A 42-year-old female presents with a history of chronic pancreatitis resulting from pancreatic divisum (a congenital abnormality in which there are two pancreatic ducts instead of one). The patient has had multiple hospitalizations for acute pancreatitis. Despite placement of pancreatic stents, she has developed chronic pancreatitis (confirmed by abnormal endoscopic ultrasound and low fecal elastase) and depends on chronic pain medications. She presents for evaluation of total pancreatectomy with islet-autotransplantation. The patient is thin with apparent muscle wasting and reports that she is very fatigued and no longer able to work because of chronic pain. She describes chronic abdominal pain that worsens with eating so that she is only drinking clear soft drinks throughout the day and eating only one small meal per day. She often is constipated, but this can alternate with diarrhea with greasy, foulsmelling loose stools. Her nutritional data include height, 160 cm; weight, 40.5 kg; ideal body weight, 52.3 kg; usual body weight, 54.5 kg (1 year ago). Her 25-hydroxy-vitamin D level is ,10 ng/mL.
Nutrition Diagnostic Statements
1. Involuntary weight loss due to pain with eating as evidenced by 31-lb weight loss.
2. Altered nutrition-related laboratory values due to malabsorption as evidenced by vitamin D level ,10 ng/mL.
Interventions
Insert feeding tube (for supplemental nocturnal nutrition) Nutrition-related medication management (start pancreatic enzymes with meals) Initiate vitamin D supplement.
Monitoring and Evaluation
Monitor total energy intake. Monitor enteral intake – formula/solution (for tolerance and adequacy). Monitor vitamin A, D, E levels.