF
DIETARY SOURCES
RECOMMENDATIONS •Processed or prepared foods
•RDA 500 mg/day for adults •Preservative or flavoring agent in
•Clients be instructed not to routinely add salt to foods food products
during cooking process •Hidden sources (Medications)

DEFICIENCY
•Symptoms: nausea, vomiting, diar-
rhea, muscle cramps, and mental status
changes (confusion and disorientation)

EXCESS
•Hypernatremia
•Contributes to the development of
edema and hypertension and lead to
neurological signs
LESSON 9 NDMU | College of Arts and Sciences | Nursing

CHLORIDE
ROLES RECOMMENDATIONS
•Fluid balance; major anion of the ECF •750 mg/day
•Acid base balance and moves across the cell membrane to •Often linked with sodium
interact with potassium in foods
•Maintain gastric acidity (HCL)

DEFICIENCY STATE EXCESS

•Infants with condition of failure to thrive •Vomiting
•Losses occur through GI tract and result in dehydration and •Not usually seen unless there is
acid base imbalance an underlying disease state

POTASSIUM
ROLES
•Important in nerve transmission and muscle
contraction
•Maintain acid base balance by transcellular
shifting in response to acid base changes in
the body
•Cardiac muscle (THINK HEART!)
•MAJOR CATION OF THE ICF

DIETARY SOURCES
•Cooked dried beans, potatoes, banana,
orange
•Fresh fruits, less in processed foods
•Large amounts of licorice in the diet
can lead to hypokalemia and sodium
water retention EXCESS
•Do not usually arise from deitary ingestion unless
DEFICIENCY clients use salt subtitutes or k+ supplements
•Seen coexisting with deficiencies of oth- •Certain medications can lead to retained levels of
er electrolytes (magnesium and calcium) potassium in the body such as ace inhibitors, ster-
•Do not usually rise from dietary factors oids, and potassium sparing diuretics
•Seen usually from the use of certain med-
ications that promote K+ excretion RECOMMENDATIONS
•Can potentiate drug actions as in the case 2000 MG/DAY FOR ADULTS
of digitalis toxicity
LESSON 9 NDMU | College of Arts and Sciences | Nursing

CALCIUM
ROLES
DIETARY SOURCES
•Constituent part of bones and teeth
•Sardines, milk, dairy
•Nerve conduction (neurotransmitter) and mus-
•Phytates – decreases calcium absorption (nuts,
cle contraction (actin/myosin)
seeds, grains)
•Coagulation pathway
•Oxalates – decreases calcium absorption (spinach,
•Active and inactive forms exist in the body beets, chocolate)
(ionized and nonionized)
•High fiber – decreases Ca+ absorption
•Phosphorus – inverse relationship
•Pth – increases serum ca+
•Calcitonin – decreases s. Ca+ RECOMMENDATIONS
•AI = 1000 mg/day for adults
DEFICIENCY (19-50 yo)
•Clinical signs: Chvostek 1500 mg/day for adults 51
(facial nerve grimace) and years and over
Trousseau (carpopedal
spasm) EXCESS
•Associated deficiencies •Metastatic process or kidney
seen with potassium and stone formation
magnesium •Constipation
•Development of tetany •Milk-alkali syndrome - alkalo-
•Osteoporosis tic condition due to increased
•Bone demineralization, re- amounts of milk or antacid
laxed nerve and muscle co- •Hypercalcemic crisis
ordination

PHOSPHOROUS
ROLES DIETARY SOURCES
•Structural component of bones, teeth and Dairy and meat products
phospholipids throughout the body Processed foods
•Synthesis of dna and rna, coenzyme in many
chemical reactions RECOMMENDATIONS
•Buffer system as a phosphate (major anion in Rda for adults (male and female) is 700 mg/day
ICF) Upper levels is listed as 4,000 mg/day for adults
•Inverse relationship with calcium in the body 19-70 years of age
EXCESS
DEFICIENCY STATES
Excess levels are associated with low serum calcium
Bone loss and muscle weakness
levels = tetany
High levels of calcium accompany low levels
Clients with compromised renal status = elevated
of phosphorus
phosphorus levels
LESSON 9 NDMU | College of Arts and Sciences | Nursing

