Kanako Miyoshi

NTRS415B
ADIME #2: Celiac Disease
A: KM states that she is hungry all the time, and she almost immediately has diarrhea when she
eats especially large amounts. She does not have any nausea or vomiting. She also reports that
when she eats fried foods or beef, her diarrhea seems worse. She has mostly been eating noodle
soups, some chicken, crackers and sprite. A bowel biopsy indicates that flat mucosa and villus
atrophy and hyperplastic crypts-inflammatory infiltrate in lamina propia. Positive TTG, EMA
antibodies have shown. Her diet order is NPO.
36 YO F Dx: Celiac disease with secondary malabsorption and anemia
Admitted with stomach pain and severe diarrhea
Ht. 53; Wt. 92#; UBW 112#; % wt change 18% in a month (severe); BMI 16; IBW 115#;
%IBW 80%
Labs: Alb 2.9; Pre-Alb 14; Hgb 10.5; Hct 35; Ferritin 12
EER: 35x52(IBW) = 1820 kcal EPR: 1.5x52(IBW) = 78 g Fluid need: 1820 mL
D: 1. Malnutrition R/T malabsorption due to damaged villi AEB positive TTG and EMA
antibodies.
2. Inadequate iron intake R/T deficient in iron rich foods in pts diet AEB Hgb of 10.5 and Hct
of 35.
3. Unintended weight loss R/T poor intake of foods AEB losing 20lbs in a month (18%, severe
weight change)
I: 1. Recommend 1800 kcal, 78 g of protein and 1800 mL of fluid with lactose-free and glutenfree diet.
2. Educate pt on lactose-free and gluten-free diet by providing food lists that pt needs to avoid.
3. Recommend to iron supplement with vitamin C to meet RDA of iron (17mg/day).
4. Recommend to eat six small, frequent meals throughout the day.
5. Educate pt on protein-rich foods by providing protein-rich food list to meet daily protein
recommendation.
6. Recommend to gain 1-2 lbs/month by increasing variety of foods in her diet and increasing
oral food intake.
M/E: 1. Pts intake will increase close to 1800 kcal, 78g of protein and 1800 mL of fluid per day
as measured by food journal.
2. Pt understands lactose-free and gluten-free diet and will interpret them into her diet.
3. Pt will intake iron supplement and meet the RDA of iron as measured by food journal.
4. Pt will eat six small, frequent meals throughout the day as measured by food journal.
5. Pt understands and eats protein-rich foods to meet protein recommendation as measured by
food journal.
6. Pt will gain 1-2 lbs by next follow up.
7. Follow up appt in a month to evaluate pts progress.
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