ADIME

#2 Assignment
Medical Nutrition Therapy
Celiac Disease

KM is a 36 year old female admitted to the hospital with stomach pain and severe
diarrhea. A bowel biopsy indicates: flat mucosa and villus atrophy and hyperplastic
crypts-inflammatory infiltrate in lamina propia. She has tested positive TTG, EMA
antibodies. Her admitting diagnosis is celiac disease with secondary malabsorption
and anemia. You interview the patient and she tells you that she is hungry all of the
time. She also states that when she does eat (especially large amounts) she almost
immediately has diarrhea. She does not have any nausea or vomiting. KM states that
when she eats fried foods or beef, her diarrhea seems worse. She has mostly been
eating noodle soups, some chicken, crackers and sprite.
Ht: 53
Wt: 92 lbs UBW: 112(1 month ago)
Labs: albumin- 2.9g/dL, prealbumin- 14mg/dL, Hgb- 10.5g/dL, Hct- 35%, Ferritin-
12
Diet Order: NPO


Sasha Sheftel
ADIME #2 Write-up
ADIME Note #2
A:
KM is a 36 y/o female admitted to the hospital with stomach pain and severe
diarrhea. A bowel biopsy indicates: flat mucosa, villus atrophy, and
hyperplastic crypts-inflammatory infiltrate in lamina propia. Has positive
tests for TTG and EMA antibodies. Patient indicates she feels hungry all of
the time and when she does eat she immediately has diarrhea. She mostly
has been eating noodle soup, chicken, crackers and sprite.

36 y/o female Dx: celiac disease with secondary malabsoprtion and anemia

Ht. 5 3 CBW: 92# UBW: 112# IBW: 115# Pt. 80% of UBW/IBW

BMI: 16.8 (CBW) 19.9 (UBW)

EER: 1300-1800 kcal/day EPR: 41-50 g/protein/day

Estimated Fluid Requirements 1300-1800 mL/day
Labs: albumin- 2.9g/dL, prealbumin- 14mg/dL, Hgb- 10.5g/dL, Hct- 35%,
Ferritin- 12
D:
1. Involuntary weight loss R/T diarrhea and malabsorption, especially
following consumption of fried foods and meats AEB 18% unexplained
weight loss
2. Malnutrition R/T severe diarrhea AEB BMI <18.5
3. Altered GI function R/T flat mucosa, villus atrophy, and hyperplastic
crypts-inflammatory infiltrate in lamina propia AEB positive tTG and EMA
antibodies
I:
1. Consult with KM about taking in 1300-1800 kcal, 41-50 g protein, and
1300-1800 mL fluid per day in order to gain 1 pound per week over the next
20 weeks and accommodate for protein malabsoprtion.

2. Consult with KM about a lactose-free, gluten-free diet

3. Educate KM about gluten-free food options

4. Advise KM to slowly start incorporating lactose into diet

5. Advise KM to attend celiac disease support groups
ME: 1. Patient will gain 20 pounds in 20 weeks to be back to UBW

2. Patient will comply with a gluten-free diet

3. Patient will be eating small amounts of lactose

4. Patient will fully understand celiac disease and have reached out to peers
for support
Signature
Sasha Sheftel, Dietetics Student