Keeping the Numbers Simple: Bedside Tips for the Liver Patient

ELIZABETH M. LIMOS, RN-DPHILIPPINE GENERAL HOSPITAL

UNIVERSITY OF THE PHILIPPINES MANILA

Mini Nutritional Assessment MNALast Name: ____________First Name: ______________Sex: Age: Weight kg: Height cm: Date:_______

Complete the screen by filling in the boxes with the appropriate numbers. Add the numbers for the screen. If score is 11 or less, continue with the assessment to gain a Malnutrition Indicator Score.

Mini Nutritional Assessment MNALast Name: ____________First Name: ______________Sex: Age: Weight kg: Height cm: Date:_______

Complete the screen by filling in the boxes with the appropriate numbers. Add the numbers for the screen. If score is 11 or less, continue with the assessment to gain a Malnutrition Indicator Score.

Diet Recommendations

• High calorie (35 kcal/kg)• Protein: Restricted at 0.6g to 0.8 g/k/d Normal at 1.0 to 1.2 g/k/d• Sodium restriction• Fluid restriction• Increase dietary fiber• Small frequent meals with bedtime snack

MEASURING YOUR FOOD To make sure your food servings are the right size, you can

use: Food scale, Measuring cups, Measuring spoons

This much is the same as 3 ounces 1 serving of meat, chicken, turkey or fish

1 cup 1 serving of cooked vegetables salads casseroles or stews, such as chili with beans milk

½ cup 1 serving of fruit or fruit juice starchy vegetables, such as potatoes or corn pinto beans and other dried beans rice or noodles cereal

1 ounce 1 serving of snack food

cheese (1 slice)

1 tablespoon 1 serving of salad dressing cream cheese

1 teaspoon 1 serving of

margarine or butter oil mayonnaise

Case Scenario

CASE I• 45 year old male, diagnosed to have chronic

hepatitis B carrier with decompensated cirrhosis admitted due to body weakness and anorexia

• Vital signs: BP = 90/60HR = 109RR = 28T = 37.3CHeight = 5’6 (1.67meters)Weight = 45kgs

Physical Examination

• Pertinent findings:– Dry skin, Pale conjunctivae, Icteric sclerae– + spider angiomata– Abdomen is globularly tense, +caput

medusae, + ascites- + Grade 2 bipedal edema with skin

hyperpigmenation

Laboratory Examinations

• CBC: Hgb = 9.7mg % Hct = 36• Albumin = 2.3 g/dl• Protime = >3 sec prolonged• Total Bilirubin = 7.6 gm/dl• Sodium = 3.0• Potassium = 3.1

What is the nutritional status of the patient?

What is the nutritional status of the patient?

Ht = 5’ 6” = 66 inches x 2.54 = 167.64 cmDBW = Ht – 100

= 167.64 – 100 = 67.64DBW = 67.64 – 6.764 = 60.87 or 61 kg

What is the nutritional status of the patient?

% DBW = Actual body weight x 100 Desirable body weight

= 45 kg x 100 61 kg = 74 % Moderate Malnutrition

How will you manage the nutritional status of the patient?

How will you manage the nutritional status of the patient?

• High calories (35 kcal/kg/d)• Protein restriction (0.6g to 0.8g/kg/d)• Sodium restriction• Small frequent meals and bedtime snack• Vitamin and mineral supplements as

needed

How will you maintain the ideal weight of the patient despite her clinical

condition?

How will you maintain the ideal weight of the patient despite her clinical

condition?

DIET CALORIES PROTEIN(g)Low CHON diet 1855 49Aminoleban Oral 320 20 (1-1/2 sachet)TOTAL 2175 69 (35kcal) (1.1g)

CASE 2• 52 year old female, diabetic for more than 20

years, hypertensive, admitted due to poor appetite

• Vital signs: BP = 150/90 mm HgHR = 105RR = 30T = 37.0Height = 5’5 (1.64 meters) Weight = 40kgs

Physical Examination

• Pertinent findings:– Pale conjunctivae, dry skin, anicteric sclerae– + spider angioma– Abdomen is flabby and soft, liver edge is

nodular– + grade 1 bipedal edema, +palmar erythema

Laboratory Examinations• CBC: Hgb = 10.9 mg %• Serum albumin = 2.8 gm• Sodium = 2.8 gm/dl• Potassium = 3.8 gm/dl• FBS = 8.0• Creatinine = 2.3 mg/dl• Ultrasound of the whole abdomen showed

incidental finding of liver cirrhosis with ascites

What is the current nutritional status of the patient?

What is the current nutritional status of the patient?

Ht = 5’ 5” = 65 inches x 2.54 = 165.1 cmDBW = Ht – 100

= 165.1 – 100 = 65.1DBW = 65.1 – 6.51 = 58.59 or 59 kg

What is the current nutritional status of the patient?

% DBW = Actual body weight x 100 Desirable body weight

= 40 kg x 100 59 kg = 68 % Severe Malnutrition

How will you manage the nutritional derangement of the patient?

How will you manage the nutritional derangement of the patient?

• High calorie (35 kcal/kg)• No protein restriction (1.1 g/kg/d)• No simple sugar, complex carbohydrates• Increase fiber intake• Sodium restriction• Frequent small meals

How will you maintain the ideal weight of the patient despite her clinical

condition?

How will you maintain the ideal weight of the patient despite her clinical

condition?

Calories = 2065 (35 kcal/kg) CHON = 65 gm (1.1g/k/d)

CHO = 295 gm (65% NPC)Fat = 70 gm (35% NPC)