Read the following Case Study and Answer the questions that follow. Mr. Munoz is a struggling young actor in Chicago who has battled alcoholism since approximately the age of 13 years. “There was a lot of fighting in our house when I was growing up,” he says. “Entering my middle school years, it just got worse,” he says. Mr. Munoz’s parents had violent fights. Although they were both very supportive of him, he cannot remember when they ever really got along. Still, Mr. Munoz was able to get through early adolescence as an honors student and starred on both the debate team and his school’s drama club. He even starred in an elaborate production of Shakespeare’s Richard III. “In our school,” he says, “if you were a drama club kind of kid instead of an athlete, you really had to prove yourself to be a real man to avoid getting picked on. I did that by drinking. We had lots of ways to sneak booze into the places we met, and it was kind of exciting at first. You’re 15 years old, you’re outside on a starry night in a big city, you’re with your friends, and there’s plenty of alcohol. It makes you feel like a big man.” Unfortunately, his parents never seemed to notice; therefore, Mr. Munoz never got help or encouragement to stop. “After high school, my stress—and the reasons I gave myself for drinking—got worse. Those good grades got me partial scholarships to some local colleges—but mostly for drama awards, which suited me fine. But when my parents found out I wanted to be an actor, they freaked out.” When Mr. Munoz refused to pursue prelaw, as his parents insisted, they withdrew all financial (and emotional) support, and they dissolved their marriage and household at the same time. “It wasn’t all bad,” Mr. Munoz says. “I used the best partial scholarship, stayed local, living with friends, and we all went to school part time and worked part time—mostly in bars. The party just sort of—yeah—continued.” Fourteen years later, Mr. Munoz is well known enough to “make a decent living” as an actor, teaching workshops on the side and waiting tables in the lean times. Half of his friends are now married and no longer trying to pursue acting. “As the loneliness has increased, so has my drinking,” he says. “I mean, I have friends, but I never married, so those old days are just gone. I never made it to the New York stage as I’d dreamed, so all I have of those old party days is the alcohol. Only the alcohol has remained available. It tastes like nostalgia, you know?” Because he started so young and because alcohol has played such a central role in his life, for the past 2 years, Mr. Munoz has already begun battling early stages of cirrhosis. “I sort of didn’t expect this until old age,” he says with a sad smile. “Imagine my shock.” He tells the nurse that he has not had a drink for 4 months. 1.      Mr. Munoz was initially treated with neomycin, followed by lactulose. “The lactulose has worked better for me,” he says, “but it has some side effect.

1. Read the following Case Study and Answer the questions that
follow.
Mr. Munoz is a struggling young actor in Chicago who has
battled alcoholism since approximately the age of 13 years.
“There was a lot of fighting in our house when I was growing
up,” he says. “Entering my middle school years, it just got
worse,” he says. Mr. Munoz’s parents had violent fights.
Although they were both very supportive of him, he cannot
remember when they ever really got along.
Still, Mr. Munoz was able to get through early adolescence as
an honors student and starred on both the debate team and his
school’s drama club. He even starred in an elaborate production
of Shakespeare’s
Richard III.
“In our school,” he says, “if you were a drama club kind of kid
instead of an athlete, you really had to prove yourself to be a
real man to avoid getting picked on. I did that by drinking. We
had lots of ways to sneak booze into the places we met, and it
was kind of exciting at first. You’re 15 years old, you’re
outside on a starry night in a big city, you’re with your friends,
and there’s plenty of alcohol. It makes you feel like a big man.”
Unfortunately, his parents never seemed to notice; therefore,
Mr. Munoz never got help or encouragement to stop.
“After high school, my stress—and the reasons I gave myself
for drinking—got worse. Those good grades got me partial
scholarships to some local colleges—but mostly for drama
awards, which suited me fine. But when my parents found out I
wanted to be an actor, they freaked out.”

2. When Mr. Munoz refused to pursue prelaw, as his parents
insisted, they withdrew all financial (and emotional) support,
and they dissolved their marriage and household at the same
time.
“It wasn’t all bad,” Mr. Munoz says. “I used the best partial
scholarship, stayed local, living with friends, and we all went to
school part time and worked part time—mostly in bars. The
party just sort of—yeah—continued.”
Fourteen years later, Mr. Munoz is well known enough to “make
a decent living” as an actor, teaching workshops on the side and
waiting tables in the lean times. Half of his friends are now
married and no longer trying to pursue acting.
“As the loneliness has increased, so has my drinking,” he says.
“I mean, I have friends, but I never married, so those old days
are just gone. I never made it to the New York stage as I’d
dreamed, so all I have of those old party days is the alcohol.
Only the alcohol has remained available. It tastes like nostalgia,
you know?”
Because he started so young and because alcohol has played
such a central role in his life, for the past 2 years, Mr. Munoz
has already begun battling early stages of cirrhosis.
“I sort of didn’t expect this until old age,” he says with a sad
smile. “Imagine my shock.”
He tells the nurse that he has not had a drink for 4 months.
1. Mr. Munoz was initially treated with neomycin, followed
by lactulose. “The lactulose has worked better for me,” he says,
“but it has some side effects that aren’t any fun.” How should
he be counseled nutritionally—taking into account both his

3. condition and his drug therapy?
2. Unfortunately, Mr. Munoz’s disorder progresses to end-
stage liver disease, and he is awaiting a liver transplant. The
good news is that he is an excellent candidate. What are likely
his most crucial nutritional needs (a) at this time and (b) during
the immediate posttransplant period?