[Answered]: Case Study II: LJ was admitted to the hospital with…

Case Study II: LJ was admitted to the hospital with decompensated cirrhosis with significant abdominal fluid accumulation and altered mental status. His family indicated that LJ had become significantly debilitated over recent weeks at home, with a weight loss of 15 pounds in the last 6 months (12 % of his body weight). Since the fluid accumulation, he has had a hard time walking and complains of poor appetite. He has been consuming less than 1000 kcals per day mostly in the form of protein shakes. He is having trouble with his speech and has poor mental acuity. His mental state did not improve with medication given to manage his blood ammonia levels. He had labs done and his total serum bilirubin was 3.5, serum albumin was 2.6 g/dl, and pro-thrombin time was 12.7 seconds. Questions: 1. Explain metabolically why LJ likely developed the following symptoms: a. Abdominal fluid accumulation b. Debilitation c. Altered mental status d. Elevated pro-thrombin time 2. LJ had his respiratory quotient (RQ) measured by indirect calorimetry and it was 0.72. What does this factor mean and what changes would need to be made to his dietary prescription based on this RQ? A RQ of 0.7 would mean that LJ is using predominantly fat as an energy source. Since he is at 0.72 it is safe to say that he is using fat for energy. 3. According to the Child-Pugh score, what is LJs mortality risk? Explain. 4. Give 5 evidence-based nutrition strategies with rationale for managing LJ’s condition.