NFS 2230 Therapeutic Nutrition
Case Study – Hepatitis C Virus (HCV)
Mr Collins is a 55-year-old physician’s assistant with a history of chronic hepatitis C. history was remarkable for a needle stick injury on the job that occurred two years ago. Following the injury, he initially experienced sporadic episodes of mild flu-like symptoms with fever, chills, and diaphoresis. Over the past six months, his complaints increased to include generalized muscle weakness, fatigue, and weight loss. Mr Collins is 5’9″ tall and weighs 150 pounds with a usual weight of 162. On examination, he was noted to have hepatomegaly and be markedly pale with icteric (jaundiced) conjunctiva and skin.
Mr Collins complains of a poor appetite. He generally eats two meals a day and prefers meat, potatoes, salted snacks, and an occasional beer. He dislikes sweets and some vegetables and fruits. He states that he often has nausea and feels bloated after eating, but is unable to pass the gas. He feels most comfortable when his stomach is empty.
- What are the risks or complications of HCV?
- Liver cirrhosis
- Liver cancer
- Liver failure
- What advice would you give Mr Collins about drinking alcohol?
Mr Collins should avoid the intake of alcohol. This is because repeated alcohol consumption interferes with the architecture of the liver leading to scarring and finally liver cirrhosis. Therefore, the liver will not function normally in the production of proteins or sieve out toxins.
- What dietary recommendations should be given to Mr Collins, consider the general needs of protein and fat?
He is nutritionally recommended to:
- Eat minimal, regular or frequent meals in a bid to reduce the chances of anorexia or abdominal discomfort.
- Take plenty of proteins of about 1.5-2g/kg/day.
- Consume enough of energy for the restoration of energy stores by sourcing from whole grain, grains or cereals.
- Take oral supplements but with caution.
- Reduce the consumption of fatty, salty or sugary foods.
- Avoid alcohol consumption.
- Take plenty of fruits and vegetables as they are the sources of vitamins, fiber or antioxidants.
- Consume adequate fluids of 2 to 3 litres per day.
- Suppose Mr Collins condition worsens and develops steatorrhea. Based on his EER with light activity recommend daily intakes of: (show calculations, get totals for this specific patient)
- energy (kcals/day)
1Kcal=1kg/hr
1Kcal x55kg/1kg= 55Kcal/hr
1 hr=55Kcal
24hrs=? 55Kcalx24hrs/hr = 1,320 Kcal/day
- protein (g/kg)
1.5g per 1kg (low end range)
? 55kg
1.5gx55kg/1kg= 82.5g
- total fat (% of kcals from fat)
Fat= 9kcals/g
70g of fat per day
Total? 70gx9kcal/g= 630kcals per day
630kcals/1320kcalsx100%= 0.48%