Clinical Cases in Dietetics

The introduction 1

A casebook approach 3

Preface 3

Introduction 4

How to use this book 5

Making the most of the cases 6

What you will need 7

Making sense of the clinical information 7

Interpretation of the clinical chemistry 8

Getting started 9

Adopting an analytical approach to the cases 10

Adopting an analytical approach to the diaries 10

Adopting an analytical approach to the referrals 11

Acknowledgements 11

The cases (and contexts) 15

Case 1 Gillian Mercer 17

Diabetes

Case 2 The Odessa fi le 18

Renal disease, haemodialysis

Case 3 Darshan 19

Renal disease, peritoneal dialysis

Case 4 Professor Plum 20

Renal disease, pre-dialysis

Case 5 Annie 21

Renal disease, pre-dialysis

Case 6 Jon 23

Obesity

Case 7 Mr Smart 24

Obesity, renal calculi

Case 8 Susan Ritzio 25

Ulcerative colitis

Case 9 Mr Rodger 26

Irritable bowel syndrome

Case 10 Pauline Trotter 27

Obesity, pharmacological management

Case 11 Harriet Baker 28

Obesity, metabolic issues

Case 12 Mr Cunningham 29

Functional dyspepsia, weight loss

Case 13 Mrs Rose Petroni 30

Obesity, infection, wound healing

Case 14 Linda Middlemiss 31

Arthralgia, food intolerance

Case 15 Josh Herriot 32

Coeliac disease, new diagnosis

Case 16 Carly Carpenter 33

Disordered eating in adulthood

Case 17 Mr Tony Marshall 34

Obesity, renal calculi

Case 18 Carrie West 35

Bulimia nervosa

Case 19 Holly Shakespeare 36

Obesity, polycystic ovarian syndrome

Case 20 Barry Morgan 37

Post-surgical weight loss, appetite failure

Case 21 Rayan Hussein 39

Iron-deficiency anaemia, ethnic diet

Case 22 Peggy 40

Dementia

Case 23 Cain 41

Cerebral palsy

Case 24 Abel 42

Down’s syndrome

Case 25 Lucinda Smythe 45

Reactive hypoglycaemia

Case 26 Mrs Jolly 46

Type 2 diabetes

Case 27 Cordelia 47

Irritable bowel syndrome

Case 28 Josh 48

Human immunodeficiency virus (HIV)

