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JB is a 53-year-old male who has recently divorced. He has experienced periods of depression and decreased appetite. His family reports a history of heavy drinking habits and a 15 kg weight loss. He was previously diagnosed with cirrhosis and portal hypertension. Paracentesis and TIPS procedures were performed. JB's condition seems to have worsened; he complains of stomach pains, nausea, and vomiting at times. His abdomen is sore to touch and feels swollen. JB has developed ascites and pedal edema. His urinary output has decreased, and he continues to lose weight. JB also complains of pain when swallowing food. Because of JB's persistent symptoms, he's been admitted to a hospital.
A referral to the SLP for an MBS was also ordered and resulted in dysphagia for which pureed diet was recommended. On day 2, JB still complains of nausea and no per os intake has been reported. The MD prescribed a dietary consultation. An RD is required to assess the patient and recommend alternate means of nutrition support, currently NPO.
Ht: 5'11" Wt: 145 # UBW: 163#
Dx: End-stage liver cirrhosis, dysphagiaPMH: alcoholic cirrhosis, portal hypertension
Labs:Na: 134 Cl: 101 BUN: 4 Alb: 2.3 TG: 305 Transferrin: 101 NH4:
53 Glu: 139 AST: 45 ALT 48 Alk Phos: 40 Bilirubin: 2.1K: 5.2 CO2: 25 Cr: 1.8 H/H: 11/35
Diet: NPOMeds: Neomycin, Aldactone, Lasix, Reglan
How would the registered dietitian determine JB's caloric needs in this situation?
A. 15–20 kcal/kg IBW
B. 20–25 kcal/kg IBW
C. 25–30 kcal/kg IBW
D. 30–35 kcal/kg current body weight
E. 35–40 kcal/kg current body weight
Answer: E
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