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James D. is referred to your outpatient clinic following a recent admit for complications related to his DM type 2. James is a 38 YOWM, 5’9” 210# with a L BKA. He has had multiple admissions to the hospital due to PVD, peripheral neuropathy and dehydration. His most recent admission was for treatment of a non-healing ankle wound that began as a blister and has progressed into a stage 3-pressure ulcer. His foot is cyanotic and the admission was for the purpose of debridement. The physician is quite concerned due to the advanced level of complications in such a young patient. She has referred the patient to your clinic for aggressive outpatient intervention and education. Lab values: Albumin: 2.2 mg/dl Prealbumin 8.9 mg/dl BUN 52 mg/dl Creatinine 3.1 mg/dl Anion gap 12 H/H 10.8/32 Fasting Blood glucose: 210 mg/dl K 4.2 mg/dl Na 136 Osmolality 289 mMol/dl 24 hour recall: 2 scrambled eggs 3 slices bacon 2 slices toast with butter 2 tsp jelly 8 ounces orange juice 1 cup whole milk Large cheeseburger (Mcdonald’s or Burger King) Large fries 2-3 pkgs ketchup apple pie 24 ounce coke 4 slices deep dish pepperoni pizza 3-12 ounce beers 6 oreo cookies Complete an assessment. This includes anthropometric, dietary and biochemical parameters. Include estimates of Kcal, protein and fluid needs. Assess the needs compared to the intakes. Is his diet adequate?


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