Final Ctn Liver Cirrhosis Meal Plan.docx

Case: RA, 55-year-old man presents to the hospital with complaints of fatigue for 2 months. The patient has a significant medical history of chronic heavy alcohol consumption of about one bottle of gin daily for around 20 years. Physical examination revealed an anorexic patient weighing 50kg and 5’4 ft tall and is oriented to person, time, place and date. The patient is also noted to have icteric sclera and loss of appetite. There were no splenomegaly, negative fluid wave and shifting dullness noted. Laboratory examination shows low hemoglobin, low sodium, elevated AST and ALT, and moderately prolonged PT. Ultrasound of the abdomen shows liver with few irregular nodules on the surface, increased echogenicity and focal atrophy. The patient is known to have a very light activity which includes seating and typing activities. Laboratory results were reported in this table: Diagnosis: Liver cirrhosis, compensated Na, 132 mEq/L K – 3.7 mEq/L Cl, 98 mEq/L Bicarbonate, 26 mEq/L BUN, 20 mg/dL SCr, 1.2 mg/dL Hgb, 11.5 g/dL

AST- 50 IU ALT – 58 IU Hct, 35% Alkaline phosphatase -140 IU LDH - 320 IU Total Bilirubin, 1.8 mg/dL PT, 16 seconds (INR 1.8)

COMPUTATIONS A. Ideal Body Weight B. Energy for BMR 50 kg + 2.3 kg (for each inch over 5 Harris – Benedict Equation BMR = 66 + (13.7 x weight in kg) + (5 x ht. in cm) – (6.8 x feet) 50 kg + (2.3 kg x 4) age in years) =66+ (13.7 x 50 kg) + (5 x 162.56 cm) – (6.8 x 55 y/o) IBW=59.2 kg =66 + (685) + (812.8) – (374) =1189.8 or 1190kcal C. % Ideal Body Weight ABW / IBW x 100 % 50 kg / 59kg x 100 % % IBW =84.75 %

D. Total Caloric Requirement TCR = BMR x Activity Factor x Injury Factor *Activity Factor = 1.3 *Injury Factor = 1.4 BMR = 1190 kcal TCR = 1,190 kcal x 1.3 x 1.4 = 2165.8 or 2170 kcal

GUIDELINES FOR MEETING NUTRITIONAL GOALS Non-protein Energy (Kcal/kg/day) Patients with compensated cirrhosis

25-35 kcal/kg/day

Patients with complicated cirrhosis 35-40 kcal/kg/day assoc. with malnutrition

Protein Intake (g/kg/day) 1-1.2 g/kg/day 1.5 g/kg/day

If stage I or II Hepatic Encephalopathy is present

0.5-1.5 g/kg/day

If stage III or IV Encephalopathy is present

0.5 g/kg/day

Hepatic

PRINCIPLES FOR DIETARY MANAGEMENT(Liver Cirrhosis, compensated) Chronic liver disease is often associated with muscle and body fat loss. So a high potein diet is important for people with chronic liver disease as the protein is used to maintain muscles and body tissues (including the liver) and to keep the function of the body normally. Patients with liver cirrhosis should receive 35–40kcal/kg per day[9] with a protein intake up to 1.6g/kg per day.[1,9] For those with compensated liver cirrhosis this goal can be achieved with a normal diet without any restrictions in carbohydrates, proteins or fat Eating six to eight smaller meals and snacks throughout the day can help you get more nutrition than having three normal sized meals. Small frequent meals is recommended. The patient should receive a late evening snack to compensate for the overnight fasting period and to avoid gluconeogenesis Replace tea, coffee or water with fluids that provide energy (such as milk, juice) especially if you are on a fluid restriction. Add eggs, legumes, yoghurt or low salt cheese to your meat dishes or salads. Oral feeding with the addition of oral supplements is generally the rule in many hospital units as far as cirrhotic patients are concerned. The study of Campillo et al. showed that oral dietary intake improved after a long hospital stay with oral nutritional support and the help of a dietician within a period of 2–3 weeks in the majority of patients. It is important to state that alcohol abstinence should be seriously considered. Alcohol intake not only aggravates liver function but has a potential negative role in deteriorating malnutrition.

