CASE STUDY FORMAT

 PATIENTS PROFILE
NAME: Mr. XYZ
AGE: 61 SEX: Male
COMMUNITY: Hindu
OCCUPATION:
ECONOMIC STATUS:
 ANTROPOMETRIC MEASUREMENTS

HEIGHT: 169 cm WEIGHT: 48.8 kg

BMI: 17 kg/m² IBW: 69 kg

 ADMISSION DETAILS

DATE OF ADMISSION: 25/4/18

ADMITTED UNDER: Dr. P. Soonawala

PRESENT COMPLAINTS: Patient went for regular check-up and was advised to undergo right
PCNL (Percutaneous Nephrolithotomy).

PAST MEDICAL HISTORY: Renal stones since 10 years

FINAL DIAGNOSIS: Right Renal Calculus

 BIOCHEMICAL PARAMETERS

PARAMETERS RANGE UNIT NORMAL RANGE

Sodium 140 mmol/L 137-145
Potassium 3.80 mmol/L 3.5-5.1
Chloride 104 mmol/L 98-106
Creatinine 0.68 mg/dl 0.5-1.5
Blood Pressure

DATE TIME RANGE UNIT NORMAL RANGE

11:00 am 130/70
12:00 pm 130/80
1:00 pm 110/70
2:00 pm 90/50
26/4/18 3:00 pm 100/60 mm/Hg 120/80
5:30 pm 120/70
6:00 pm 120/70
7:00 pm 110/80
10:00 pm 120/70

 MEDICATION PRESCRIBED BY HOSPITAL

MEDICATION DOSAGE ACTION

IV-Magnex Forte 1.5gm 12 hourly Anti-bacterial
IV-Pause 500mg 10 hourly Anti-fibrinolytic
IV-Perfalgan 1gm 8 hourly Paracetamol
IV-Pantocid 40mg 12 hourly Antacid

 PATHOPHYSIOLOGY
Kidney stones, or renal calculi, are solid masses made of crystals. Kidney stones usually
originate in your kidneys. However, they can develop anywhere along your urinary tract, which
consists of these parts:- kidneys, ureters, bladder, urethra. Kidney stones are one of the most
painful medical conditions. The different types of kidney stones include:- calcium phosphate,
calcium oxalate, uric acid or magnesium ammonium phosphate. The common type of calculi is
calcium oxalate.
Urine super-saturation
↓
Nucleation
↓
Crystal growth
↓
Crystal aggregation and agglomeration
↓
Crystal retention
↓
Stone formation and growth

.
  HOME RECALL

TIMINGS MEAL MENU INGR. AMT ENERGY CHO PRTN FATS

8.30AM Breakfast 1 cup (with sugar , Cow's milk 50 33 2 1.6 2

cow’s milk Sugar 5 20 5 - -
50ml) Biscuits 50 50 12 0.5 0.2
+ 2-3 biscuits
2.00PM Lunch 2no. roti (with oil) Wheat flour 60 200 42 5 1
+1 vati rice Rice 30 100 21 2.5 0.5
+1 vati sabzi Sabji 100 100 24 - -
+1 vati dal Dal 30 100 17 7 0.5
Oil 15 135 - - 15
Evening 1 cup (with sugar , Cow's milk 50 33 2 1.6 2
cow’s milk Sugar 5 20 5 - -
50ml) 10- 15
cups tea
9.30PM Dinner 2no. roti (with oil) Wheat flour 60 200 42 5 1
+1 vati rice Rice 30 100 21 2.5 0.5
+1 vati sabzi Sabji 100 100 22 - -
+1 vati non veg - Dal 30 100 17 7 0.5
chicken Chicken 90 100 - 24 0.5
Oil 20 180 - - 20

 NUTRITIONAL PROFILE OF DIET

ENERGY - 1571 kcal

PROTEINS - 56.2 gms

CARBOHYDRATES - 232 gms

FATS - 43.5 gms

 3 DAY HOSPITAL RECALL

 DAY-1 Date:- 25/4/18

TIME MEAL MENU INGREDIENTS AMT ENERGY CHO PROTEIN FATS

8:00 am Breakfast Daliya Daliya 30 100 2.5 21 0.5

upma Onion 25 25 2.5 0.2 -
Brown Tomato 25 12.5 1.5 0.2 -
bread Oil 5 45 - - 5
Jam Brown bread 100 100 2.5 21 0.5
Butter Butter 5 35 - - 5
Porridge Milk 50 33 2 1.2 2
 Tea Sugar 5 20 5 - -
Muskmelon Muskmelon 100 50 10 - 0.3

1:00 pm Lunch Mix veg Vegetables 100 25 7 1 -

soup Corn 50 25 5 0.5 -
Milli juli Peas - - - - -
veg Onion - - - - -
Dal with Tomato - - - - -
tadka Capsicum - - - - -
Plain rice Oil 5 45 - - 5
Curd Moong 30 100 17 7 0.5
Vermicilli Oil 5 45 - - 5
Kheer Rice 30 100 21 2.5 0.5
Chapati Curd 100 66 4 3.3 4
Vermicilli 30 100 21 2.5 0.5
Milk 100 66 4 3.3 4
Sugar 5 20 5 - -
Wheat flour 30 100 21 2.5 0.5

