A case Presentation on Lactic Acidosis, Hyperammonemia & Vitamin D Defficiency Mehrima Binte Hasan, hailing from a village of Cumilla presents with- complains of development delay, behavioral problems. According to her parents, she was well stable after birth until before two years. In past two years, she is being less responsive to others gradually. In addition, she is not physically growing like other kids, which concerns her parents. Age: 7y 3m Height: 114 cm (Less height for Age) Weight: 16 kg (Less weight for Height) EBW: 19.4 kg

1. Title
Introduction
Patient
Profile
Assessment
&
Diagnosis
Nutrition
Therapy
Special
Instructions
Thank
you
Case Presentation
On
Lactic Acidosis & Hyperammonemia
Presented By
Nabila Binte Kabir
Intern Dietitian
BIRDEM General Hospital

2. Title
Introduction
Patient
Profile
Assessment
&
Diagnosis
Nutrition
Therapy
Special
Instructions
Thank
you
• Lactic acidosis is a form of metabolic
acidosis that begins when a person
overproduces or underutilizes lactic acid
and their body is not able to adjust to
these changes.
• Hyperammonemia refers to excess
levels of ammonia in the blood. It is a
dangerous condition that may lead
to brain injury and death.

3. Title
Introduction
Patient
Profile
Assessment
&
Diagnosis
Nutrition
Therapy
Special
Instructions
Thank
you
Mehrima Binte Hasan, hailing from a village
of Cumilla presents with- complains of
development delay, behavioral problems.
According to her parents, she was well
stable after birth until before two years.
In past two years, she is being less
responsive to others gradually. In addition,
she is not physically growing like other
kids, which concerns her parents.
Age: 7y 3m
Height: 114 cm (Less height for Age)
Weight: 16 kg (Less weight for Height)
EBW: 19.4 kg

4. Title
Introduction
Patient
Profile
Assessment
&
Diagnosis
Nutrition
Therapy
Special
Instructions
Thank
you
Assessment
Vitamin D
S HBC
S. Iron
Ferritin
Lactic Acid
P. Ammonia
TSH
Free T4
: 19.06 ng/mL (30-40 ng/mL)
: 81.8 umol/L (40.8-76.6 umol/L)
: 18.4 umol/L (6.6-26.0)
: 9 ng/mL (15-150 ng/mL)
: 24.5 umol/L (3.6-18.0 umol/L)
: 53 umol/L (9-30 umol/L)
: 5.10 uIU/mL (0.37-6.00 uIU/mL)
: 12.15 pmol/L (9.14-23.18 pmol/L)
Diagnosis
Short stature.
Underweight.
High Serum Haemoglobin Binding Capacity.
Vitamin D deficiency.
Lactic acidosis.
Hyperammonemia.

5. Title
Introduction
Patient
Profile
Assessment
&
Diagnosis
Nutrition
Therapy
Special
Instructions
Thank
you
Calorie : 1800 kcal/day
Diet Type : High Protein (1.2g/kg body wt./Day),
Lactic acid & Ammonia lowering Diet.
Cooking oil : 20-25ml
Water : 6-8 glasses
Dietary
Restrictions
: Milk and Milk products (Cream,
Yogurt, Butter, Cheese, Buttermilk, Ice
cream, Cake, Pastry, Chocolates)
: Pulses, Nuts, Seeds and derived
products
: Extra salt, Processed foods, Frozen
foods, Sauces, Tasting salt

6. Title
Introduction
Patient
Profile
Assessment
&
Diagnosis
Nutrition
Therapy
Special
Instructions
Thank
you
 Follow medical nutrition therapy strictly.
 Have homemade, customized foods.
 Take lactose free milk as alternate to milk.
 Have more fibrous and green fruits &
vegetables.
 Exercise for at least 30-40 minutes (Sports/
Running/Swimming).
 Sunbathe for at least 30 minutes a day.
 Monitor weight routinely.

7. Title
Introduction
Patient
Profile
Assessment
&
Diagnosis
Nutrition
Therapy
Special
Instructions
Thank
you
Our food should be our medicine & our
medicine should be our food.
-Hippocrates