Case 29 Murdo MacKenzie 49

Cardiovascular and colorectal cancer risk

Case 30 Anna Walker 50

Bone health

Case 31 Shirley Stringfellow 51

Angioedema, salicylate exposure

Case 32 Family tree 52

Diet and lifestyle change over time

Case 33 RMS Titanic 53

Dietary judgement of menus

Case 34 Maria von Twigg 56

Anorexia nervosa

Case 35 Alan Wanderlust 57

Colorectal cancer

Case 36 George and Dragon 58

Dementia, weight loss

Case 37 Mandy Morton 59

Ventilated patient, enteral feeding

Case 38 Betty Meldrew 60

Breast cancer, weight loss

Case 39 Sheila Borrowman 61

Chronic pancreatitis, diabetes

Case 40 Miss Taylor 62

Cancer of lung, cachexia

Case 41 Mary Glover 63

Coeliac disease, lymphoma

Case 42 Pamela Nightingale 64

Chronic fatigue syndrome

Case 43 Jenny Friel 65

Crohn’s disease

Case 44 Alan Lehman 66

Type 1 diabetes

Case 45 Mark 67

Attention deficit hyperactivity disorder

Case 46 Mary Montgomery and Mary Hamilton 68

Oral pathology, nutritional issues

Case 47 Sara Bloomfield 69

Chronic obstructive airways disease

Case 48 Jonny Morgan 70

Thinness, faulty diet and health risk

Case 49 Patrick Foley 71

Burn injury

Case 50 Doris Blessing 72

Type 2 diabetes, pressure sore

Case 51 Rupert St. John Stevens 74

Alcoholic liver disease

Case 52 Mrs Morningside 75

Chronic peptic ulceration

Case 53 Mandy Goodenough 76

Gestational diabetes

Case 54 Mrs Jessie Banks 77

Renal disease, type 2 diabetes

Case 55 Toby Harris 80

Fractured mandible

Case 56 John Thomson 81

Motor neurone disease

Case 57 Daisy Marsden 82

Alcoholic liver disease

Case 58 Freda Ingram 84

Obesity, cognitive behavioural therapy

Case 59 Susan O’Connel 85

Crohn’s disease, anorexia

Case 60 Dominic Pruz 87

Ulcerative colitis, loop ileostomy

Case 61 Rudi Jordache 88

Obesity, behaviour modification

Case 62 Glenda Henderson 90

Gestational diabetes, obesity

Case 63 Daniel Borden 91

Head injury, nutritional support

Case 64 Shaun Gascoine 92

Oesophageal carcinoma

Case 65 Frank Calder 94

Type 1 diabetes, overweight

Case 66 Stanislaw Roza 95

Hypertension, ethnic diet, health risk

Case 67 Peter Donnelly 96

Overweight, hypertension

Case 68 John Mortimer 98

Stroke

Case 69 Maude Ashby 99

Stroke, clinical chemistry

Case 70 Christopher Smith 100

Terminal cancer, palliative care

The diaries (and contexts) 103

Diary 1 Weight loss, diet patterns 105

Diary 2 Migraine, diet exclusion 106

Diary 3 Type 2 diabetes, diverticulitis 108

Diary 4 Irritable bowel syndrome 109

Diary 5 Coronary artery disease, health risk 110

Diary 6 Hypertension, renal calculi 111

Diary 7 Reactive hypoglycaemia 113

Diary 8 Bowel habit, dietary influences 114

Diary 9 Constipation, hunger 116

Diary 10 Obesity 117

The referrals (and contexts) 119

Referral 1 Letter 121

Mrs Brown (managing serum cholesterol levels)

Referral 2 Letter 122

Ms Philpott (irritable bowel syndrome)

Referral 3 Letter 123

Mrs Young (obesity, conflict with medications)

Referral 4 Letter 124

Mrs Leadbetter (coeliac disease, iron-deficiency anaemia)

Referral 5 Letter 125

Mr Grant (obesity, hypothyroidism)

Referral 6 Letter 126

Ms Horvig (abdominal pain, elimination diet)

Referral 7 Nutritional screening 127

Mr Al-Khatim, Room 221 (prostatic cancer, chemotherapy)

Referral 8 Nutritional screening 129

Mrs Collins, Room 401 (anterior resection of bowel)

Referral 9 Nutritional screening 131

Mr Roundman, Room 613 (type 1 diabetes, infection)

Referral 10 Handwritten note 133

Mrs Lundquist, Room 408 (gestational diabetes)

The mini-cases (and contexts) 135

Mini-case 1 Multiple sclerosis, obesity 137

Mini-case 2 Anterior resection of bowel 137

Mini-case 3 Obesity, weight control 137

Mini-case 4 Obesity, nutritional screening 137

Mini-case 5 Coeliac disease, peer-reviewed information 138

Mini-case 6 Type 2 diabetes, dietary compliance 138

Mini-case 7 Obesity, aggressive weight loss 138

Mini-case 8 Hip replacement, nutritional status 138

Mini-case 9 Unconscious patient, feeding issues 139

Mini-case 10 Weight loss, older client 139

The commentaries 141

The commentaries: the cases 143

Case 1 Gillian Mercer 143

Diabetes

Case 2 The Odessa file 144

Renal disease, haemodialysis

Case 3 Darshan 145

Renal disease, peritoneal dialysis

Case 4 Professor Plum 145

Renal disease, pre-dialysis

Case 5 Annie 146

Renal disease, pre-dialysis

Case 6 Jon 148

Obesity

Case 7 Mr Smart 149

Obesity, renal calculi

Case 8 Susan Ritzio 150

Ulcerative colitis

Case 9 Mr Rodger 150

Irritable bowel syndrome

Case 10 Pauline Trotter 151

Obesity, pharmacological management

Case 11 Harriet Baker 152

Obesity, metabolic issues

Case 12 Mr Cunningham 153

Functional dyspepsia, weight loss

Case 13 Mrs Rose Petroni 153

Obesity, infection, wound healing

Case 14 Linda Middlemiss 154

Arthralgia, food intolerance

Case 15 Josh Herriot 155

Coeliac disease, new diagnosis

Case 16 Carly Carpenter 156

Disordered eating in adulthood

Case 17 Mr Tony Marshall 158

Obesity, renal calculi

Case 18 Carrie West 159

Bulimia nervosa

Case 19 Holly Shakespeare 160

Obesity, polycystic ovarian syndrome

Case 20 Barry Morgan 161

Post-surgical weight loss, appetite failure

Case 21 Rayan Hussein 161

Iron-deficiency anaemia, ethnic diet

Case 22 Peggy 162

Dementia

Case 23 Cain 163

Cerebral palsy

Case 24 Abel 164

Down’s syndrome

Case 25 Lucinda Smythe 165

Reactive hypoglycaemia

Case 26 Mrs Jolly 166

Type 2 diabetes

Case 27 Cordelia 167

Irritable bowel syndrome

Case 28 Josh 168

Human immunodeficiency virus (HIV)

