1. Mr. S experienced pain in his upper and lower quadrants similar to more than 50% of cases of
Crohn’s disease involving both the distal ileum and the colon. Diarrhea and abdominal pain are
both extremely common symptoms of Crohn’s disease.
Explanation of Laboratory Findings:
Lab value Normal range Patient Value Reason for Deviation
Albumin 3.4 – 5.4 g/dL 3.2 g/dl IBD
Prealbumin 15 – 35 mg/dL 11.0 mg/dl Insufficient protein
Glucose <100 mg/dL 82 mg/dl Normal
Na+ 135 – 145 mEq/L 136 mEq/L Normal
K+ 3.5 – 5.0 mEq/L 3.7 mEq/L Normal
Cl- 96 – 106 mEq/L 101 mEq/L Normal
Creat 0.7 – 1.3 mg/dL 1.8 mg/dL Impaired Kidney
BUN 7 – 20 mg/dL 11 mg/dl Normal
AST 40 – 20 U/L 35 U/L Kidney or lung damage
ALT 7 – 55 U/L 22 U/L Normal
Alk Phos 25 – 100 U/L 120 U/L Damage to liver cells
CRP 1 – 3 mg/L 2.8 mg/dl Normal
Cholesterol <200 mg/dL 149 mg/dl Normal
LDL-C <70 mg/dL 101 mg/dl Bad diet/inactivity
HDL-C >60 mg/dL 48 mg/dl Bad diet/inactivity
Hgb 13.5 – 17.5 g/dL 12.9 g/dl Kidney problems
Hct 38.8 – 50% 38.9% Normal
MCV 80 – 95 fl 87 fl Normal
WBC 4,500 – x103/mm3 11.1 x103/mm3 Immune disorder
RBC 4.7 – 6.1 x106/mm3 4.9 x106/mm3 Normal
Ferritin 24 – 336 ng/ml 16 ng/ml Iron deficiency
PT 2.0 – 3.0 sec 15 sec Overactive proteins/liver problems
Vit D 20 – 50 ng/ml 22.7 ng/ml Normal
Potential nutritional consequences of Crohn’s Disease include diarrhea, fever, weight loss,
anemia, food intolerances, malnutrition, growth failure, and extraintestinal manifestations.
Mr S was previously prescribed a low fiber diet in the period following diagnosis because fiber is
a solid food that doesn’t digest or absorb well, it is hard to get through the narrow areas that are
present in a patient with Crohn’s.
Most people who are candidates for SBS have a loss of 70% - 75% of the small bowel. Although
since Mr. S has recently lost a lot of weight, he might be at risk for SBS because of his inability
to maintain nutrition needs with food intake.
If patient develops SBS subsequent to surgery, recommended MNT would be small, frequent,
mini meals (6 – 10 per day). Tube feeding if needed. Increase glutamine in diet for small

2. intestinal enterocytes. Normal balance of protein, fat and CHO. Avoid lactose, concentrated
sweets and caffeine. Supplements if needed.
Mr. S’s energy and protein requirement post-op (when he is on TPN)
109.8 g, 1820 kcal
In order to adjust this requirement when he begins to eat solid food (assume SBS) we would
need to decrease his protein levels after most of the healing has occurred unless his lab results
still indicate a low prealbumin level and monitor his albumin and prealbumin levels.
PES statements:
Low prealbumin levels due to insufficient protein intake/absorption. Low levels seen in lab
reports. Increase prealbumin levels by at least 4 mg/dl. Increase protein concentrations if on
TPN, increase uptake orally if no longer on TPN.
Low prealbumin levels due to poor diet, milk allergy and lack of appetite. Lab levels indicated
low levels, assessment indicated no appetite and milk intolerance. Increasing prealbumin levels
to appropriate levels is the goal. Because of his lack of appetite, EN might alternative.