8:00 pm Dinner Carrot and Carrot 100 50 10 1 -

dill soup Dill - - - - -
Pahadi Paneer 40 100 2 7 8
paneer Oil 5 45 - - 5
Plain rice Rice 30 100 21 2.5 0.5
Curd Curd 100 66 4 3.3 4
Chapati Wheat flour 30 100 21 2.5 0.5
Veg kadhai Vegetables 50 25 5 0.5 -
Oil 5 45 - - 5

DAY-2 CLEAR LIQUID DIET Date:-27/4/18

TIME MEAL MENU INGREDIENTS AMT ENERGY CHO PROTEIN FATS

7:00 am NBM

8.30 am NBM

10:00 Barley - - - - -
am water
11.30 Dal water - - - - - -
am
1:00 pm Rice kanji+ - 100ml - - - -
Jelly - 50 10 - -

2.30 pm Strewed Apple 100ml 25 5 - -

apple
puree + Apple 100ml 50 10 - 0.3
apple
juice
4.00 pm Barley Barley water - - - - -
water
5.30 pm Dal water Dal water - - - - -
7:00 pm Rice kanji Rice kanji + - - - - -
+ Jelly Jelly 50 10 - -
8:30 pm Strewed Apple 100ml 25 5 - -
apple
puree
10:00 Apple juice Apple 100ml 50 10 - 0.3
pm

DAY-3 FULL DIET Date:- 28/4/18

TIME MEAL MENU INGREDIENT AMT ENERGY CHO PROTEIN FAT

S S
8:00 am Breakfast Seviyan Vermicilli 30 100 21 2.5 0.5
upma Onion 25 25 2.5 - -
Papaya Tomato 25 12.5 1.5 - -
Oil 4 45 - - 5
Papaya 100 50 10 - -

1:00 pm Lunch Mulligata- Rice + dal 100 100 21 2.5 0.5

wny Bhendi 50 25 7 - -
soup Onion 25 25 0.2 - -
Bhendi Tomato 25 12.5 0.2 - -
bhaji Oil 5 45 - - 5
Dal Moong 30 100 17 7 0.5
Rice Oil 5 45 - - 5
Chapati Rice 30 100 21 2.5 0.5
Wheat flour 30 100 21 2.5 0.5

8:00 pm Dinner Mix veg Vegetable 100 25 7 1 -

soup Macroni 30 100 21 2.5 0.5
Baked Chicken 90 100 - 24 0.5
macro- Butter 5 35 - - 5
ni and Vegetables 100 50 10 - -
 minced Butter 5 35 - - 5
chicken
Saute mix
veg
Moccha
souffle

 DIET FOLLOWED DURING HOSPITAL STAY:

Full diet
↓
NBM
↓
Clear Liquids
↓
Full diet

 NUTRITIONAL PROFILE OF DIET

ENERGY - 2070 Kcal (30 kcal/kg IBW)

PROTEINS - 67 gms (1g/kgIBW) (13%)

CARBOHYDRATES - 336 gms (65%)

FATS - 50.6 gms (22%)

 MEDICAL NUTRITION THERAPY

 GOALS:
 To maintain optimum nutrition
 To relieve symptoms
 To prevent further complications

 ENERGY: 30-35 kcal/kg is recommended to prevent negative nitrogen balance and to

maintain appropriate weight.

 CARBOHYDRATES: 50-65% of CHO is recommended. Combination of both simple

and complex CHO should be included in the diet.

 PROTEINS: 1 gm/kg body weight is recommended.

 FATS: Moderate i.e. 15-25% intake fat is recommended.

  FLUIDS: The fundamental principle in the treatment of kidney stone is to supply
adequate fluids like water, coconut water, fruit juices, etc, in order to ensure the passage
of over 2000 ml of urine per day.

 EXCHANGE LIST

Food No. Of Amounts Energy Cho Proteins Fats

Exchange Exchange (gms) (kcal) (gms) (gms) (gms)

Cereals 7 210 700 147 17.5 3

Pulses 2 60 200 34 14 1
Egg 1 50 85 - 6.7 6.7
Nuts 1 15 100 30 3 7
Chicken ½ 45 50 - 12 -
Curd 1 150 100 6.6 5 6
Coconut dry 1 15 100 2.5 1 0.9
Coconut water 1 100 24 4.4 1.4 -
Veg A 2 200 50 12 2 -
Veg B 2 200 100 20 2 -
Fruit 3 300 150 37.5 - -
Sugar 3 15 60 15 - -
Oil 6 30 270 - - 30
Total 1989 309 64.6 54.6
% Energy 65% 13% 22%
Distribution
 DISTRIBUTION OF EXCHANGES BETWEEN THE VARIOUS MEALS OF THE DAY

