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The Rational Clinical Examination
David L. Simel, Drummond Rennie
Malnourishment, Adult
Allan S. Detsky, Philip S. Smalley, Jose Chang
Case 1


Topics Discussed: malnutrition

Excerpt: "Ten days before being treated, a 65-year-old man experienced a Wallenberg stroke involving the lateral medulla, which left him with difficulty swallowing. Since then, he had been treated with intravenous fluids, as attempts at eating led to mild aspiration with pneumonia. In that period, he lost 6% of his usual body weight and was continuing to lose weight. He felt weak and was able to ambulate only with difficulty because of his stroke-related ataxia and generalized weakness. On physical examination, there was an obvious squared-off appearance to his shoulders from subcutaneous tissue and muscle wasting. There was no edema...."
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