Based on the case, what is/are the patient’s significant laboratory result? Based on the case, what is the cause of hypoalbuminemia and poor weight gain? Explain. Explain the importance of protein in this case. What is the cause of edema that was observed in this case? Explain. What diet/food can you recommend to the subject? Provide a rationale.
An exclusively breastfed boy infant developed AD at the age of 4 months. In the beginning, the eczema was treated with antibiotics, topical steroids and brief courses of oral steroids. The mother was dissatisfied by the outcome of the pediatrician’s advice so she consulted a naturopathic doctor who prescribed a restricted diet At 6 months the child’s daily diet consisted of rice milk, fruits, rice poultry and vegetable broth. After about 2 months of this diet, the child began to reject the food, in particular solid foods and to suffer from dysphonia and dysphagia due to the occurrence of laryngeal edema. Because of this the child was given only rice milk. After a few days the edema appeared on his feet, legs and upper extremities followed by a reduced urine output. He had no symptoms of gastroesophageal reflux, but he had forceful vomiting. When hospitalized, he was in a poor clinical condition with generalized edema (Fig. 1) and low urine output. He weighed 7.600 Kg from the age of six months up to 1 year. Blood and urine findings were normal except for the following results: total protein 3 g/dl; albumin 1.365 g/dl (45.5 %); total serum IgE 30 KUA/L; specific serum IgE: milk 0.64 KUA/L; albumen 1.74 KUA/L. Protein was not found in the urine. He required central access due to difficulty obtaining peripheral access due to severe edema. He was also found to be anemic with a haemoglobin 5.7 g/dl and he received 4 g of albumin three times in 48 h, a red blood cells transfusion, oral iron and folic acid. Vitamin K was also supplied because of a state of coagulopathy [activated partial thromboplastin: 31 s; prothrombin time 69 % (normal value: 80–100 %)]; fibrinogen 139 mg/dl; antitrombin III: 65 % (normal value: 80–100 %)]. The child was immediately fed with cow’s milk, which was well tolerated. Guidance from a nutrionist was essential and the edema gradually resolved.
- Based on the case, what is/are the patient’s significant laboratory result?
- Based on the case, what is the cause of hypoalbuminemia and poor weight gain? Explain.
- Explain the importance of protein in this case.
- What is the cause of edema that was observed in this case? Explain.
- What diet/food can you recommend to the subject? Provide a rationale.
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