Problem:
Ellen is a 71 y.o. F referred by physician for nutrition consult in the outpatient clinic today for complaints of poor appetite and persistent fatigue. Her medical work-up failed to identify any underlying etiology for her complaints. Ht: 5' 7" Current weight: 192 lbs. Usual body weight 2 months ago: 210 lbs. Labs: Na: 141 (135-145) K: 3.8 (3.6-5.5) Cl: 110 (101-111) HCO3: 26 (21-31) BUN: 11 (5-20) Cr: 0.8 (0.6-1.2) Glucose: 82 (70-99) Alb: 2.9 (3.5-5) GFR: 79 (>60) Phos: 3.1 (3-4.5) Ca: 8.2 (8.5-10.5) Mg: 1.8 (1.5-2.5) H/H: 12.9/38 (14-17/40-54) MCV: 77 (80-100) Vitamin D: 22.7 (30-100) Medications: takes lisinopril for hypertension; blood pressure well controlled Dietary supplements: none Exercise: too tired to exercise Social history: spouse of 39 years died 8 months ago; has 2 sons - both live out of state but visit every 6 months Nutrition-focused physical exam: temporal wasting, orbital fat mass loss and dry mucous membranes noted; loss of lean mass also noted in quadriceps and gastrocnemius; 1 pedal edema Diet History: B: 1 large cup of black coffee, 1 c of regular cheerios w/4 oz. whole milk L: 1 c of vegetable soup and ~6 saltine crackers plus 6 oz. unsweetened iced