List abnormal biochemical values for 3/29, describe why they might be abnormal, and explain any nutrition-related implications

Question

What will be an ideal response?

Answer 1

Abnormal biochemical values on 3/29 and reason for abnormalities:
• Sodium (H): Sodium was slightly elevated due to slight dehydration related to extensive fluid loss through his abdominal wounds and drains, despite having a high fluid intake
• BUN (H): GI bleeding and dehydration; enhanced gluconeogenesis/protein metabolism
• Creatinine (H): Possible renal insufficiency, GI bleeding, and catabolic state
• Glucose (H): Possible history of DM, metabolic stress response; currently receiving SSI
• Phosphate (L): Low nutritional intake, malabsorption
• Osmolality (H): Dehydration, hyperglycemia, hypernatremia
• Total protein (L): Metabolic stress/inflammation resulting in decreased production of this acute-phase protein in critical illness, impaired hepatic function
• Albumin (L): Fluid overload, metabolic stress/inflammation resulting in decreased production of this negative acute-phase protein in critical illness, impaired hepatic function
• Prealbumin (L): Fluid overload, metabolic stress/inflammation resulting in decreased production of this negative acute-phase protein in critical illness, impaired hepatic function
• Alkaline phosphorous (H): Damage to the liver (liver laceration)
• ALT/AST (H): Damage to liver (liver laceration), recent surgery
• CPK (H): Tissue damage to skeletal muscle, possible history of heart disease
• Lactate dehydrogenase (H): metabolic stress response, liver damage (liver laceration)
• CRP (H): Tissue damage, inflammation,
• HDL (L), VLDL (H), LDL (H): Possible history of hyperlipidemia/heart disease related to inadequate diet/lipid metabolism prior to admission, possible history of DM (uncontrolled)
• TG (H): Possible history of hyperlipidemia/heart disease related to inadequate diet/lipid metabolism prior to admission; current metabolic stress response related to lipolysis and impaired transport of lipids with liver damage (liver laceration); possible history of DM (uncontrolled); current use of propofol; possible metabolic syndrome related to obesity
• A1c (H): Possible history of DM, uncontrolled DM prior to admission
• PT/INR/PTT (L): Longer blood clotting time; possible underlying liver disease or recent liver laceration/hemorrhage, low vitamin K intake or change in GI tract microbiota (flora)
• WBC (H): Presence of an infection, presence of inflammatory response, stress, tissue damage
• RBC (L): Blood loss due to hemorrhaging and recent surgeries, trauma, acute or chronic bleeding of the GI tract, possible history of anemia
• Hct (L): Possible history of anemia; acute or chronic bleeding within the GI tract; possible nutritional deficiencies such as folate, vitamin B12, or iron; presence of inflammation
Nutrition implications with these lab values include fluid restriction, increased protein/energy needs, and insulin administration.
Abnormal urinalysis values and reason for abnormalities:
• Cloudy appearance: Possible presence of infection
• Specific gravity (H): Dehydration, presence of infection, presence of glucose/ketones, uncontrolled DM, possible renal insufficiency, blood loss (decreased blood flow to kidneys)
• Protein (+): Dehydration, possible UTI, possible kidney insufficiency, possible diabetic nephropathy
• Glucose (+): Uncontrolled DM, metabolic stress
• Ketones (+): Metabolic stress response (increased metabolism), acute or severe illness, possible fever
• Bact (+): UTI (infection present)
• Mucus (+): UTI (infection present)
• Yeast (+): UTI (infection present)