Erica Frost, Katlyn Rhodes Samantha Mallik, Onalee Neff

 Chad, 28 year old high school graduate  Employed at a drug store  Doesn’t eat fruit and vegetables, only meals with minimal preparation  States abnormal thirst and hunger, and not feeling right  Admitted after found throwing up blood and barely responsive

 Breakfast: ◦ 2 strawberry poptarts ◦ 1 glazed doughnut ◦ 1 cup lowfat milk  Snack: ◦ 2 cups of coffee ◦ 1 fruit danish  Dinner: ◦ 1 frozen dinner, Hungry man Salisbury Steak ◦ 12 oz Mountain Dew ◦ 1 slice white bread ◦ 1 tsp. butter  Snack: ◦ 5 slices pepperoni pizza ◦ 5, 12 oz light beers

 24 hour recall ◦ 13 medium fat meat exchanges ◦ 1 low fat milk exchange ◦ 22.5 starch exchanges ◦ 30 fat exchanges  Kcals: ◦ Carbohydrates: 1398 ◦ Protein: 666 ◦ Fat: 2183 ◦ Total: 4247

 Sex: Male  Age: 28  Height: 5’10” (70 inches)  Weight: 230 lbs (104.5 kg)  Ideal body weight: 166 lbs  % Ideal body weight: 139  BMI: between  Interpretation: Obese

 pH: 7.0 ◦ Indicates acidosis  HCO3: 19 ◦ Low  Interpretation: ◦ Metabolic acidosis due to decrease in both pH and HCO3

 Diabetes *polydypsia and increased hunger- evident by patients subjective history. *Weight=139% IBW, BMI, upon admission *Diet high in trans fatty acids, contributed more than 7% of his daily fat intake *Hyperglycemia- evident by *Excessive alcohol consumption *Blood Glucose=560 *Too much food *Nausea *Diabetic Ketoacidosis (DKA)- evident by *Hyperglycemia *BP indicated Hypertension, which is a screening factor for diabetes *Pt. HCO3 and PCO2 levels are low

 Cardiovascular disease * Stage 1 hypertension- BP= 150/90 *Poor diet- *Pt. diet is high in Saturated and Trans fatty acids, more than 50% of his current dietary intake are from Fat *Alcohol consumption- *more than 1-2 drinks a day increases BP * HDL lowers and Triglycerides raise *Obesity- *BMI: *related to hypertension *glucose intolerance *Lab values- *Cholesterol: 325-elevated undesirable *LDL: 265-elevated *HDL: 40-borderline * elevated serum triglycerides *Microalbuminuria- *marker of increased cardiovascular risk and hypertension

 Primary ◦ Excessive fat intake related to frequent consumption of high risk lipids as evidenced by serum cholesterol level of 325 mg/dL, LDL of 265, and triglyceride of 300.  Secondary ◦ Inappropriate intake of types of carbohydrates related to cultural practices that affect the ability to regulate carbohydrates consumed evidenced by hyperglycemia and random blood glucose level of 560.

 Angiotension II ◦ Avapro  Reduces hypertension by restricting narrowing of blood vessels  Lovastatin ◦ Lowers cholesterol by blocking the production of cholesterol in the body ◦ Reduces LDL and total cholesterol levels ◦ Lovastatin combined with a cholesterol lowering diet plan is very effective

 Caloric needs ◦ RMR= 10xwt(kg)+6.25xht(cm)-5x x x x28+5 RMR= 1982 Kcal *Ambulatory *BMR=1.3x1982=2577 Kcal *Adjusted BMR=1.5x2577= 3866 Kcal * The Pt. calorie need is 2,577 Kcal

 Protein needs ◦ Oral anabolic requirements *Protein needs g/Kg *Kg actual body wt x1.2= x1.5=157 g Protein/day ◦ Grams of Nitrogen= 3866/150=25.7 g N required ◦ 25.7N x 6.25=161 g Protein/day *The Pt. protein need is g Protein/day

 Pt. IBW would be between lbs, this is a unrealistic short term goal, but could be a great long term goal for the patient to strive for *We do recommend a 5-10% reduction of his current weight of 230lbs/ kg - with this reduction his weight would then be lbs which is a realistic goal * We do not recommend any weight loss until the Pt. is in a stable condition

 The prescribed diet will consist of: ◦ 55% of calories from carbohydrates ◦ 20% of calories from protein ◦ 25% of calories from fat  RMR= 2,577 kcal daily ◦ 1417 kcal, 354 g carbohydrates ◦ 515 kcal, 129 g protein ◦ 644 kcal, 72 g fat

 Calorie Consumption: ◦ The pt. is currently consuming 4247 kcal ◦ Prescription: Reduce caloric intake to 2558 kcal  Fat Intake: ◦ Current Intake: 242 kcal (150 g) ◦ Prescription: 70 kcal (35 g)  Protein Intake: ◦ Current Intake:167 kcal (42 g) ◦ Prescription: 129 kcal (32 g)  Fruit and Vegetable Intake: ◦ We recommend he adds fruits and vegetables to his diet.  Meat: ◦ We are encouraging him to eat lean meat instead of medium meat.  Milk: ◦ We are encouraging a higher milk consumption

Number of exchanges ProteinCarbohydrateFat Meat856 g--24 g Milk432 g48 g-- Vegetable48 g20 g-- Starch1133 g165 g11 g Fruit g Fat g TOTAL42129 g353 g70 g

ExchangeFood Breakfast 3 starch 3 fruit 2 milk 1 fat Lunch 3 meat 2 starch 2 fat 1 vegetable 1 fruit Snack 3 fruit 1 milk 1 fat Dinner 5 meat 4 starch 2 fat 2 vegetable 1 milk 1 fruit Snack 2 starch 1 vegetable 1 fat

 11 starch exchanges : 11 g  8 meat exchanges : 24 g  7 fat exchanges : 35 g  4 milk exchanges (skim) : 0 g  TOTAL : 70 g

 5-10% weight reduction, short term goal  Glucose maintained to desirable limit  Achieve and maintain desirable lipid levels, through diet and therapeutic lifestyle changes ◦ LDL cholesterol < ◦ HDL > 40 ◦ Triglycerides < ◦ Cholesterol < ◦ Blood Pressure /85-89

 Patient will regularly see RD, 4-8 times within 6 month period.  Set timeline with RD for setting goals, and visits  Record 3-day or weekly diet record for first visit showing understanding of prescription  Lab values will be taken to ensure BGL and lipid profile are effectively being reduced.