Jeremy Bartel

April 7, 2014
Medical Nutrition Therapy I
Case tudy !"# Crohn$s %isease
&lease 'rin( your )nal typed copy o* this case study to class on the due date+ ,e
-ill (o o.er the case study in class+ /ou may -rite notes 0corrections, etc1 in class,
and then turn in the case study *or *ull credit+ 2emem'er also to su'mit a copy
online+
Mr+ M, a 34 year old commercial artist, -as admitted to the hospital *or
-ea5ness+ 6e is 3$47 and -ei(hs 1"0l' on admission+ 6e reports a -ei(ht loss o*
a'out "0 l' since his most recent small 'o-el resection *or Crohn$s disease+ 6e
reports that he can only eat small amounts o* *ood at a time+ 6e is tired and
lethar(ic+ The 8astrointestinal doctor dia(noses the patient -ith short (ut
syndrome9 he has : *eet o* small intestine le*t a*ter his most recent 0"
rd
1 'o-el
resection+ The medical team is recommendin( that the patient ha.e a central line
placed in order to recei.e lon( term T&N+
6is current la's are as *ollo-s9
8lucose9 1"0 m(;dl really hi(h
Al'umin9 "+0 m(;dl sli(htly lo-
6emo(lo'in9 11 m(;dl lo-
6ematocrit9 "7< 42#32 lo-
&AB9 10 m(;dl 1=+3#"3+4 m(;d> norm
1+ Calculate the *ollo-in(9
IB, ?Male9 IB, 05(1 ? hei(ht 0cm1 @ 100 @ ABhei(ht 0cm1 @ 130C;4D ?
172+72 cm # 100 # AB172+72 # 130C;4D ? 172+72 cm # 100 # 3+:4 ? :7+04 5(
<IB, ? 3= 5( ; :7+04 5( E 100 ? 44<
<FB, ? 3= 5( ; 72+37 5( E 100 ? 41+"<
BMI ? 5( ; m
2
? 3= 5( ; 1+7"
2
? 3= ; 2+== ? 1=+7
2+ ,hat are Mr+ M$s 5cal, protein and Guid needsH 0Fse 'oth MiIin t Joer or
6arris Benedict JKuation and 5cal;5( IB, *or these calculations+1
Males9 5cal;day ? 100-t1 L :+230ht1 # 3 0a(e1 L 3 ?
100:7+04 5(1 L :+230172+721 # 30341 L 3 ?
:70+4 L 107=+3 # 2=0 L 3 ? 14:3 5cal;day
23#"0 5cal;5( ? 23 E :7+04 5( ? 1:7: 5cal, "0 E :7+04 ? 2011 5cal
&rotein ? +4#1 (;5( ? +4 E :7+04 ? 3"+: ( 1 E :7+04 ? :7+04 (
Mluid ? 23 ml;5( ? :7+04 5( E 23 ml;5( ? 1:7: ml
"+ Based on his history and la'oratory .alues, -hat do you conclude re(ardin(
his nutritional status;ris5H
Mr+ M$s serum (lucose is really hi(h, so he may ha.e a pro'lem -ith insulin
resistance+ 6is al'umin is sli(htly lo- and his preal'umin is .ery lo-, so he
may ha.e protein ener(y malnutrition+ 6is hemo(lo'in and hematocrit le.els are
lo-, so he many ha.e anemia+ 6is serum le.els indicate that he$s not (ettin(
-hat he needs *rom his diet+
4+ Consider the possi'ilities that he mi(ht eEperience nausea, .omitin(, -ei(ht
loss, mala'sorption, anemia, and 'one disease+ ,hy mi(ht each o* these
occurH
Mr+ M is missin( more then hal* o* his small intestine+ 6e can$t
possi'ly eat small enou(h meals to let his small intestine ta5e up the
contents o* his stomach+ The nausea and .omitin( -ould indicate that
his di(esti.e system is Nust *ull+ 6e Nust can$t )t a normal amount o*
*ood in his di(esti.e system+ 6e -ould eEperience -ei(ht loss 'ecause
he can$t eat the normal amount o* *ood+ 6e -ould eEperience
mala'sorption 'ecause he doesn$t ha.e most o* the a'sor'in( area
-ithin his di(esti.e system+ 6e could 'e anemic 'ecause he can$t
a'sor' iron+ Bone disease -ould de.elop 'ecause he can$t a'sor'
.itamins and minerals li5e calcium and .itamin %+
3+ Are there any other .itamin or mineral issues that the 2% should considerH
Any .itamin or mineral that -ould 'e a'sor'ed across the small
intestine -ould 'e a possi'le pro'lem+ 6e -ould ha.e pro'lems -ith
.itamin %, .itamin B12, and calcium, especially+
:+ ,hy is the medical team recommendin( T&N and not TMH %o you a(ree -ith
this course o* actionH ,hy or -hy notH
Mr+ M$s (ut is not -or5in( to (et him -hat he needs to sur.i.e+ 6e de)nitely
needs a T&N+ 6e could eat small amounts o* *ood to 5eep his (ut -or5in(,
'ut he pro'a'ly -ill ne.er 'e a'le to a'sor' -hat he needs *rom *ood+
7+ %o you anticipate that Mr+ M -ill e.er 'e a'le to meet his needs 'y oral
inta5eH
Mr+ M$s small intestine may reco.er some o* its a'sorpti.e properties, 'ut I
see Mr+ M needin( a T&N *or the rest o* his li*e+
4+ Assume he (ets 23< o* his calorie and protein needs *rom *ood eaten durin(
the day+ 2ecommend nutrition support to meet the remainder o* his protein,
calorie and Guid needs that -ill not inter*ere -ith his appetite durin( the day+
Mr+ M needs a'out 1,700 5cal per day+ 1,700 E +73 ? 1,273 5cal -ould need
to come *rom the T&N+
Mr+ M needs :7 ( o* protein per day+ :7 E +73 ? 30 ( o* protein -ould need to
come *rom the T&N+
Mluid needs ? 1,:7: ml E +73 ? 1,237 ml
1,237 ml Guids
<AA ?30 (&; 1,237 ml E 100 ? "+=4< AA
30 (& E 4 5cal;(ram ? 200 5cal&
200 ml 020< *at1 ? 400 5cal *at
1,237 # 200 # 400 ? :37 5cal deE
:37 5cal deE 0( deE;"+4 5cal1 ? 1=" ( %eE
1=" ( %eE;1,237 ml E 100 ? 13+4< %eE
01=" ( %eE;%ay101000(;:7+04 5(10%ay;1440 min1 ? 1=" E 14+= ; 1440 ?
2 ( %eE;5(;min
1,237;24 ? 32 ml;hr
32 m>;hr E 24 hrs to pro.ide 1,237 m> "+=4< AA, %13+4,, 200 m> 20< *at+
=+ ,rite a &J statement appropriate *or this patient+
InadeKuate ener(y inta5e related to short (ut syndrome as e.idenced
'y lo- serum pre#al'umin, al'umin, hemo(lo'in and hematocrit le.els+