Answer to Question 1
Glucose (high): Glucose may be elevated due to underlying diabetes.
HbA1c (high): 6.1 is consistent with a diagnosis of diabetes mellitus.
Cholesterol (high): The value is 201, which is just above the upper threshold and not a huge concern or a huge factor in the nutritional intervention for IBS, except that perhaps the patient may be advised to decrease fat intake, especially saturated fat intake.
Triglycerides (high): High, potentially due to excessive dietary fat intake. High dietary fat intake may contribute to IBS symptoms.
HDL-C (low): Not directly related to her IBS symptoms, but does place her at a greater risk for CVD (along with the other abnormal lipid values)
Answer to Question 2
RQ value = mol CO2 expired/ mol O2 consumed = 0.76
An RQ value of 0.7-0.8 indicates fat as the main energy source, an RQ of 0.8-0.9 indicates a mix of lipids, carbs, and some protein as energy sources, and an RQ of 0.9-1.0 indicates carbohydrates as the main energy source. According to the nutrition consult note, Mr. Perez's RQ was 0.76 . This indicates that while on TPN, fat is his primary energy source. This could be due to the propofol administered at 35 mL/hr (10 lipid solution). Also, this indicates that he is closer to a fasted state (<0.70), compared to overfeeding (>1.0). Although it is optimal to not over feed this patient, this could indicate that he is being underfed and may not be meeting his nutritional requirements.
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