Medical Nutrition Therapy in Ischemic Hepatitis and Acute Kidney Injury Due to Congestive Heart Failure NYHA III

Abstract

ObjectivesCongestive Heart Failure is a major public health problem with an estimated prevalence of 1–2% of the adult population in developed countries, rising to ≥ 10% among persons > 70 years of age. The incidence of impaired liver function in the form of congestive hepatopathy and ischemic hepatitis ranges from 15% to 65% of patients with significant heart failure. MethodsMr.T, Male, 63 years old was suffered from ischemic hepatitis due to congestive heart failure NYHA III. He had history of hipertension since 2011 and a history of heart disease since 2011. The patient has reduced oral intake since 2 weeks ago and worsening 5 days ago due to decreased appetite and shortness of breath. Anthropometric examination found body length was 166 cm, ideal body weight was 59.4 Kg, Mid Upper Arm Circumference (MUAC) was 19 cm and Handgrips strength 8,6 kg. Laboratory assessments found leukocytosis (13,100 103 /ml), impaired kidney function (Ureum was 206 mg/dL and Creatinine was 3.51 mg/dl), increased transminase enzymes (SGOT 4113 U/L and SGPT 4721 U/L) and increased levels of bilirubin (Total Bilirubin 9.79 mg/dL and Bilirubin Direk 7.79 mg/dL). ResultsMedical Nutritional Therapy was determined with a calorie target of 1700 kcal; protein 1,4 gr/Kg ideal body weight/day; 50% carbohydrates and 30% fat, respectively. We provided oral suplementation in the form of zinc, vitamin B Complex and curcuma. The Patient was discharged after being treated for 11 days and recovered from shortness of breath and jaundice, with adequate nutritional intake (according to calorie targets), increased anthropometric parameters (MUAC was little increased 19,3 cm but handgrips strength was significantly increased to 28,3 kg), improved laboratory result including leukocytes decreased to normal (9.940 103/ml), ureum and creatinine were also turned to normal (47 mg/dL and 1,1 mg/dL, respectively), liver function was markedly decreased (SGOT 71 U/L, SGPT 468 U/L) as well as total bilirubin (2,90 mg/dL) and direct bilirubin (1,20 mg/dL). ConclusionsOptimal treatment of the underlying disease (CHF) and adequate nutritional therapy could improve nutritional status and quality of life patients with CHF NYHA III with complications of ischemic hepatitis and acute kidney injury. Funding SourcesThe author(s) received no financial support for research, authorship, and/or publication of this article.