RE: CASE:pt c/o chronic nausea

[Guest guest]

Recommend a Psych consult.

Beth Whelan, MS,RD,LD

Outpatient Dietitian

Harbin Clinic

office: (706) 378-8163

fax: (706) 238-8037

 

CASE:pt c/o chronic nausea

Hi everyone!

I have a patient s/p GBypass 1 year ago. Since then she has had

multiple admissions with N/V. She has had complete GI w/u over the

course of the year. She did end up with a chole last admission.

However, she continues to c/o N/V. Cureently on TPN. Docs are not

doing a full w/u yet and are pointing towards an eating d/o.

History: Consumes 1 cup of food w/ea meal. Not overeating. Forces

self to eat even though has nausea. Denies dumping (has experienced

it). Intolerance to SF products. Not taking vit/minerals b/c " i can't

swallow them " Denies eating d/o.

Data: Prealb 149. other labs wnl. Perhaps borderline iron def

developing. No B12,thiamine,etc.

Assessment: Seems to have developed a food aversion or eating

disorder and/or depression secondary to sx.

Plan: I discussed chewable vitamins w/pt. Not sure if she has a def

such as thiamine. Continue TPN for now. Asked Docs to r/o

deficiencies and encourage future compliance w/vit/minerals.

I told the pt that I would be discussing her case with all of you.

Hopefully You can provide some insight as to anything I am missing.

Thank You!!

Amy Pirozek

[Guest guest]

you might want to check for a narrowing at the anastomosis--this happens quite

frequently which can often cause n/v.

Karey Schutte, RD

Denver Health Medical Center

Denver, Colorado

CASE:pt c/o chronic nausea

Hi everyone!

I have a patient s/p GBypass 1 year ago. Since then she has had

multiple admissions with N/V. She has had complete GI w/u over the

course of the year. She did end up with a chole last admission.

However, she continues to c/o N/V. Cureently on TPN. Docs are not

doing a full w/u yet and are pointing towards an eating d/o.

History: Consumes 1 cup of food w/ea meal. Not overeating. Forces

self to eat even though has nausea. Denies dumping (has experienced

it). Intolerance to SF products. Not taking vit/minerals b/c " i can't

swallow them " Denies eating d/o.

Data: Prealb 149. other labs wnl. Perhaps borderline iron def

developing. No B12,thiamine,etc.

Assessment: Seems to have developed a food aversion or eating

disorder and/or depression secondary to sx.

Plan: I discussed chewable vitamins w/pt. Not sure if she has a def

such as thiamine. Continue TPN for now. Asked Docs to r/o

deficiencies and encourage future compliance w/vit/minerals.

I told the pt that I would be discussing her case with all of you.

Hopefully You can provide some insight as to anything I am missing.

Thank You!!

Amy Pirozek

[Guest guest]

sorry--didn't see that the pt already had a complete GI work-up....I agree with

a psych consult.

Karey Schutte, RD

Denver Health Medical Center

Denver, Colorado

CASE:pt c/o chronic nausea

Hi everyone!

I have a patient s/p GBypass 1 year ago. Since then she has had

multiple admissions with N/V. She has had complete GI w/u over the

course of the year. She did end up with a chole last admission.

However, she continues to c/o N/V. Cureently on TPN. Docs are not

doing a full w/u yet and are pointing towards an eating d/o.

History: Consumes 1 cup of food w/ea meal. Not overeating. Forces

self to eat even though has nausea. Denies dumping (has experienced

it). Intolerance to SF products. Not taking vit/minerals b/c " i can't

swallow them " Denies eating d/o.

Data: Prealb 149. other labs wnl. Perhaps borderline iron def

developing. No B12,thiamine,etc.

Assessment: Seems to have developed a food aversion or eating

disorder and/or depression secondary to sx.

Plan: I discussed chewable vitamins w/pt. Not sure if she has a def

such as thiamine. Continue TPN for now. Asked Docs to r/o

deficiencies and encourage future compliance w/vit/minerals.

I told the pt that I would be discussing her case with all of you.

Hopefully You can provide some insight as to anything I am missing.

Thank You!!

Amy Pirozek

[Guest guest]

It was mentioned on the listserv not too long ago that N/V may present

itself with a thiamine deficiency.

SR , RD

" amprd77 "

<amypirozek@catholich

ealth.net> cc:

Subject:

CASE:pt c/o chronic

10/20/2004 03:25 PM nausea

Please respond to

BariatricNutritionDie

titians

Hi everyone!

I have a patient s/p GBypass 1 year ago. Since then she has had

multiple admissions with N/V. She has had complete GI w/u over the

course of the year. She did end up with a chole last admission.

However, she continues to c/o N/V. Cureently on TPN. Docs are not

doing a full w/u yet and are pointing towards an eating d/o.

History: Consumes 1 cup of food w/ea meal. Not overeating. Forces

self to eat even though has nausea. Denies dumping (has experienced

it). Intolerance to SF products. Not taking vit/minerals b/c " i can't

swallow them " Denies eating d/o.

Data: Prealb 149. other labs wnl. Perhaps borderline iron def

developing. No B12,thiamine,etc.

Assessment: Seems to have developed a food aversion or eating

disorder and/or depression secondary to sx.

Plan: I discussed chewable vitamins w/pt. Not sure if she has a def

such as thiamine. Continue TPN for now. Asked Docs to r/o

deficiencies and encourage future compliance w/vit/minerals.

I told the pt that I would be discussing her case with all of you.

Hopefully You can provide some insight as to anything I am missing.

Thank You!!

Amy Pirozek

[Guest guest]

thanks for responding. I forgot to mention she did have a psych eval which was negative.

-----Original Message-----From: Beth Whelan [mailto:mbwhelan@...]Sent: Wednesday, October 20, 2004 4:31 PM Subject: RE: CASE:pt c/o chronic nauseaRecommend a Psych consult. Beth Whelan, MS,RD,LDOutpatient DietitianHarbin Clinicoffice: (706) 378-8163fax: (706) 238-8037 -----Original Message-----From: amprd77 [mailto:amypirozek@...] Sent: Wednesday, October 20, 2004 4:26 PM Subject: CASE:pt c/o chronic nauseaHi everyone!I have a patient s/p GBypass 1 year ago. Since then she has had multiple admissions with N/V. She has had complete GI w/u over the course of the year. She did end up with a chole last admission. However, she continues to c/o N/V. Cureently on TPN. Docs are not doing a full w/u yet and are pointing towards an eating d/o.History: Consumes 1 cup of food w/ea meal. Not overeating. Forces self to eat even though has nausea. Denies dumping (has experienced it). Intolerance to SF products. Not taking vit/minerals b/c "i can't swallow them" Denies eating d/o.Data: Prealb 149. other labs wnl. Perhaps borderline iron def developing. No B12,thiamine,etc.Assessment: Seems to have developed a food aversion or eating disorder and/or depression secondary to sx.Plan: I discussed chewable vitamins w/pt. Not sure if she has a def such as thiamine. Continue TPN for now. Asked Docs to r/o deficiencies and encourage future compliance w/vit/minerals.I told the pt that I would be discussing her case with all of you. Hopefully You can provide some insight as to anything I am missing. Thank You!!Amy Pirozek