Sarah Alarid

FSN 429
ADIME: Brigit
October 7, 2015
9:26pm
Assessment:
17 YO female referred by MD after complaining of chronic fatigue, tingling in the extremities, pale skin,
increased appetite. Has recently suffered a decreased running performance and has trouble
concentrating. Patient is immunocompromised as she cant recover from a cold. Has low but normal
level of serum iron at 31 g/dL, low H and H at 33% hematocrit and 9.5 g/dL hemoglobin. Ferritin and
RBC count are at normal level. Has low transferrin at 2.2 g/L and high total iron binding capacity at 475
ug/dL. MCV is low at 73 fL. MCH is low at 22 pg/cell. Labs show patient has hypochromic microcytic iron
deficiency anemia. Patient is high school athlete playing on varsity volleyball team and runs track.
Diet Hx: (from 24 hour recall) Currently consuming caloric intake that is slightly high than her estimated
energy needs at 51 kcals/kg but the patient is highly active and has not gained weight. Protein
consumption is adequate at 1.8 g protein per kg body weight. Diet does contain some fruit and
vegetable consumption. ~58% of kcals consist of CHO with 460g consumed, ~14% of kcals consist of
protein with 112g, ~32% of kcals consist of fat with 133g consumed. Diet is adequate in macronutrient
consumption but is inadequate in iron rich foods such as meat, beans, or dark leafy greens.
Anthropometrics:
Wt: 61.36 kg
Ht: 167 cm
BMI: 22 (normal)
IBW: 136 lbs
%IBW: 100% (normal)
TSF: 10 mm (at 10th percentile, below average fat stores)
MAMA: 41.57 cm^2 (between 85th-95th percentile, above average musculature)
Glucose: 112mg/dL (high but not fasting blood glucose)
Fe (serum): 31 g/dL (low but normal)
Hct: 33% (low)
Hgb: 9.5 g/dL (low)
Ferritin: 150 g/L (normal)
RBCs: 4.5X10^12/L (normal)
Transferrin: 2.2 g/L (low)
TIBC: 475 ug/dL (low)
MCV: 73 fL (low)
MCH: 22 pg/cell
MAC: 25 cm
Estimated kcal needs for maintenance: about 31000 kcals (according to Mifflin-St. Jeor method
and an AF of 2.2) and 37 kcals/kg weight consumed
Estimated Protein needs: 92 grams or 1.5g per kg body weight
Estimated CHO needs: about 55% of kcals or about 426 grams/day
Estimated Fat needs: about 25% of kcals or 86grams/day
Estimated fluid needs: 2135-2440 ml/day
Patient seems motivated to make changes to diet to improve athletic ability and perform better in
school.
Diagnosis
PES:

1. Inadequate iron intake related to low consumption of iron rich foods as evidence by 24 hour
recall
a. Increase iron intake by:
i. Taking 30 mg ferrous iron supplement 1-2 times a day
ii. Increase vitamin c consumption by consuming vitamin c rich foods at each
meal
2. Food and nutrition knowledge deficit related to vegetarian diet as evidence by patient
report
a. Increase nutrition education by:
i. Performing quiz on food labels
ii. Performing food frequency questionnaire
Intervention
Goal:
1. Increase consumption of iron
2. Increase protein consumption to 155 grams a day
3. Improve nutrition education on an iron rich diet
Recommendations:
Provide education on high iron diet and iron content of diet to improve blood labs.
Diet to provide 3100 kcals and 155 grams of protein a day with a 30 mg iron supplement taken
1-2 times a day with vit c.
Monitoring & Evaluation
Monitor:
Indicator
1. Iron intake

Current level of indicator

Hypochromic microcytic
deficiency anemia

Criteria for success

iron Meet current diet Rx of 300 mg
iron supplementation

RD to monitor and evaluate energy intake for increase of transferrin, MCV and MCH.
Evaluation:
RD to follow up in 1 week. Monthly visits for first 6 months of diet. Blood test for iron levels should be
conducted in 3 months to monitor levels.
Sarah Alarid, R.D.

October 7, 2015