1. Erica Frost, Katlyn Rhodes Samantha Mallik, Onalee Neff

2.  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

3.  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

4.  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

5.  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 33-34  Interpretation: Obese

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

7.  Diabetes *polydypsia and increased hunger- evident by patients subjective history. *Weight=139% IBW, 33-34 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

8.  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: 33-34 *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

9.  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.

10.  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

11.  Caloric needs ◦ RMR= 10xwt(kg)+6.25xht(cm)-5x28+5 10x104.5+6.25x171.5-5x28+5 RMR= 1982 Kcal *Ambulatory *BMR=1.3x1982=2577 Kcal *Adjusted BMR=1.5x2577= 3866 Kcal * The Pt. calorie need is 2,577 Kcal

12.  Protein needs ◦ Oral anabolic requirements *Protein needs 1.2-1.5g/Kg *Kg actual body wt. 104.54x1.2=125 104.54x1.5=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 is125-161 g Protein/day

13.  Pt. IBW would be between 156-176lbs, 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/104.54 kg - with this reduction his weight would then be 207-218 lbs which is a realistic goal * We do not recommend any weight loss until the Pt. is in a stable condition

14.  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

15.  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

16. Number of exchanges ProteinCarbohydrateFat Meat856 g--24 g Milk432 g48 g-- Vegetable48 g20 g-- Starch1133 g165 g11 g Fruit8--120 g Fat7-- 35 g TOTAL42129 g353 g70 g

17. 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

18.  11 starch exchanges : 11 g  8 meat exchanges : 24 g  7 fat exchanges : 35 g  4 milk exchanges (skim) : 0 g  TOTAL : 70 g

19.  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 < 130-159 ◦ HDL > 40 ◦ Triglycerides < 150-199 ◦ Cholesterol < 200-240 ◦ Blood Pressure 130-139/85-89

20.  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.