MAGNESIUM
ROLES
•Bones in the body
•Nature’s calcium channel blocker – decreases blood pressure and smooth muscle contraction
•Coenzyme in energy metabolism and a neurotransmitter
•Regulates blood pressure and blood clotting by balancing these effects
DIETARY SOURCES RECOMMENDATIONS
•Sunflower seeds, legumes, dark green leafy Rda for adult males= 400-420 mg/day
vegetables Females = 310-320 mg/day
•Chocolate cocoa, nuts, and seafood
EXCESS
•Excess is often related to underlying conditions
(renal failure, dehydration states, diarrhea, alkalo-
tic imbalances
•Use of medications with magnesium such as laxa-
tive and antacids

DEFICIENCY
•Malabsorption problems and suffer chronic
alcohol abuse
•Increased magnesium excretion (chronic use
of laxatives)
•Manifestations: muscle weakness, mental
status changes, tetany like symptoms, mental
status changes

SULFUR
ROLES
•Sulfur maintains protein structure because of the disulfide linkages between parallel peptide chains
•Activates enzymes
•Participates in detoxification reactions by which toxic materials conjugate with active sulfate and con-
vert them to non-toxic forms which are excreted in the urine

DIETARY SOURCES RECOMMENDATIONS

•Protein contains about 1% sulfur so that a •DRI not established
diet adequate in protein will contain enough
sulfur DEFICIENCY
•Deficiencies do not occur
EXCESS
•Deficiencies do not occur
LESSON 9 NDMU | College of Arts and Sciences | Nursing

TRACE MINERALS

IRON
ROLES
•Component of RBCs in hemoglobin formation and as a component of muscles in the form of myoglobin
•Stored and transported in the body through a series of blood carrying proteins
•Heme is the iron-holding part of the hemoglobin molecule and is usually found in animal sources
•Non-heme sources of iron are usually found in plant sources, not considered good sources (difference in
absorption)

DIETARY SOURCES RECOMMENDATIONS

•Meat, poultry, fish RDAfor adult male = 8 mg/day
•Vitamin c promotes iron absorption RDA for adult female – 18 mg/day 19-50 yo, and
•Non-heme sources of iron not absorbed well 8 mg/day for 51 and over
•Certain sugars and wine also help in enhancing ab- Growth states require increased iron levels
sorption of non heme iron sources
EXCESS
DEFICIENCY Iron overload symptoms include tissue damage,
•NUTRITIONAL ANEMIA – IRON DEFICIEN- infections, liver damage
CY ANEMIA – fatigue, weakness, headache, pallor Hemochromatosis
•Pica Pediatric clients – at risk

•Females due to menstrual flow, pregnant females

due to dilutional anemia in pregnancy

IODINE
ROLES DIETARY SOURCES
•Important component of thyroid hormone (t3, t4 and TSH) •Saltwater fish and shellfish
•Growth and development, reproduction and balance of •Iodized salt (fortified)
metabolic rate and temperature •Broccoli, brussel sprouts and cabbage =
DEFICIENCY thyroid antagonist, interfered with the
body’s absorption of iodine
•Goiter formation
•Hypothyroid clinical states exist due to insufficient hor- RECOMMENDATIONS
mones, this can lead to cretinism (congenital condition due
to maternal deficiency) and myxedema (deficiency seen in •RDA 150ug MALE AND FEMALE
children and adults due to decreased thyroid activity)
LESSON 9 NDMU | College of Arts and Sciences | Nursing
DEFICIENCY EXCESS
•Manifestations: slowing down of metabolism, weight gain, •Accidental exposures to excess iodine levels
temperature intolerance (cold), hypotension, bradycardia during pregnancy can lead to teratogenic effects
and constipation •Manifestations: opposite of deficiency