Food Early Breakfast Mid- Lunch Post- Snacks Mid Dinner Bed
group morning morni lun eveni time
ng ch ng
Cereals 2 1 1 1 2
Pulses 1 1
Egg 1
Nuts 1
Chicken 1
Curd ½ ½
Coconut 1
dry
Coconut 1
water
Veg A ½ ½ 1
Veg B ½ ½ ½
Fruit 1 1 1
Sugar 1 2
Oil 1½ 2 2½

 MENU PLANNING

Time Meal Menu Ingredients Justification Variation

7:00 am Early Coconut Coconut It is refreshing and Detox water

morning water water provide
vitamins and
mineral
9:00 am Breakfast Egg omelet Egg Provides HBV Egg paratha
Chapati Onion protein and Plain omelet
Tomato calories
Oil
Wheat flour
Oil
11:00 am Mid- Fruit juice Watermelon Provides good Any fruit juice
morning Lime amount of
Mint fluids and is
Sugar hydrating and
also provide
vitamins and
 mineral
1:00 pm Lunch Rice Rice Provides HBV Chicken pulao
Chicken Chicken protein and
gravy Coconut adequate
Raita dry calories and
Onion fibre
Oil
Curd
Onion
Tomato
3:00 pm Post-lunch Apple Oats Apple Provides high Lassi
Smoothie Oats soluble and Banana
Curd insoluble fibre, smoothie
Sugar proteins and
CHO
5:00 pm Snacks Kurmura Puffed rice Good combination Bhel
chana Chana of pulse and Chiwda
chat Onion cereal
Tomato
7:00 pm Mid Nuts Almonds Good source of Any dry fruit
evening essentials oils
8:30 pm Dinner Dal Moong Good combination Veg pulao
Rice Oil of cereal and Khichdi with
Sabji Rice vegetables and veg soup
Chapati Tendli also provides
Onion calories, fibre
Tomato
Oil
Wheat flour
Oil

10:30 pm Bed time Fruit Pear Provides fibre Any fruit

  DETAILED MENU PLAN

Meal & Menu Ingredients Amt Energy Cho Protein Fat

Time Gm Kcal Gm Gm Gm
7:00 am Coconut water Coconut water 100 24 4.4 1.4 -
Early
morning
9:00 am Egg omelet Egg 50 85 - 6.7 6.7
Breakfast Chapati Onion 25 25 2.5 0.2 -
Tomato 25 12.5 1.5 0.2 -
Oil 5 45 - - 5
Wheat flour 60 200 42 5 1
Oil 2.5 22.5 - - 2.5

11:00 am Fruit juice Watermelon 100 50 12.5 - -

Mid-morning Lime 2.5 - - - -
Mint 2.5 - - - -
Sugar 5 20 5 - -

1:00 pm Rice Rice 30 100 21 2.5 0.5

Lunch Chicken gravy Chicken 45 50 - 12 -
Raita Coconut dry 15 100 2.5 1 0.9
Onion 25 25 2.5 0.2 -
Oil 10 90 1.5 0.2 10
Curd 75 50 3.3 2.5 3
Onion 25 25 2.5 0.2 -
Tomato 25 12.5 1.5 0.2 -

3:00 pm Apple Oats Apple 100 50 12.5 - -

Post-lunch Smoothie Oats 30 100 21 2.5 0.5
Curd 75 50 3.3 2.5 3
Sugar 10 40 10 - -

5:00 pm Kurmura chana Puffed rice 30 100 21 2.5 0.5

Snacks chat Chana 30 100 17 7 0.5
Onion 25 25 2.5 0.2 -
Tomato 25 12.5 1.5 0.2 -

7:00 pm Nuts Almonds 15 100 30 3 7

8:30 pm Dal Moong 30 100 17 2.5 0.5
Rice Oil 5 45 - - 5
Sabji Rice 30 100 21 7 0.5
Chapati Tendli 100 25 7 0.5 -
Onion 25 25 2.5 0.2 -
 Tomato 25 12.5 1.5 0.2 -
Oil 5 45 - - 5
Wheat flour 30 100 21 7 0.5
Oil 2.5 22.5 - - 2.5

10:30 pm Fruit Pear 100 50 12.5 - -

 RECCOMENDATIONS:

DO’S

 Small frequent meals are recommended.

 Active physical lifestyle to be included.
 Limit the consumption of alcohol.
 Increase the intake of fruits and vegetable in the diet, atleast 4-5 serving of fruits to be
included.
 Delicate use of spices, condiments and mild seasonings.
 Increase in fluid intake.
 Healthy foods to be included especially plant source.
 Eat plenty of whole grain, fruits and vegetables.
 Eating fruit as a snack.
 Maintain a healthy body weight.

DONT’S

 Do not smoke or drink alcohol or consume tobacco.

 Avoid spicy and acidic foods in the diet.
 No highly seasoned or spicy preparations.
 No heavy preparations.
 Avoid bakery products, canned, tinned products.
 Avoid preservatives such as papad, pickles, chutney, sauce, etc.
 Do not skip meals or go for many hours without eating.
 Avoid carbonated beverages, commercial soft drinks.
 Diet should be low in oxalic acid and purine contents such as leafy vegetables,
chocolates, yam, red meat, organs etc.