Question

Krause's Food & the Nutrition Care Process 14th edition CLINICAL CASE STUDY

Winifred, a 38 year old F, is seen at City Hospital emergency department

(ED). She has a history of hypertension, obesity and unsuccessful

weight loss attempts. She loves fried foods, soft drinks, beer and pretzels. She has a history of binge eating. Winifred is required to have a

yearly physical by her employer, but has put off scheduling the appointment until she can lose some weight. She fell down some stairs in a

work-related accident and was sent to the ED for observation. The emergency department doctor determined that Winifred has no broken

bones, but is concerned about her elevated blood pressure, 185/98. The

doctor orders laboratory tests and Winifred is admitted to the hospital.

Her medical pro?le today is:

Age 38 years old Normal

Height 5,1-

Weight 285 lb

Glucose 142 mg/dL; 7.8 mmol/L

Calcium 9.1 mg/dL; 2.27 mmol/L

Sodium 140 mEq/L; 140 mmol/L

Potassium 3.6 mEq/L; 3.6mmol/L

CO2 25 mEq/L/ 25 mmol/L

Chloride 96 mEq/L; 96 mmol/L

BUN 30 mg/dL; 10.7 mmol/L

Creatinine 0.9 mg/dL; 79.6 %mol/L

Albumin 3.8 g/dL; 38 g/L

Total protein 8.0 g/dL; 80 g/L

ALP 35 U/L; 0.5 %kat/L

ALT 28 units/L; 28 units/L

AST 23 units/L; 0.38 %kat/L

Bilirubin, total 1.5 mg/dL; 25.65 %mol/L

RBC 5.1 ' 10

6

mL; 5.1 ' 10

12

L

Hgb 11 g/dL; 7 mmol/L

Hct 30%; 0.30

MCV 78 mm3

; 78 fL

MCH 23 pg

MCHC 40 g/dL; 40%

WBC 8 ' 10 9

Total cholesterol 245 mg/dL

LDL 145 mg/dL

HDL 30 mg/dL

Triglycerides 210 mg/dL

Winifred is referred for medical nutrition therapy. NFPA indicates a

robust female, with excessive fat stores, normal muscular development

and no ?uid accumulation. Assess her nutrition status using the data

provided.

Nutrition Diagnostic Statement

Altered laboratory values related to disordered eating pattern as evidenced

by signs of nutritional anemia and dyslipidemia.

QUESTIONS:

6. What does the lab value for glucose (non-fasting) suggest?

7. What additional lab test would be helpful to confirm answer to #6?

8. You measure Winifred’s waist circumference as 38 inches, what additional information does this provide?

9. What is Winifred’s WHtR?

10. You suspect Winifred has inflammation, what will happen to her positive and negative acute phase reactants if inflammation is present?

Answer 1

6. The lab report shows blood sugar (random) is 142 mg/dl, which is at the borderline. It indicates that she is having risk for developing diabetes.

7. In order to confirm the risk for developing diabetes , another lab test , HbA1C should perform. It shows the last three month blood sugar was under control or no.

8. The information, about her waist circumference, that is 38 inches which tells that she is obese . Also she is on road to develop diabetes and heart disease.  

10. Acute-phase proteins (APPs) are a class of proteins whose plasma concentrations increase (positive acute-phase proteins) or decrease (negative acute-phase proteins) in response to inflammation. This response is called the acute-phase reaction (also called acute-phase response). The terms acute-phase protein and acute-phase reactant (APR) are often used .In response to injury, local inflammatory cells (neutrophil granulocytes and macrophages) secrete a number of cytokines into the bloodstream, most notable of which are the interleukins IL1, IL6 and IL8, and TNF?. The liver responds by producing a large number of acute-phase reactants. At the same time, the production of a number of other proteins is reduced; these proteins are, therefore, referred to as "negative" acute-phase reactants. Increased acute-phase proteins from the liver may also contribute to the promotion of sepsis.Negative" acute-phaseproteins decrease in inflammation. Examples include albumin, transferrin, transthyretin, retinol-binding protein, antithrombin, transcortin. The decrease of such proteins may be used as markers of inflammation.