Question

Essay:

ZM is a 50-year-old Caucasian man with a history of renal cancer (currently in remission), diverticulosis, hyperlipidemia, sleep apnea and pancytopenia. His past surgical history includes right partial nephrectomy and clavicle repair. He recently tested positive for HIV during a hospital admission for persistent fever, diarrhea and abdominal pain. He was also diagnosed with an opportunistic infection; mycobacterium avium complex (MAC) and later Karposi’s sarcoma. He is alert and oriented and appears appropriate weight for height, although he does appear to have some facial wasting with lesions on his face. He is complaining of diarrhea and poor energy level, which has been going on for the past several months. He is currently on disability. He has a history of alcohol, and drug abuse as well as tobacco use. He eats two meals per day which is prepared by his wife. He skips lunch due to fatigue.

24 Hour Recall:

Breakfast          Breakfast-type sandwich from a donut shop

                        Small coffee with cream and sugar

Snack               1 Apple

                        2 mini Snickers bars

                        16 oz water

Dinner              5 oz baked chicken

                        1 cup white rice

                        1 cup broccoli

                        1 tbsp butter

Ht:  70”             Wt:  184#                     UBW: 254# (70# wt loss x one year)

Labs:    WBC 2900 (L)                Na 141                         K+ 4.5                           Chloride 107 (H)

            BUN 19                         Creat 0.8                      Glu 94                          Alb 2.5 (L)

            Chol 151                       LDL 78                          HDL 37 (L)                     TG 151 (H)

Meds: Fosamprenavir, Rionavir, Truvada, Simvastatin, Pravastatin, Bupropion, Ranitidine, Co-Rimoxazole, Clarithromycin, Azithromycin

Supplements: Vitamin B₁₂, 1000 mg

1. Define AIDS-wasting syndrome. Does this patient meet the definition for wasting? Why or why not? (5 points)
2. Calculate his calorie and protein needs. What factors would affect this patient’s estimated nutritional needs? (4 points)
3. Commend on the adequacy of this patient’s current diet. Is he meeting his estimated needs? What factors are affecting his food intake? (5 points)
4. What micronutrients is this patient at risk for becoming deficient in secondary to his disease state? Would you recommend a vitamin and/or mineral supplement? (5 points)
5. The patient tells you that he has been thinking about starting garlic supplements because he has heard that garlic has many health benefits, and with his history of hyperlipidemia, he thought the garlic might help. What do you tell him about herbal supplements in general, and specifically about garlic? (5 points)

Answer 1

1.AIDS wasting syndrome -The involuntry weight loss of 10% baseline bodyweight plus either chronic diarrhea (two loose stools per day for more than 30 days.) or chronic weakness and documented fever ( for 30 days or more intermittent or constant.) in the absence of a concurrent ilness or condition other than HIV infection that would explain the findings.This patient is having chronic diarrhea and fever like this definition.

2-When we have HIV infection we burn calories fast.This could be because of our imuune system is working hard or it may because HIV has affected the hormones that control our metabolism.Whatever the reason the patient wants to take more calories to keeop up the body weight.This can be a challenge because HIV can reduce the appetite.Other things that may make the patient not want to eat and lead to weight loss include medication side effects like nausea ,change in taste or mouth tingling,symptoms of oppertunistic infections like a painful throat or feeling full,and Depression.Sometimes the body may not absorbing the nutrients that you are getting.HIV can damage the lining of the intestine.

Calories are the energy in food that provide your body with fuel.To maintain your lean body mass you may need to take more calories.

*consume 17 calories per pound of your body weight if you have been maintaing your weight.

*Consume 20 calories per pound if opportunistic infection present.

*Consume 25 calories per pound if losing weight.

PROTEINS

Aim for 100-150gms a day

80-100 gms if HIV positive

To get extra protein spred nut butter on fruit,vegetables add cheese to sauces,soups ,potatos.

3-Other things that may make the patient not want to eat and lead to weight loss include medication side effects like nausea ,change in taste or mouth tingling,symptoms of oppertunistic infections like a painful throat or feeling full,and Depression.Sometimes the body may not absorbing the nutrients that you are getting.HIV can damage the lining of the intestine.

4-It is common for HIV positive people to have multiple nutrient deficiencies,even early on in the course of infection.Defeciencies of zinc,selenium,copper,B6 ans B 12 are common in patient.

5-B vitamins:Vitamin B1 (Thiamine),Vitamin B2 (Ribiflabin) Vitamin B 6( Pyrodoxine) Vitamin B12 (Cobalamin.)

and Folic acid is suggested.Niacin also help in increase good cholesterol and decrease bad cholesterol.

6-Researchers have found that garlic supplements can cause a potentially harmful sideeffects when combined with a type of medication used to treat HIV.Investgators from National institute of health observed that garlic supplements sharply reduced blood levels of the anti HIv drug saquinavir.