You have reviewed EPIC for Mr. Powell and found that he was admitted to the hospital with non-alcoholic fatty liver disease. He is 65 years old, is 5’10”, and weighs 280 lbs. He has a history of Type 2 diabetes and is taking clear liquids but will be advanced to a diabetic diet when tolerated. Has a peripheral IV with normal saline running at 100 mL/hr. Mr. Powell complains of nausea, vomiting, muscle pain, weakness, and has voided 100 mL of brownish-colored urine.
Medications: Aspart insulin 8 units sq each morning Aspart insulin 6 units sq each night before bed Insulin detemir 40 units sq each night before bed Metformin 500 mg PO twice a day Terazosin 2 mg PO each night at bedtime Finasteride 5mg PO each morning Atorvastatin 20 mg PO once daily
Labs: Fasting blood glucose – 155 mg/dL Serum triglyceride – 275 mg/dL (50 - 150 mg/dL) HDL 35 mg/dL (>40 mg/dL) Glycosylated hemoglobin (A1C) – 7.3% Alanine aminotransferase (ALT) – 90 Units/L Aspartate aminotransferase (AST) – 275 Units/L Blood urea nitrogen (BUN) – 26 mL/dL (6 – 20 mL/dL) Creatinine – 1.3 mL/dL (0.6 – 1.3 mL/dL) Hemoglobin 13.4 Hematocrit 55
Questions: Mr. Powell 1. When reviewing Mr. Powell’s history, what do you think has caused the non-alcoholic fatty liver disease? Click or tap here to enter text.
2. What condition do you feel Mr. Powell has based on his history, A1C, triglyceride level, and HDL level?
3. Is Mr. Powell’s blood sugar well controlled? How do you know?
4. Why do you think his BUN and creatinine are elevated?
5. What kind of diet would be helpful for a person with non-alcoholic fatty liver disease? .
6. How is metformin helpful to a person with non-alcoholic fatty liver disease?
7. What concerns do you have when the nurse states that Mr. Powell has been experiencing muscle pain, weakness, and brownish-color urine?
1. When reviewing Mr. Powell’s history, what do you think has caused the non-alcoholic fatty liver disease?
The cause of the non-alcoholic fatty liver disease are
2. What condition do you feel Mr. Powell has based on his history, A1C, triglyceride level, and HDL level?
Insulin resistance of cells leads to increased blood glucose levels. This develops the condition of diabetes and hyperlipidemia. This results in the storage of excess triglycerides levels and leads to chronic inflammation of the liver.
3. Is Mr. Powell’s blood sugar well controlled? How do you know?
No. Mr.Powell fasting blood sugar level and HbA1C indicates that his blood sugar level is not under controlled. This is due to the resistance of cells to the insulin which increases the blood glucose level.
4. Why do you think his BUN and creatinine are elevated?
Elevated BUN level indicates that the more amount of urea is produced by the liver and kidney was unable to excrete the excess urea. The failure in the function of the kidney is due to the activation of the renin-angiotensin-aldosterone syndrome.
5. What kind of diet would be helpful for a person with non-alcoholic fatty liver disease?
Bland diet, Mediterranean diet such as healthy fat, antioxidants helps to reduce the fat in the liver. Include of monosaturated fat, Omega-3 fatty acids improve insulin activity.
6. How is metformin helpful to a person with non-alcoholic fatty liver disease?
Metformin will decrease the blood glucose level by inhibiting the progress of gluconeogenesis in the liver. It also stimulates the glucose uptake by the muscle cells and increase of oxidation of fatty liver in adipose tissues.
7. What concerns do you have when the nurse states that Mr. Powell has been experiencing muscle pain, weakness, and brownish-color urine?
Mr.Powell symptoms of muscle pain, weakness, and brownish color urine indicate the patient is suffered from Viral Hepatitis. The patient has developed to the stage of Non-alcoholic steatohepatitis which leads to cirrhosis of the liver.
You have reviewed EPIC for Mr. Powell and found that he was admitted to the hospital...
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