This topic contains a solution. Click here to go to the answer

Author Question: Explain the rationale for prescribing a low-carbohydrate diet in the treatment of NAFLD. What ... (Read 61 times)

lbcchick

  • Hero Member
  • *****
  • Posts: 550
Explain the rationale for prescribing a low-carbohydrate diet in the treatment of NAFLD.
 
  What will be an ideal response?

Question 2

Write a note for your initial inpatient nutrition assessment with nutrition support recommendations.
 
  What will be an ideal response?



Related Topics

Need homework help now?

Ask unlimited questions for free

Ask a Question
Marked as best answer by a Subject Expert

otokexnaru

  • Sr. Member
  • ****
  • Posts: 314
Answer to Question 1

 High-carbohydrate diets may lead to hepatic insulin resistance by activating carbohydrate responsive element binding protein (ChREBP), inducing glycolysis and lipogenic pathways within liver tissue

Answer to Question 2

DATE/TIME
A: 37 yo M
Admitted with SOB now on mechanical ventilation with probable sepsis
PMH: T2DM, HTN, Hyperlipidemia, Osteoarthritis
PSH: s/p Roux-en-Y bariatric surgery 4 months previously, total knee replacement
Meds: lovastatin 60 mg/day (d/c Lantus and metformin 2 months ago)
Skin: warm, dry to touch; ecchymosis, abrasions, petechiae on lower extremities, 2+ pitting edema
Abdomen: obese appearance with rashes under skinfolds; soft, active bowel sounds
I/O: +1430 mL
Labs: K 5.8, CO2 31, Glu 385, Phos 2.1, Pro 5.8, Alb 1.9, Prealb 11, Ammonia 35, WBC 23.5, CRP 110, Ferritin 14, Transferrin 385, Lactate 4.2, Fibrinogen 525, Hgb 12.5, Hct 38, TG 245
Urine: Pro +, Glu +, Ket +, Bact +, WBC +
Diet: NPO
Diet Hx: unable to speak to patient due to mechanical ventilation. Hx of childhood obesity. Patient's highest historical weight was 425 lbs  recent weight loss of 76 after bariatric surgery.
Ht: 5'10 Wt: 325 UBW: 425 UBW: 76 IBW: 166 IBW: 196 BMI: 46.7 kg/m2
EER: 1660-1886 kcal/d (based on 22-25 kcal/kg IBW); EPR: 151-189 (based on 2.0-2.5 g/kg/IBW)
D: Predicted suboptimal energy intake related to induced sedation as evidenced by an order for nothing by mouth and mechanical ventilation status.
I: Goal to meet 100 nutritional needs via enteral feeding.
When medically able, recommend a post-pyloric feeding tube to prepare for enteral feeding.
Within 24-48 hours after hemodynamically stable, initiate Peptamen Bariatric  20 mL/hour. Increase as tolerated by 10-20 mL every 8-12 hours until goal rate of 80 mL/hour (based on 22 hours per day -ICU protocol). This will provide daily 1760 mL total volume, 1760 total kcalories, 164 g protein, and 1478 mL free water. Provide approximately 5 flushes of 60 mL free sterile water throughout the day (ever 4 hours).
Make HOB elevated between 30-45 degrees.
Communicate with team the nutrition support recommendations per above.
M/E: RD to follow patient in ICU.
Monitor weight changes, I/O, abdominal sounds, and GI tolerance.
Monitor BG and suggest insulin therapy if consistently above 180 mg/dL.
Monitor lab trends and risks for refeeding syndrome.
Reassess enteral feeding needs once weaned off of ventilator.




lbcchick

  • Member
  • Posts: 550
Reply 2 on: Aug 21, 2018
Gracias!


cam1229

  • Member
  • Posts: 329
Reply 3 on: Yesterday
:D TYSM

 

Did you know?

Immunoglobulin injections may give short-term protection against, or reduce severity of certain diseases. They help people who have an inherited problem making their own antibodies, or those who are having certain types of cancer treatments.

Did you know?

Patients who have undergone chemotherapy for the treatment of cancer often complain of a lack of mental focus; memory loss; and a general diminution in abilities such as multitasking, attention span, and general mental agility.

Did you know?

Everyone has one nostril that is larger than the other.

Did you know?

Adolescents often feel clumsy during puberty because during this time of development, their hands and feet grow faster than their arms and legs do. The body is therefore out of proportion. One out of five adolescents actually experiences growing pains during this period.

Did you know?

Common abbreviations that cause medication errors include U (unit), mg (milligram), QD (every day), SC (subcutaneous), TIW (three times per week), D/C (discharge or discontinue), HS (at bedtime or "hours of sleep"), cc (cubic centimeters), and AU (each ear).

For a complete list of videos, visit our video library