糖尿病腎病變合併鬱血性心臟衰竭病人之營養照護個案報告

Nutrition Care of a Diabetic Nephropathy Patient With Congestive Heart Failure: A Case Report

唐怡伶(Yi-Ling Tang) ； 樹金忠(Chin-Chung Shu) ； 彭惠鈺(Hui-Yu Peng) ； 林京美(Jing-Meei Lin)

《臺灣膳食營養學雜誌》 10卷2期 (2018/12) Pp. 21-28

https://doi.org/10.6709/TJD.201812_10(2).0003

摘要

個案為一位79歲女性，因有嚴重雙下肢水腫與端坐呼吸喘症狀住院，入院主要診斷為糖尿病腎病變急性惡化合併鬱血性心臟衰竭，平日未水腫體重約為75.0 kg，住院因水腫體重為89.0 kg，經由營養評估建議熱量需求為1900 kcal/day，蛋白質需求為60 g/day。入住時由營養師訪視，其營養診斷（problem, P）為液體攝取過量、病因（etiology, E）為糖尿病腎病變急性惡化合併鬱血性心臟衰竭需限制液體攝取量，病徵（symptom, S）為雙下肢水腫；蛋白質攝取不足（problem, P），病因（etiology, E）為關於糖尿病腎病變之營養相關知識不足，病徵（S）為蛋白質攝取小於0.8 g/kg/day。藉由營養介入給予個別飲食指導與口服營養補充品以攝取足夠熱量與適當蛋白質；教導個案如何減少水分攝取，以及對個案進行飲食指導，使其能有效的執行低鈉飲食，以減少心衰竭的惡化。個案出院時營養攝取已改善，其熱量攝取約可達1800～1900 kcal/day，蛋白質攝取約可達60g/day，水腫改善體重由89.0 kg降至81.9 kg，出院後持續於門診追蹤，1個月後體重降至75.0 kg。此個案藉由營養介入後，達到攝食適當的營養及水分控制，得以增進其營養狀況與改善臨床症狀。

關鍵字

糖尿病腎病變 ； 限水 ； 營養照護

並列摘要

A 79-year-old woman was admitted to our hospital with symptoms of severe bilateral leg edema and orthopnea, and was diagnosed as diabetic nephropathy with acute exacerbation and congestive heart failure. Her usual body weight was about 75.0 kg; however, her weight was 89.0 kg at admission due to edema. By nutritional assessment, we suggested energy requirement/supplement of 1900 kcal/day with protein 60 g/day. Her admission nutrition diagnosis (problem, P) indicated excessive fluid intake with an etiology (etiology, E) of diabetic nephropathy with acute exacerbation and congestive heart failure that required fluid restrictions and symptoms (symptom, S) of pitting edema. The second nutrition diagnosis was inadequate protein intake (P) with an etiology (E) of food and nutrition-related knowledge deficit about diabetic nephropathy, and symptoms (S) of actual protein intake was less than 0.8 g/kg/day. After the nutritional intervention, individual dietary counselling and the use of oral nutritional supplements in combination to meet her energy and protein requirement, and to educate the patient on how to reduce fluid intake, the advice of dietary content enabled the patient to comply with a sodium restricted diet that contributed to the control of heart and renal failure, the edema problem was gradually improved. When this patient was discharged from our hospital, her energy intake could achieve around 1800-1900 kcal/day, and protein intake 60 g/day, then her body weight decreased to 81.9 kg. She was followed up at the outpatient clinic and her body weight decreased to 75.0 kg after one month. We concluded that nutritional intervention and care improved the nutritional status and clinical symptoms of the patient.

並列關鍵字

diabetic nephropathy ； fluid restriction ； nutrition care