The Rational Clinical Examination
David L. Simel, Drummond Rennie
Malnourishment, Adult
David L. Simel, Alan Detsky, Amy Rosenthal
Clinical Scenario
Topics Discussed:
dyspnea, emphysema, pulmonary, malnutrition
Excerpt:
"A 68-year-old man with advanced emphysematous lung changes has
been hospitalized 3 times during the past winter for episodes of
dyspnea. His diet is not as good as usual, but his weight has not changed
during the past 2 months. Because of his breathing difficulty, he
spends much of his day in and out of a reclining chair. You notice
that his arms are a bit thin, with loss of muscle. There is some
peripheral edema. Overall, his weight is down about 2 kg from what
he considers his baseline (a 3% loss). During his last
hospitalization, a serum albumin level was 3.4 g/dL, and
you see that his total lymphocyte count was 1525 cells/
L. Is
he appropriately nourished?..."
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