Case 6: A 32-year-old Filipino female was referred to a hepatologist for a liver biopsy following presentation to an emergency department (ED)

where she had complained of fever and flank pain secondary to pyelonephritis from obstructive renal calculi. Past history was remarkable for a needle stick injury (the patient was a registered critical care nurse), sustained 10 years earlier in 1982 from a patient believed to be infected with non-A, non-B hepatitis. Six weeks subsequent to the needle stick, she became ill with a mild flu-like syndrome. She was not icteric and no laboratory tests were obtained. Routine physical exams following this exposure revealed sporadic elevations in liver function tests (LFTs). No further workup was obtained until her visit to ED. On physical exam in the ED, the patient was found to be well developed, well nourished, 53 tall, 128 lb., and in no acute distress. She was anicteric. Lymph nodes were negative, chest was clear to auscultation, and there was no hepatosplenomegaly. No spider angioma or palmar erythema was present, and there was no edema of the extremities. The patient was very active and did not complain of fatigue and malaise. There was no evidence or history of decompensated liver disease or cirrhosis. At the ED visit, laboratory values revealed abnormal liver function tests, with an aspartate aminotransferase (AST) of 48 U/L. In light of these elevated LFTs, a complete hepatitis profile was obtained. The patient was found to be hepatitis C (HCV) antibody positive for HCV by polymerase chain reaction (PCR). The patient was referred to a hepatologist who procured a percutaneous liver biopsy to establish baseline liver condition. Interferon alpha (IFN) therapy was initiated after careful consideration of side effects versus possible benefits. The patient began a drug regimen of 3 million international units (MIU) administered subcutaneously three times a week. She was also placed on a special diet. 1. Compute for her desirable body weight using the modified Tannhaussers method.
DBW= (160.02-100))-10 %( 160.02-100) = 54.0 kg

2. Compute for her nurtriture and classify. 3. Make a dietary prescription for this pregnant woman. Show all computations. 4. What micronutrient deficiency do you expect in this adult? How will you manage them? 5. Make a menu that would fit her requirements. Show all the computations and rationalize why you are including each food in her diet. 6. What would be a reasonable nutritional advice you can give?

VITAMIN A DEFICIENCY - Hepatitis C virus (HCV) infection is associated with oxidative stress and
vitamin A possesses antioxidant activity, also due to diet restriction.

VITAMIN E DEFICIENCY - May occur due to diminished fat absorption and diet restriction.
VITAMIN C DEFICIENCY -Also an antioxidant vitamin. By this function, it helps prevent oxidation of water-soluble molecules that could otherwise create free radicals, which may generate cellular injury and disease, since HCV is associated with oxidative stress so it would be deficient.

VITAMIN D DEFICIENCY - Inability to absorb and diet restrictions. VITAMIN K DEFICIENCY -Liver disease causes a decrease in bile salt synthesis, leading to
impaired absorption and Vitamin K deficiency. B VITAMINS DEFICIENCY - Due to restricted diet and inability to absorb. `FOLIC ACID DEFICIENCY -

MINIERALS IRON DEFICIENCY - Because of diet restrictions. CALCIUM DEFICIENCY - Vitamin D is a fat-soluble vitamin that helps the body absorb calcium but due to vitamin D deficiency calcium is less absorb by the body.
MAGNESIUM DEFICIENCY - Because of impaired mineral absorption. SELENIUM DEFICIENCY ZINC DEFICIENCY -

MANAGEMENT: Eat plenty of vegetables and fruits to maximize free- radical fighting antioxidants. But supplements should not be given except for patients with faulty absorption, because toxicity of vitamins and minerals are known to happen when theres liver disease. Advise patients taking vitamin or mineral supplements not to exceed the recommended doses as excesses of some nutrients can be harmful or may be an additional source of stress to the liver. Bhe wait lang ha hanapin ko pa yung magandang cause nung iba