Hepatitis C Case Study

1. Hepatitis C Case Study Shaza Lauren

2. 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.

3. 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

4. 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%

5. Biochemical data Chemistry 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 ↑

6. Biochemical data Chemistry Ref Range RBC 4.2-5.4 4.1 ↓ Hemoglobin 12-15 10.9 ↓ Hematocrit 37-47 35.9 ↓ Urinalysis Protein Neg 1+ ↑

7. 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

8. 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

9. 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

10. Bruising related to vitamin k deficiency

11. 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

12. 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.

13. Subjective global assessment parameters History Weight changes Appetite Taste changes Dietary intake Persistent gastrointestinal problems Physical findings Muscle wasting Fat stores Edema

14. Subjective global assessment parameters Existing conditions Other problems that could influence nutrition status Nutrition rating based on results Well nourished Moderately malnourished Severely malnourished

15. 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

16. Intervention 24 hour recall Sips of water, juice, and diet coke Usual intake Breakfast: Calcium fortified orange juice Lunch: soup and crackers with diet coke Dinner: carry-out Chinese or Italian food

17. 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 day Iron supplementation 200 mg milk thistle twice daily chicory 3 grams daily 500 mg ginger twice daily

18. The corrective sample menu Breakfast Whole milk 1 cup oatmeal 1 package Banana 1 Whole wheat toast 1 slice Peanut butter 1 tbsp Snack Non-fat Greek yogurt

19. The corrective sample menu Lunch Vegetables salad 1,5 cup Olive oil 1 tbsp Tilapia fillet 1 fillet Sauteed spinach 1 cup Brown rice 0.5 cup Snack Apple 1 Chopped cucumbers 1 cup

20. The corrective sample menu Dinner Homemade vegetable soup 1 bowl Grilled chicken breast 1 slice Cannola oil 1 tbsp Shredded Parmesan cheese 2 tbsp Boiled Asparagus 1 cup Snack Orange juice 1 cup

21. Comparison Corrective Menu 2100 cal Usual intake 900 cal

22. 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

23. 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

24. Monitoring and evaluation Weight Blood glucose Biochemical data Anemia Hydration Skin bruising Food diary

25. 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.

26. Any question ??! Thank you 