Principles and Practices of Enteral and Parenteral Nutrition CD is a 28-year-old administrative hospital worker
Principles and Practices of Enteral and Parenteral Nutrition CD is a 28-year-old administrative hospital worker who presented to the emergency room complaining of headaches and shortness of breath. She was admitted to the hospital for evaluation
when she was found to have a blood pressure of 170/110 mm Hg and mild congestive heart failure
(CHF) by chest X-ray. CD reports that over the past year, her weight has increased about 10 pounds
(4.5 kg), although her dietary intake has remained unchanged or even lower due to desire for weight
loss.
Past Medical History
CD has had no recent viral illness, sore throat, or upper respiratory infections but did report frequent sore throats treated with antibiotics as a child. She has never had rheumatologic symptoms,
and has no knowledge of a family history of renal disease. She is currently not taking any medications, vitamins, minerals, or herbal supplements and has no known drug or food allergies.
Social History
CD has her own apartment and lives alone. She occasionally drinks alcohol but denies tobacco and intravenous or oral drug use.
CD’s 24-Hour Dietary Recall
Breakfast (home)
Tea 8 ounces (240 mL)
Orange juice 8 ounces
Non-dairy creamer 2 Tbsp.
Bagel Frozen, store bought, eating
½
Cream cheese 1 Tbsp. on whole bagel,
eating ½
Skim milk 8 ounces
Lunch (grocery store)
Salad with scoop of tuna or
chicken salad 1 cup, eating ⅓
Iced tea (unsweetend) 16 ounces (480 mL)
Orange or grapes 1 medium orang
Dinner (home)
Chicken breast, broiled 3.5 ounces (eating maybe
almost ¾)
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Principles and Practices of Enteral and Parenteral Nutrition
Broccoli, spinach 1/2 cup each
Margarine 1 tsp total for 2 vegetables
Salt 1 tsp total for vegetables
and chicken consumed
Diet cola soda 16 ounces (480 mL)
Snack (movies)
Salted nuts 2 small 1 ounce bags
Diet cola soda 16 ounces (480 mL)
Total calories: 1122 kcal
Protein: 68 g
Fat: 72 g
Carbohydrate: 118 g
Potassium: 2974 mg
Sodium: 1650 mg
Calcium: 819 mg
Phosphorus: 1095 mg
Review of Systems
General: Fatigue, weakness, shortness of breath
GI: Anorexia
Physical Examination
Vital Signs
Temperature: 97 °F (36 °C)
Heart rate: 96 BPM
Respiration: 24 BPM
Blood pressure: 170/110 mm Hg
Height: 5′4″ (162 cm)
Current weight: 130 lb (59 kg)
Usual weight: 120 lb (54.5 kg) 6 months ago (Use for estimated “dry” weight)
Exam
General: Well-developed female
Lungs: Decreased breath sounds with faint crackles at the right base Cardiac: Regular rate and rhythm, systolic murmur at the apex, S3 gallop Abdomen: Soft, non-tender, no hepatomegaly
Extremities: 2+ peripheral edema on both legs, ring tight on finger Skin: Warm to touch
Neurologic: Intact, mild asterixis
Initial Laboratory Data
Patient’s Values Normal Values
Sodium: 132 mEq/L 133-143 mEq/L
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Principles and Practices of Enteral and Parenteral Nutrition Case Analysis 2
Potassium: 6.4 mEq/L 3.5-5.3 mEq/L
Chloride: 111 mEq/L 98-108 mEq/L
CO2: 15 mEq/L 24-32 mEq/L
Calcium: 7.5 mg/dL 9-11 mg/dL
Adjusted calcium: 8.1 mg/dL 9-11 mg/dL
Phosphorus: 7.2 mg/dL 2.5-4.6 mg/dL
BUN: 90 mg/dL 7-18 mg/dL
Creatinine: 8.0 mg/dL 0.6-1.2 mg/dL
Albumin: 3.2 g/dL 3.5-5.8 g/dL