ZINC
ROLES DIETARY SOURCES
•Zinc occurs in varying concentrations in all hu- •Milk, nuts, legumes
man cells •Meat, liver, oyster, eggs
•Involved in wide range of cellular functions a an •Whole grain cereals
integral part of several metalloenzymes •Wheat
•Regulator of certain enzymes in the body RECOMMENDATIONS
•Present in RNA
•RNI for Males: 6.4 mg/day
DEFICIENCY EXCESS •RNI for Females: 4.5 mg/day
•Slow growth •Nausea, vomiting, cramps
•Alopecia •Diarrhea, fever
•White cell defects
•Delayed sexual
maturation

COPPER
ROLES
•Essential in formation of hemoglobin
•Promotes absorption of iron from GI tract
•Maintains integrity of myelin sheath
•Part of tyrosinase involved in formation of mela-
nin pigment of hair and skin

DEFICIENCY
•Depigmentation of hair and skin
•CNS abnormality
•Chronic microcytic anemia

EXCESS DIETARY
•Wilson’s disease— SOURCES
excessive accumulation of •Organ meats,
copper shellfish
•leafy vegetables,
eggs, beans
LESSON 9 NDMU | College of Arts and Sciences | Nursing

MANGANESE
ROLES DIETARY SOURCES
•Activator of a number of metabolic reactions •Nuts, whole grain cereals, dried legumes
•Catalyst of a number of enzymes for fat and glu- •fruits, leafy vegetables
cose metabolism
RECOMMENDATIONS
•Increases storage of thiamin
•DRI not established
DEFICIENCY
EXCESS
•Deficiencies not established
•Deficiencies not established

WATER
Water constitutes about 60 percent of an adult’s body weight and a higher percentage
of a child’s. Because water makes up about three-fourths of the weight of lean tissue and less
than one-fourth of the weight of fat, a person’s body composition influences how much of the
body’s weight is water. The proportion of water is generally smaller in females, obese people,
and the elderly because of their smaller proportion of lean tis-

PURPOSE
•Aids in maintaining the body’s blood pressure and temper-
ature
•Maintains blood volume
•Acts as a lubricant and cushion around joints and inside the
eyes, the spinal cord, and, in pregnancy, the amniotic sac
surrounding the fetus in the womb
•Aids in the regulation of normal body temperature, as the
evaporation of sweat from the skin removes excess heat
from the body
•Carries nutrients and waste products throughout the body
• Maintains the structure of large molecules such as proteins
and glycogen
• Participates in metabolic reactions
• Serves as the solvent for minerals, vitamins, amino acids,
glucose, and many
other small molecules so that they can participate in meta-
bolic activities
Fluid inside cells is called intracellular fluid, whereas
fluid outside cells is called extracellular fluid. The extra-
cellular fluid that surrounds each cell is called interstitial
fluid.
LESSON 9 NDMU | College of Arts and Sciences | Nursing

WATER IMBALANCES
•Dehydration: the condition in which body water output exceeds water input. Symptoms include thirst,
dry skin and mucous membranes, rapid heartbeat, low blood pressure, and weakness.

•Water Intoxication: the rare condition in which body water contents are too high in all body fluid
compartments.

WATER SOURCES
• The obvious dietary sources of water are water itself and other beverages, but nearly all foods also
contain water. Most fruits and vegetables contain up to 90 percent water, and many meats and cheeses
contain at least 50 percent.

WATER LOSSES
• The body must excrete a minimum of about 500 milliliters (about 2 cups) of water each day as urine—
enough to carry away the waste products generated by a day’s metabolic activities.

WATER RECOMMENDATIONS
• Because water needs vary depending on diet, activity, environmental temperature, and humidity, a gen-
eral water requirement is difficult to establish. Recommendations are sometimes expressed in proportion
LESSON 9 NDMU | College of Arts and Sciences | Nursing

THINK!
Activity: Create a one day—meal plan specifically targeted for a patient with known
hypertension. Take into consideration the minerals, and water intake that may affect
his condition.

References
Cruz-Caudal, M. L. (2019). Basic Nutrition and Diet Therapy. Quezon City: C&E Publishing.
Grodner, M. (2012). Foundations and Clinical Applications of Nutrition: A Nursing Approach. Sin-
gapore: Elsevier.
Wilson, T., & Bray, G. (2015). Nutrition Guide for Physicians. New York: Humana Press.