HEPATITIS C CASE STUDY

Shaza Lauren

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

BRUISING RELATED TO VITAMIN K DEFICIENCY

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.

Any question ??!

Thank you