Module 9: Diabetes Mellitus in Children and Adolescents

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IU Indiana University on the IUPUI Campus
Advanced Pediatric Nutrition N572
School of Health and Rehabilitation Sciences
Karyl Rickard, PhD, RD, FADA
(Mary) Sue Brady, DMSc, RD, FADA
Module 10: Parenteral Nutrition in Infants and Children: Evaluation Scenarios
In the Evaluation Section, you will have the opportunity to apply what you learned from the readings and
expert approach to real case problems. You will make feeding and nutrition recommendations for the case
problems in Scenarios 1 and 2 below. Scenario 1 is an individual assignment; Scenario 2 is a group
assignment. As well, you will have the opportunity to apply what you learned to some additional clinical
situations and scenarios listed with Scenario 1.
Scenario 1
You are a pediatric dietitian at Children's Miracle Hospital. Dr. Scott Smith asked you to evaluate Mathew,
a 9-month-old infant with severe failure to thrive and diarrhea. You are asked to create a nutrition plan
for initiating and maintaining parenteral nutrition.

Anthropometrics Measurements at 9-months: Weight: 6.4 kg; length: 65.4 cm; OFC: 45 cm; triceps
skinfold: 6.0 mm and subscapular skinfold: 4.0 mm.

Summary of Past weights (kg) and lengths (cm): Birth weight: 3.4 kg, birth length: 50 cm, 6-month;
weight: 6.4 kg, and 6-month length: 64 cm

Biochemical measures of nutritional status at 9 months: Albumin – 2.2 g/dl and prealbumin - < 7
mg/dl.
Questions to guide your learning for Scenario 1
Answer each question and submit the answers with the nutrition care plan.
1. Given appropriate normative growth data (CDC growth grids, 2000, Guo et al data from module 2),
what percentile weight, length and weight for length was Mathew at Birth, 6 and 9 months?
2. What levels of albumin and prealbumin are considered normal for infants and
Oncourse.iu.edu
Copyright, 2004
IU Indiana University on the IUPUI Campus
Advanced Pediatric Nutrition N572
School of Health and Rehabilitation Sciences
Karyl Rickard, PhD, RD, FADA
(Mary) Sue Brady, DMSc, RD, FADA
children? Interpret Mathew’s albumin and pealbumin relative to the norms.
3. Given appropriate normative energy intakes (Fomon et al, Beal data) (module 2), what is an
appropriate energy intake for a 9 month-old male infant? For an infant of this weight age? Provide
10th, 50th and 90th percentile intakes.
4. Create a nutrition care plan for Mathew using the information from the scenario and above.
Include specific recommendations and rationale for

Fluid intake (show your calculations)

Energy intake (indicate the basis for your recommendation and how you would determine the
adequacy of this intake)

Parenteral nutrition composition and script for this patient (use the script included with this
scenario)

Plan for initiating and maintaining parenteral nutrition

Recommendations for monitoring anthropometric measures and biochemical (metabolic) labs
including trace elements

Recommendations for determining an appropriate time to transition to enteral feeding.
Oncourse.iu.edu
Copyright, 2004
IU Indiana University on the IUPUI Campus
Advanced Pediatric Nutrition N572
School of Health and Rehabilitation Sciences
Karyl Rickard, PhD, RD, FADA
(Mary) Sue Brady, DMSc, RD, FADA
Additional Questions related to complications and clinical scenarios
1.
Describe treatment for the following complications:
a. metabolic (hypoglycemia, hyperglycemia, sudden glucosuria, hypertiglyceridemia, EFA
deficiency, etc)
b. nutritional (protein - azotemia, hyperaminoacidemia, hyperammonemia; osteopenia, rickets;
iron deficiency anemia)
c. infectious (catheter infections)
2.
3.
List the trace minerals that you would want to monitor closely for the following clinical scenarios:
a.
2 yr old on PN for protein-losing enteropathy presents with microcytic anemia
[Cu, Fe, Al]
b.
5 yr old w/ gastroschisis-related short gut on PN presents with skin rash and poor growth
Also, what enzyme may be low on the metabolic panel as a clue?
[Zn, alkaline phosphatase]
c.
8 yr old on PN w/ cholestasis/liver dysfunction
[Avoid excess Cu & Mn; prevent carnitine, choline & taurine deficiency]
d.
15 yr old w/ renal failure on PN
[Al, Chr, Molybdenum, Se, carnitine]
List the nutrients that are at risk for being deficient with the following conditions:
a. Short gut
[At risk for deficiency of fluids, Zn, electrolytes (Na, K, Mg), vitamins, Fe, folate]
Oncourse.iu.edu
Copyright, 2004
IU Indiana University on the IUPUI Campus
Advanced Pediatric Nutrition N572
School of Health and Rehabilitation Sciences
Karyl Rickard, PhD, RD, FADA
(Mary) Sue Brady, DMSc, RD, FADA
b.
Renal failure
[Protein deficiency; low Vitamin D, Ca, water soluble vitamins, carnitine; high K, P, Mg,
glucose (peripheral insulin resistance)]
c.
Cardiac
[Fluid and Na overload]
d.
Burn
[Increased need for Cu, Zn, Se]
e.
Acute stress
[If high C-reactive protein, Fe & Zn may decrease & Cu may increase]
Parenteral Nutrition Script
After you complete the answers and the nutrition care plan, you will put them into your Drop Box located
on the left menu bar in Oncourse. Upload your document into the drop box and then proceed on to the
next scenario. Title the document with your last name, course #, module # and title and date (e.g.,
Brown_N572_mod 10_ParenteralNutrition101507).
Oncourse.iu.edu
Copyright, 2004
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