University of Maryland

College Park
Dietetic Internship
2014-2015 MINI CASE STUDY
Rory Costigan
Nutrition Assessment:
Admitting Diagnosis: CKD, abdominal ache/pain and watery stools over past 3
weeks
Final Medical Diagnosis Inadequate fluid intake
Age: 60
Labs:
Gender: Male
Creatinine- 2.1mg/dl
H (0.7-1.5)
Weight: 76.4kg (168lbs)
Glucose- 90mg/dl
(70-121)
Height:175cm (59)
Urea Nitrogen- 25mg/dl H (6-23)
BMI: 24.8 (normal, healthy weight)
Sodium- 137mmol/L
(135-147)
Calcium- 8.9mg/dl
(8.9-10.5)
Phosphorous- 2.4mg/dl
L (2.5-4.5)
PMH:
Cholesterol- 181mg/dl
(170-200)
Chronic Kidney disease Stage 3
Albumin- 3.0g/dl
L (3.7-5.0)
Renal Transplant
WBC- 2.0 K/cmm
L (3.2-9.5)
Hypertension
HGB- 12.0g/dl
L (13.2-17.3)
Hyperlipidemia
HCT- 35.1%
L (38.6-50.1)
Coronary Artery Disease
HGB A1c- 6.1%
(4.3-6.1)
Diabetes Mellitus II
GERD
Hepatitis C
Symptoms:
Lower abdominal pain with watery
diarrhea over the past 3 weeks.
7/10 on pain scale and increases when he
has a bowel movement and relieves with
emptying bowl.
Diarrhea has no blood or mucus and denies
food borne illness or consuming different
types of food.

Medications:
Amlodipine, Clopidogrel, Insulin Sliding
Scale, Metoprolol, Omeprazole,
Rosuvastatin

Diet History:
Current Diet:
Per Patient, good appetite and usually
No Condensed Sweets, Renal Diet 1
consumes all the food on his plate. Patient
has been previously counseled by a
dietitian about keeping blood sugars down,
therefore patient tries to follow diabetic
diet and tries to keep his weight around 160
pounds. Patient eats 1-3 meals a day when
at home.
Nutrition Diagnosis utilize PES Statements
NI 3.2 Inadequate fluid intake related to excessive fluid loss through diarrhea x 3 weeks
as evidence by patient statements.
Nutrition Intervention Nutrition prescription, Interventions with goals

Nutrition Prescription:

Intervention with goals:

No concentrated sweets and Renal Diet 1

Diet: Continue on no concentrated sweets

and Renal Diet 1
Food and Nutrient delivery: Turkey
sandwich for night time snack
Patient Educations: Patient has been
counseled by a dietitian in the past about
controlling blood sugars and could recall
and verbalize information about the
importance of keeping blood sugar within
normal limits.

Calories- 1,909-2,290 Kcal/day

(25-30 Kcal/Kg)
Protein- 61 g/day
(0.8g/kg)
Fluid- 1909ml/day
(1ml/kcal)
Nutrition Monitoring and Evaluation
Indicator
1. Energy intake
2. Monitor sugar intake
3. Weekly weights
4. Replete electrolytes

Source
Facility standards
EAL
Online nutrition care
manual

Criteria
1. Consumes 75% of tray.
2. Patient consumes limited concentrated
sweets.
3. Monitor lean body mass by recording
weights weekly.
4. Replete electrolytes RPN

Kcal requirements
1,909-2,290 Kcal/day
(25-30 Kcal/Kg)
n/a- nothing found
CKD stages 1-4
diabetic meal pattern
should be estimated
around 2,200 calories.

Protein requirements
61 g/day
(0.8g/kg)
n/a- nothing found
For patients with a
kidney transplant, 0.8
protein/kg/ day to 1.0 g
protein/day should be
prescribed.

Fluid requirements
1909ml/day
(1ml/kcal)
n/a nothing found
The need for a fluid
restriction is
determined by medical
status, blood pressure
control, physical
findings (fluid
accumulation), and
alterations in urine
output.

References:
1. Academy of Nutrition and Dietetics. International Dietetics and Nutrition Terminology (IDNT)
Reference Manual. Chicago, IL: American Dietetic Associations; 2013
2. Academy of nutrition and Dietetics. Nutrition Care Manual. Accessed November 11, 2014
http://www.nutritioncaremanual.org/topic.cfm?
ncm_category_id=1&ncm_toc_id=144973&ncm_heading=Nutrition
%20Care&ncm_content_id=90573#LaboratoryandLabValueNorms
http://www.nutritioncaremanual.org/client_ed.cfm?ncm_client_ed_id=336
3. Evidence Analysis Library. Academy of Nutrition and Dietetics. www.adaevidencelibrary.com.
Accedded November 11, 2014