References: health.qld.gov.au http://www.medscape.com/viewarticle/575158_4 Distribution of CHO, CHON and Fats PROTEIN REQUIREMENT Protein requirement = 1.2 g/kg x 50kg = 60g = 60g x 4 = 240 kcal for proteins Energy from Non-protein = TER- Kcal from protein = 2170 kcal - 240kcal

=1930 kcal CHO (70%) = 1930 x 0.70 = 1351 kcal = 1351 /4 = 337.75 grams or 338 grams Fats (30%) = 1930 x 0.30 = 579 kcal = 579/9 = 64.33 grams or 64 grams Diet RX: Kcal 2170

CHO 338g (62%)

CHON 60g (11%) 338g

FOOD Veg A Veg B Fruits Milk Sugar 338g-173= 165/23= 7 exchange Rice 75-52= 23/8= 3 exchange meat Meat, LF 62 -42= 20/5 = 4 exchange fat Fats Total FOOD

No. of exchange

Veg A Veg B Fruits Milk Sugar Rice Meat, LF Fats TOTAL

4 3 8 4 6 7 1 4 37

FATS 64g (27%)

60g

64g

EXCHANGE 4 3 8 4 6

CHO 6 (3) 9 (3) 80 (10) 48 (12) 30 (5) 173

CHON 2 (1) 2 (1) 32 (8) -

FATS 40 (10) -

ENERGY 32 44 320 680 120

7

161 (23)

16(2) 52

-

708

1

-

8 (8)

2(2) 42

50

4 37

334

60

20 (5) 62

180 2134

Breakfast

1 2 2 2 2

9

AM Snack

Lunch

2

2 1 2

1

PM Snack

2 1 1 1

8

2 3

Late Evening Snack

2

1 1 2 1

7

5

1 2 1

2 5

Dinner

24 hour meal plan FOOD Veg B

EXCHANGE 1

Fruits

2

Milk Sugar

2 2

Rice

2

TOTAL

9

FOOD Fruits

EXCHANGE 2

Sugar

1

Fats

2

BREAKFAST MENU CHO ½ cup cooked 3 mashed kalabasa 2 medium slice 10 20 x 6 x 2 cm, ripe papaya 8 24 4 tsp 10 Jam/Jelly/Preserve 4 pcs 7 x 4cm pan 46 de sal 103

AM SNACK MENU CHO 2 small 10 x 4 20 cm saging saba 1 tsp brown 10 sugar 2 ½ medium 12 x 7 cm avocado 30

TOTAL

CHON 1

FAT

16

10

4 21

10

CHON

FAT

10 10

LUNCH FOOD

EXCHANGE

MENU

CHO

CHON

VEG A

2

6

2

VEG B

1

3

1

FRUITS

2

2 CUP, COOKED (45G) AMPALAYA, DAHON AT BUNGA (BITTERMELON) MIXED WITH NILAGANG ATAY ½ CUP, COOKED (45G) KALABASA, BUNGA (SQUASH FRUIT) MIXED WITH NILAGANG ATAY 6 SEGMENTS 8X4X3 CM SUHA(POMELO)

RICE

2

1 CUP COOKED RICE

46

MEATS,LF

1

1 SLICE 4 ½ X 3 X1 CM ATAY (LIVER) OF PORK NILAGA

TOTAL

8

FAT

20

75

4 8

2

15

2

PM SNACK FOOD

EXHANGE

MENU

CHO

SUGAR

1

½ TBSPS UBE HALAYA

5

FATS

2

1 MEDIUM 12X7CM AVOCADO RED

TOTAL

3

CHON

FAT 10

5

10

FOOD VEG A

EXCHANGE 2

VEG B FRUITS

1 1

MILK RICE

1 2

TOTAL

7

DINNER MENU 1 CUP, RAW PETSAY SLICE IN TINY BITS (CABBAGE) 25G MIXED WITH SEAWEED WRAP ½ CUP DRIED GAMET (SEAWEED) WRAPPER 1 MEDIUM SLICE 11X6 CM MANGO, MEDIUM, RIPE WRAPPED WITH SEAWEED AND RICE. 1 GLASS COW’S FRESH MILK 1 ½ OF SLICE BIKO 10 X 5X1 CM MIXED WITH PETSAY AND MANGO WRAPPED BY SEAWEEDS

CHO 3

CHON 1

FATS

3 10

1

12 46

8 4

10

74

14

10

LATE EVENING SNACK FOOD

EXCHANGES

MENU

CHO

CHON

FATS

FRUITS

1

1 CUP STRAWBERRY

10

MILK SUGAR

1 2

4 LEVEL TEASPOONS POWDERED MILK ½ BAR – 8CM PEANUT BRITTLE

12 10

8

10

RICE TOTAL

1 5

1 SLICE- 3X2X2CM CHOCOLATE CAKE

23 55

2 10

10