Download - Hepatitis C Case Study
PATIENT DATA Age: 26 Sex: Female Ethnicity: European American Height: 5’8’’ Weight: 125 lbs Diagnosed with Hepatitis C, 3 years
ago Complaints: fatigue, anorexia, pale
skin and weakness.
ASSESSMENT Food and nutrition related history:
Had no appetite for the past few weeks Only juice, water, diet coke in the past 2 days About 1200 cal intake per day Lost 10# in 6 months Doesn’t like liver or lima beans 200 mg of milk thistle twice daily 3 grams chicory 500 mg ginger at least twice daily Daily multivitamin/mineral supplements Treated with Alpha-interferon and ribavirin
ASSESSMENT Anthropometric measurements:
Height = 5’8’’ Weight = 125 lb Usual body weight = 135 lb BMI = 19 which is normal IBW% = 87.6% UBW% = 92.6%
BIOCHEMICAL DATAChemistry Ref Range
BUN 8-18 21 ↑Creatinine serum 0.6-1.2 1.4 ↑
Glucose 70.110 115 ↑Bilirubin <0.3 3.7 ↑
Total Protein 6-8 5.4 ↓Alkaline Phosphatase 30-120 275 ↑
ALT 4-36 62 ↑AST 0-35 230 ↑HDL >55 50 ↓
Triglycerides 35-135 256 ↑PT 12.4-14.4 18.5 ↑
BIOCHEMICAL DATA
Chemistry Ref RangeRBC 4.2-5.4 4.1 ↓
Hemoglobin 12-15 10.9 ↓Hematocrit 37-47 35.9 ↓
Urinalysis Protein Neg 1+ ↑
LAB DATA INTERPRETATION High BUN: indicates kidney disease or
dehydration High Creatinine: indicates kidney disease or
dehydration as well Slightly high glucose: pre-diabetes High Bilirubin: confirms that the liver is the
cause of jaundice Low total protein: caused from the liver
disease, malnutrition and protein-loss enteropathy
High Alkaline Phosphatase: suggests cholestasis
High ALT and AST: increase with liver damage
LAB DATA INTERPRETATION High triglycerides: because of the decreased
bile salts. And in Cirrhosis, the body prefers lipids for energy in the fasting state
High PT: indicates vitamin K deficiency and decreased synthesis of clotting factors
Low RBC, hemoglobin, and hematocrit: anemia
Protein in urine: a sign of kidney disease Stool is light brown: Fat malabsorption
NUTRITION FOCUS PHYSICAL FINDINGS
Dry skin and mucus because of the dehydration
Bruises because of the liver disease and vitamin K deficiency
Weight loss due to loss of appetite Enlarged esophageal veins; hypertension Pale skin is a sign of anemia
CLIENT HISTORY The patient was in a good health until 3 years
ago when she was diagnosed with Hepatitis C. Mother(living) – HTN, diverticulitis,
cholecystitis, carpal tunnel syndrome. Father(deceased) – diabetes mellitus, peptic
ulcer disease. Maternal grandmother – cholecystitis, bilateral
breast cancer. Maternal grandfather – leukemia Parental grandfather – cirrhosis Parental grandmother – amyotrophic lateral
sclerosis
CLIENT HISTORY The previous nutrition therapy was 3 years
ago: small, frequent meals, plenty of liquids. Previously treated with alpha-interferon and
ribavirin. Seasonal allergies treated with
antihistamines. Live with a roommate who is a law student.
SUBJECTIVE GLOBAL ASSESSMENT PARAMETERS
HistoryWeight changes Appetite Taste changesDietary intakePersistent gastrointestinal problems Physical findings Muscle wastingFat storesEdema
SUBJECTIVE GLOBAL ASSESSMENT PARAMETERS
Existing conditionsOther problems that could influence nutrition
status Nutrition rating based on results Well nourishedModerately malnourishedSeverely malnourished
NUTRITION DIAGNOSIS Medical diagnosis: chronic Hepatitis C and
recreantly, Cirrhosis. Pre-diabetes, weight loss, bruising, Vitamin K
deficiency, and anorexia resulted from the disease
Iron deficiency Anemia
Inadequate intake related to decreased appetite as evidenced by and intake of 57% of the estimated energy requirements
INTERVENTION 24 hour recall
Sips of water, juice, and diet coke
Usual intake
Breakfast: Calcium fortified orange juiceLunch: soup and crackers with diet cokeDinner: carry-out Chinese or Italian food
INTERVENTION The goal is gradually increasing the caloric
intake on a two weeks period till the EER is met. And to improve the anemia, vitamin K deficiency, and the hyperglycemia.
Protein: 1.3 g/kg/day = 15%Fat: 40%Carbohydrates: 45%Water: at least 10 glasses per dayIron supplementation 200 mg milk thistle twice dailychicory 3 grams daily500 mg ginger twice daily
THE CORRECTIVE SAMPLE MENU
BreakfastWhole milk 1 cupoatmeal 1 packageBanana 1
Whole wheat toast 1 slicePeanut butter 1 tbsp
SnackNon-fat Greek yogurt
THE CORRECTIVE SAMPLE MENU Lunch
Vegetables salad 1,5 cupOlive oil 1 tbsp
Tilapia fillet 1 filletSauteed spinach 1 cupBrown rice 0.5 cup
SnackApple 1Chopped cucumbers 1 cup
THE CORRECTIVE SAMPLE MENU Dinner
Homemade vegetable soup 1 bowl
Grilled chicken breast 1 sliceCannola oil 1 tbspShredded Parmesan cheese 2 tbspBoiled Asparagus 1 cup
SnackOrange juice 1 cup
COMPARISON
Carbohydrates 43%Protein 17%Fat 40%
Carbohy-drates 57%Protein 16% Fat 27%
Corrective Menu 2100 cal Usual intake 900 cal
NUTRITION EDUCATION
Healthy food choices Macro and micro nutrients Nutritional impact on anemia The good fat sources Carbohydrate control for hypoglycemia Vitamin and mineral supplements importance Oral liquid and rehydration
NUTRITION COUNSELING Always eat breakfast Eat small, frequent meals Healthy snacks choices Use spices to increase the appetite Exercise Keep a food diary Avoid eating alone
MONITORING AND EVALUATION Weight Blood glucose Biochemical data Anemia Hydration Skin bruising Food diary
POSSIBLE MONITORING
Adjunctive nutrition support should be given to malnourished patients if their intake is less than DRI levels of 0.8g of protein and 30 cal/kg per day.
Esophageal varices are not a contraindication for tube feeding.
Medium chain fatty acids and whole protein formulas are encouraged
May contribute to 50% of the daily nutrient intake.
Intravenous vitamin K for 3 days to rule out the deficiency.