Case 29 Murdo MacKenzie 169

Cardiovascular and colorectal cancer risk

Case 30 Anna Walker 170

Bone health

Case 31 Shirley Stringfellow 171

Angioedema, salicylate exposure

Case 32 Family tree 172

Diet and lifestyle change over time

Case 33 RMS Titanic 172

Dietary judgement of menus

Case 34 Maria von Twigg 173

Anorexia nervosa

Case 35 Alan Wanderlust 174

Colorectal cancer

Case 36 George and Dragon 174

Dementia, weight loss

Case 37 Mandy Morton 175

Ventilated patient, enteral feeding

Case 38 Betty Meldrew 176

Breast cancer, weight loss

Case 39 Sheila Borrowman 177

Chronic pancreatitis, diabetes

Case 40 Miss Taylor 178

Cancer of lung, cachexia

Case 41 Mary Glover 179

Coeliac disease, lymphoma

Case 42 Pamela Nightingale 179

Chronic fatigue syndrome

Case 43 Jenny Friel 180

Crohn’s disease

Case 44 Alan Lehman 181

Type 1 diabetes

Case 45 Mark 181

Attention deficit hyperactivity disorder

Case 46 Mary Montgomery and Mary Hamilton 182

Oral pathology, nutritional issues

Case 47 Sara Bloomfield 183

Chronic obstructive airways disease

Case 48 Jonny Morgan 184

Thinness, faulty diet and health risk

Case 49 Patrick Foley 185

Burn injury

Case 50 Doris Blessing 186

Type 2 diabetes, pressure sore

Case 51 Rupert St. John Stevens 187

Alcoholic liver disease

Case 52 Mrs Morningside 188

Chronic peptic ulceration

Case 53 Mandy Goodenough 189

Gestational diabetes

Case 54 Mrs Jessie Banks 190

Renal disease, type 2 diabetes

Case 55 Toby Harris 191

Fractured mandible

Case 56 John Thomson 192

Motor neurone disease

Case 57 Daisy Marsden 193

Alcoholic liver disease

Case 58 Freda Ingram 194

Obesity, cognitive behavioural therapy

Case 59 Susan O’Connel 195

Crohn’s disease, anorexia

Case 60 Dominic Pruz 195

Ulcerative colitis, loop ileostomy

Case 61 Rudi Jordache 196

Obesity, behaviour modification

Case 62 Glenda Henderson 197

Gestational diabetes, obesity

Case 63 Daniel Borden 198

Head injury, nutritional support

Case 64 Shaun Gascoine 199

Oesophageal carcinoma

Case 65 Frank Calder 200

Type 1 diabetes, overweight

Case 66 Stanislaw Roza 201

Hypertension, ethnic diet, health risk

Case 67 Peter Donnelly 202

Overweight, hypertension

Case 68 John Mortimer 204

Stroke

Case 69 Maude Ashby 205

Stroke, clinical chemistry

Case 70 Christopher Smith 206

Terminal cancer, palliative care

The commentaries: the diaries 209

Diary 1 Weight loss, diet patterns 209

Diary 2 Migraine, diet exclusion 209

Diary 3 Type 2 diabetes, diverticulitis 210

Diary 4 Irritable bowel syndrome 210

Diary 5 Coronary artery disease, health risk 211

Diary 6 Hypertension, renal calculi 211

Diary 7 Reactive hypoglycaemia 212

Diary 8 Bowel habit, dietary influences 213

Diary 9 Constipation, hunger 213

Diary 10 Obesity 214

The commentaries: the referrals 215

Referral 1 Letter 215

Mrs Brown (managing serum cholesterol levels)

Referral 2 Letter 216

Ms Philpott (irritable bowel syndrome)

Referral 3 Letter 216

Mrs Young (obesity, conflict with medications)

Referral 4 Letter 217

Mrs Leadbetter (coeliac disease, iron-deficiency anaemia)

Referral 5 Letter 218

Mr Grant (obesity, hypothyroidism)

Referral 6 Letter 219

Ms Horvig (abdominal pain, elimination diet)

Referral 7 Nutritional screening 220

Mr Al-Khatim, Room 221 (prostatic cancer, chemotherapy)

Referral 8 Nutritional screening 220

Mrs Collins, Room 401 (anterior resection of bowel)

Referral 9 Nutritional screening 221

Mr Roundman, Room 613 (type 1 diabetes, infection)

Referral 10 Handwritten note 222

Mrs Lundquist, Room 408 (gestational diabetes)

The commentaries: the mini-cases 223

Mini-case 1 Multiple sclerosis, obesity 223

Mini-case 2 Anterior resection of bowel 223

Mini-case 3 Obesity, weight control 224

Mini-case 4 Obesity, nutritional screening 224

Mini-case 5 Coeliac disease, peer-reviewed information 225

Mini-case 6 Type 2 diabetes, dietary compliance 225

Mini-case 7 Obesity, aggressive weight loss 226

Mini-case 8 Hip replacement, nutritional status 226

Mini-case 9 Unconscious patient, feeding issues 227

Mini-case 10 Weight loss, older client 228

The appendices: clinical information and reference data 231

Appendix 1 Weights and measures 233

Appendix 2 Dietary data 237

Appendix 3 Body mass index 243

Appendix 4 Anthropometric data 245

Appendix 5 Predicting energy requirements 248

Appendix 6 Clinical chemistry 253

Appendix 7 Abbreviations 260

The appendices: tools 265

Appendix 8 Algorithm for treating malnutrition: decision-making tool 267

Appendix 9 Malnutrition universal screening tool (‘MUST’) 268

Appendix 10 Balance of good health: sensible eating tool 274

Index 275