Guest guest Posted December 12, 2011 Report Share Posted December 12, 2011 Hi all! I have assummed the care of a patient who had a gastric bypass over 5 years ago and did very well with weight loss and maintenance of adequate nutritional status until a couple years ago when diagnosed with lung carcinoid and pancreas mets. She had to undergo a whipple procedure this past June. Starting in October, she noticed lower extremity swelling and went to her cardiologist who also diagnosed her with pericardial effusion following an echo. Her PCP and cardiologist felt both of these were the result of protein malnutrition. Her most recent labs second this. Labs from 12/7/11: Albumin 3.0, Total protein 4.9, prealbumin 13, K+ 3.0, MCHC 31.5, Ca 8.1, AST 42, ALT 50, TIBC 248, all others WNL. I have extensive experience with bariatric surgery patients, but not bariatric surgery patients who've had a second malabsorptive surgery. Prior to this second set of labs we met and her typical intake indicated 70-75 g protein/d with a daily variety of fruits, vegetables, eggs, lean meat and chicken, beans, cheese, nuts, and some whole grains. I encouraged her to increase her protein intake by 30 g/d with supplements (bars and shakes) if necessary. I am not sure she can physically fit in anymore food or fluid. The labs from 12/7 were after almost 3 weeks of increasing her protein as recommended. Her albumin is virtually unchanged (0.1 increase) and they didn't run a prealbumin prior to 12/7, so I am not sure what, if any, change there is with that. She did tell me she felt the swelling has increased since we met. Any tips with this case would be greatly appreciated! Thanks! Kate Rountree, RD, LDN Rountree Dietetics Lafayette, LA kate@... Quote Link to comment Share on other sites More sharing options...
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