Question

A 29 year old white male on active duty in the US Marines is admitted to the emergency room with nausea, fatigue, confusion, hypothermia, and bradycardia. Two weeks prior to admission, he began feeling weaker and trailed behind other trainees during boot camp sessions. He recently spent three months in intense training as a newly recruited US marine. Three months prior to recruit training, he began a weight loss regimen in an effort to achieve his desired goal weight based on US Marine standards and lost 20 lbs. Patient went on a calorically-restrictive low carbohydrate and high protein diet of 1700 kcal/day while undergoing a progressive increase in exercise load in a hot and humid climate. Three months later, his training with the Marines was more physically demanding than his pre-marine training. As a result, patient lost an additional 33 lbs. He was administered IV fluids of normal saline on day I. Due to his nutritionally depleted status and weight changes, the physician promptly ordered a non-restricted 2000-calorie diet. Patient complied with the orders and began experiencing cardiac, mental status, fluid, and electrolyte complications by Days 2 to 4 of hospital stay. Evaluate all parameters as you respond to each question below. Height: 6'1" HR: 40 bpm Admission weight: 163 lb. UBW: 255.4 lb. BP: 130/110 Temperature: 30 degrees C Table L Laboratory Results Day 1 135 4.6 Day 2 144 3.9 110 27 Day 4 143 3.2 26 | 26 Biochemistry Sodium Potassium Chloride Bicarbonate Glucose Magnesium Calcium Phosphorus Total Protein Albumin Creatinine BUN Hemoglobin Hematocrit Mean Corpuscular Volume 1.6 32 40 90 46% 90 What is this patient's BMI and interpretation? Calculate his IBW and %UBW. What was his % weight change interpretation over the first three months? What was his % weight change and interpretation over the last six months? What trends can you note in his laboratory indicators over the last four days? Is his albumin level a good indicator of his present nutritional status in this situation? Why or why not? Considering his history and current medical situation, what risk factors for refeeding syndrome has this patient been presenting? Construct at least two PES statements that would be appropriate for this case (Nutrition Diagnosis), What feeding adjustments should the RD make to aid in restoring his nutritional status and electrolyte balance and which members of the healthcare team does he or she need to consult with and communicate recommendations to intervention)? Based on the scoring system of the mini nutritional assessment, how would you define this patient's level of nutrition risk? What measurable indicators will you continue to monitor patient progress with and how frequent should you follow up until this patient has achieved stability (Monitoring and Evaluation)?

Answer 1

17 Height of the pt 6' 1" x 1.85m weight of the p Initial weight (1634 63 +20 - 216 lus) Praesent weight - 163 lbs 2 73.3kg Doree months prior weight & 196 lbs Free months later weight & 163 lbs 261 124) Wesk 36 29 Tuesday BHI - Weight (kg) Height ² cm) 73.3 - 21.5 1.85x1.85 Interpretation - Normal BMI

2017 2) IBW 2 50+ 2.3kg for each ench were 5feet - 50+(2.3x1) x 50+ a.s 2 52.3kg 4. uew - Ceverent body weight luen σο 2 73.3 x 100 114.9 (use - 255.4 lbs given) 2 63.7% Thursday

3 7. heeight change interpretation over the first 3 months Initial weight = 216 lbs weight loss a 20 lbs New weight 2 196 lbs. % meight change : - 2020 X 100 - 90.77 9% weight change interepre - Saturday 0 itation over the last 6 months 1200 Intitial weight - 216 lbs. after 6 months 2 163 lbs. ge a / weight change a 163 4100 sundon 75.4% 163 8100 216 Sunday