Download File - Clinical Nutrition Manual Mariah Guthrie

Case Study 22: Depression, Drug-Nutrient Interaction
Mariah Guthrie
Miami University
1. What is depression?
Depression is a disorder that involves the body, mood, and thoughts. It can
change the way a person eats, sleeps and how they view themselves (Nelms
632).
2. Dr. Byrd has decided to treat Ms. Geitl with Zoloft, a selective serotonin
reuptake. Are there any permanent nutritional conciderations when using this
medication?
If taking the medication for extending periods of time ones brain can become
dependent on the medication. Stopping taking medication quickly can cause
headaches, nausea, dizziness or flu like symptoms.
3. How do serotonin reuptake inhibitors (SSRIs) work?
SSRIs work to ease the symptoms of depression by blocking the reabsorption of
serotonin neurotransmitters. This changes the chemical balance of the brain and
causes the brain to flood with serotonin. SSRIs are selective by only affecting the
serotonin neurotransmitter (MayoClinic).
4. During the diet history, you ask Ms. Geitl if she used any OTC vitamins,
minerals, or herbal supplements. She tells you her mother suggested she try
Hypericum perforatum (St. John’s wort) because in Germany it is prescribed to
treat depression. Ms. Geitl did as her mother suggested, as it is available without
prescription in the Unites States. What is St. John’s wort?
St. John’s wort is an herb and is used to treat depression, nervousness, insomnia
and infections. It is available over the counter at most supplement stores and
pharmacies (St. John’s Wort).
5. How is St. John’s wort used in the United States?
St. John’s wort is an herb and is used to treat depression, nervousness, insomnia
and infections. It is available over the counter at most supplement stores and
pharmacies. St. Johns wort is not regulated, and it often taken with food (St.
Johns Wort).
6. How does St. John’s wort work as an antidepressant?
St. Johns wort contains chemicals hypericin and hyperforin, they act as chemical
messengers in the nervous system that regulate mood (RxList).
7. Does St. John’s wort have any side effects?
Side effects can include: skin sensitivity to sunlight, rashes, feelings of fullness in
the stomach and constipation. St. Johns wort can also cause allergic reacxtion
although they are rare (St. Johns Wort).
8. How is St. John’s wort regulated in the United States?
St. John’s Wort is not regulated in the U.S. and it is classified as a dietary
supplement.
9. How is St. John’s wort used in Europe?
St. Johns wort is only available by prescription in Germany and several other
European countries (American Cancer Society).
10. Why do you think people are interested in alternative medicine and herbal
treatments?
It is very common for people to try to self medicate. A lot of people prefer taking
supplements that they feel are more natural and organic than prescription
medications. Supplements are also available over the counter and less
expensive than prescription medications.
11. Because Ms. Geitl is ambulatory, you are able to measure her height and
weight. She is 5’11” tall and weights 160 pounds. You also determine that she is
of medium frame. Because Geitl is from Germany, she is used to reporting her
weight in kilograms and her height in centimeters. Convert her height and weight
to metric numbers.
Height: 5’11”=71 inches x 2.54cm/inch = 180.34cm
Weight: 160lbs = 160lbs/2.2kg/lb = 72.72kg
12. Is. Ms. Geitl’s recent weight loss anything to be worried about?
Ms. Geitl only lost 5 pounds in the last 3 months, and she is still at an ideal
weight for her height. Since the weight loss was fairly gradual and she’s still at a
healthy weight there is not need for concern as of current.
13. Because Ms. Geitl is alert and cooperative, you ask her to complete a PatientGenerated Subjective Global Assessment (PG-SGA) of Nutritional Status. How
would you score her?
Sections
Score
Box 1
1
Box 2
1
Box 3
3
Box 4
1
Weight loss section
0
Disease section
0
Metabolic section
1
Physical section
0
Total
7
14. Using Appendix I, how would you triage nutritional intervention?
Ms. Geitl has a high score for box 3 because of her lack of appetite. I would
recommend that she takes in small meals thorough out the day so she will be
able to take in more calories and small meals will also keep her from feeling too
full too quickly.
15. What methods are available to estimate Ms. Geitl’s energy needs?
The Mifflin-St. Jeor equation and Harris benedict equation can be used to
calculate her energy needs. You can also estimate her energy needs based on
height.
16. Calculate Ms. Geitl’s basal energy needs using one of the methods you
listened in question 15.
Harris Benedict Equation:
REE= 655+ (9.56 x wt(gk)) + (1.85 x ht (cm))- (4.68 x age (yrs))
655+ (9.56 x 72.73kg) = (1.85 x 180.34cm) – (4.68 x 20yrs)
655 +695 + 334 – 94 = 1590kcal
17. What is Ms. Geitl’s estimated energy expenditure?
Since Ms. Geitl does not currently exercise, an activity level of 1.4 can be used.
1590kcal x 1.4 =2226
18. Evaluate her diet history and her 24-hour recall. Is she meeting her energy
needs?
Ivanna is clearly not taking in enough calories based on her 24 hour recall. She is
not taking in enough, thus the weight loss.
19. What would you advise?
Since she does not feel hungry it would be a good idea for her to take in high
calorie foods and eat 5-6 small meals per day. Small meals will keep her from
getting to full and allow her to take in more. She should also reduce her caffeine
intake as this is a stimulant and reduces appetite.
20. List each factor from your nutritional assessment and then determine an
expected outcome from each.
Moderately malnourished If she does not increase her calorie intake throughout
her day, she will continue to lose weight and become more malnourished.
Nutrition impact symptoms If her weight loss continues she will deteriorate
further, she could become ill and experience weakness and muscle wasting. She
may have to be put on a supplement like ensure so she will be able to keep her
weight up if her weight continues to drop.
21. What is your immediate concern regarding this patient’s use of St. John’s
wort?
St. Johns wort should not be taken with Zoloft or other SSRI’s because it can
increase the risk of a condition called serotonin syndrome. Side effects include
confusion, fever, sweating, hallucinations, seizures, nausea, vomiting and diarrhea (St.
Johns Wort).
22. Review the initial nutrition note written for this patient. Is this progress note
appropriate? Is it complete? Any errors? Any omissions?
The note should include the nutrition education plan to make sure that she is
progressing. It should also include a monitoring plan so that her progress can be
tracked. The note is also not in ADIME form.
Works Cited
American Cancer Society. St. Johns Wort. Retrieved form
http://www.cancer.org/treatment/treatmentsandsideeffects/complementaryandalt
ernativemedicine/herbsvitaminsandminerals/st-johns-wort.
MayoClinic. Depression. Retrieved from
http://www.mayoclinic.org/diseases-conditions/depression/in-depth/ssris/art20044825.
Nelms, M., Sucher, K., Lacey, K., Roth, S. Nutrition Therapy and Pathophysiology. 2/e.
RxList. Retrieved from http://www.rxlist.com/st_johns_wort-page2/supplements.htm.
St. Johns Wort. Drugs. (2015). Retrieved from http://www.drugs.com/cdi/st-john-swort.html.