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  Experts Corner - Health Care Questions and Health Care Answers from Health Care Professionals
 Expert Category Question Expert's Answer Member's Response
Mansi Shah
Post was submitted on DietitianCentral.com 		General Nutrition Posted on DietitianCentral.com by seven (05/07/08)
Article 1431— Hi Mansi, In revising your protocol for obese non-critically ill pt's with the Mifflin Equation with adjusted wt's and stress factors what do you based adjusted wt on .25% or .38% and what do ... 		   
Betsy Oriolo
Post was submitted on DietitianCentral.com 		Diabetes Posted on DietitianCentral.com by steph24 (05/04/08)
Article 1430— What are some general guidelines for pts with gestational DM as far as meal planning, snacks, and foods to limit/ avoid. ... 		05/05/08  Hello Steph, We typically provide only 30 gm carb at breakfast, usually 60 gm for lunch and dinner and 30 gm for snacks three times per day. We discourage juice or other high carb liquids, ...  
Mansi Shah
Post was submitted on DietitianCentral.com 		Enteral and Parenteral Nutrition Posted on DietitianCentral.com by Suki (05/03/08)
Article 1429— Ms. Shah, I have a 72 years old Hispanic male with dx osteomyelitis, dm,cva,CHF,CRI,depression,sacral ulcer stg III, gangrene R ft/ankles, R lateral TMA. Receive complete nutrition via PEG. ... 		05/05/08  Suki, Thanks for the detailed information. It seems your question is whether it is appropriate to switch the patient to a peptide formula because of the diarrhea. Before switching, have you ...  
Lanah Brennan
Post was submitted on DietitianCentral.com 		Supplements Posted on DietitianCentral.com by rgrabski (05/02/08)
Article 1428— Dear Dr L. Brennan, My father recently had GI surgeries that resulted in gall bladder removal and stent (im not sure about the spelling... its a plastic prosthetic tube) inserted in to his ... 		05/06/08  Hello Robert: Thank you for your question. Sorry to hear about your father. It sounds like he was suffering from cholecystitis, an inflammation of the gallbladder typically caused by an ...  
Diane M. DellaValle
Post was submitted on DietitianCentral.com 		Research Posted on DietitianCentral.com by komalsaideep (05/02/08)
Article 1427— Madam, I am Komal Wadhwa from India, would like to settle in US. I am aware about the RD which I will have to get through to start working. I have heard that RD examination can be done with ... 		05/02/08  I am not the best person to ask that question - i do not know how your education/experience would be transferred or how the CDR accounts for time/experience in other countries. My best advice ...   komalsaideep (05/03/08):
Thank You Ma'am for a promt reply. Very appreciative of you to respond that fast. I did contact ...  
Diane M. DellaValle
Post was submitted on DietitianCentral.com 		General Nutrition Posted on DietitianCentral.com by seven (04/30/08)
Article 1426— What caculation do you use for pt that IBW > 125%, pt that are obese with IBW < 125% and pt wt's that are normal? Do you applied IBW with certain types of pt's or BW or adjusted BW ? ... 		05/02/08  I am not sure exaclty what you're asking. Are you asking how to calculate energy needs or IBW? I will answer your question for Energy needs: There are dozens of equations to determine ...  
Mansi Shah
Post was submitted on DietitianCentral.com 		General Nutrition Posted on DietitianCentral.com by seven (04/29/08)
Article 1425— Hi Mansi, I know ADA does not support adjusted body wt but they used to have in there fifth edition Nutrition Assessment pocket manual 38% as a correction factor for males instead of 25% and ... 		05/02/08  Seven, You should check out the American Dietetic Association's Evidence Analysis Library. They have a collection of all the available research and recommendations for what formula's and ...  
Mansi Shah
Post was submitted on DietitianCentral.com 		Enteral and Parenteral Nutrition Posted on DietitianCentral.com by seven (04/29/08)
Article 1424— Hi Mansi If a pt is underwt or at normal wt on vent requiring tube feeding, how do you go about estimating there caloric requirements ? ... 		05/02/08  I usually would do a range of 25-30 KCal/Kg actual weight for patients who have a normal wt. For those who are underweight, it depends on how underweight they are, because I also want to make ...  
Mansi Shah
Post was submitted on DietitianCentral.com 		Enteral and Parenteral Nutrition Posted on DietitianCentral.com by GKerwin (04/29/08)
Article 1423— Mansi, I received an order for Blue Food Coloring to be added to an enteral feeding. What is your opinion on using blue food coloring or Methylene blue with feedings? I know there is a ... 		05/02/08  Ginny, Check out these references: Opilla M. Aspiration Risk and Enteral Feeding: A Clinical Approach. Practical Gastroenterology. April 2003. Available online at: http://www.healthsystem.  
Lanah Brennan
Post was submitted on DietitianCentral.com 		GI Disorders Posted on DietitianCentral.com by christinerd (04/27/08)
Article 1422— What is latest and greatest MNT for IBS? I hv pt w/IBS and also vegetarian, but does eat seafood. What is best advice I can give her? She is on med for IBS (Donnatal?) Thanks a lot. ... 		04/30/08  Hello Christine: Suggested IBS treatments vary depending on the patient’s symptoms. You may want to suggest that the patient avoid foods typically thought to exacerbate symptoms including ...  
Betsy Oriolo
Post was submitted on DietitianCentral.com 		Diabetes Posted on DietitianCentral.com by steph24 (04/27/08)
Article 1421— I am a new Registered Dietitian who is just starting on my quest to become a CDE. In the acute care hospital that I work in we tell most patients to have a 4 servings of CHO 4 times a day (3 ... 		04/28/08  Hi Steph, Yes you sound in line with what most hospitals are doing. Most do 4 servings per meal and 1 - 2 per snack. With my patients snacks are not always necessary but I do recommend if they ...  
Mansi Shah
Post was submitted on DietitianCentral.com 		Enteral and Parenteral Nutrition Posted on DietitianCentral.com by steph24 (04/27/08)
Article 1420— Are there any specific requirements or differences that need to be considered for a patient who is on PD and TPN or PD and ... 		04/28/08  Hello, When you state PD, do you mean Peritoneal Dialysis? There are no significant differences in energy and protein requirements. With any type of dialysis, if patients are on TPN, close ...  
Lanah Brennan
Post was submitted on DietitianCentral.com 		GI Disorders Posted on DietitianCentral.com by steph24 (04/27/08)
Article 1419— What are some common reasons that a person would have an ileostomy and a colonostomy. I am confused as to why a person would need both. Thanks. 		04/28/08  Hello Steph24: Colostomy and ileostomy are surgeries that may be preformed for the treatment of large intestine diseases such as ulcerative colitis, Crohn’s disease, familial polyposis, ...  
Lanah Brennan
Post was submitted on DietitianCentral.com 		Supplements Posted on DietitianCentral.com by honeyb (04/26/08)
Article 1418— Hello, What nutritional supplements can you suggest for pt ages 0- 24 mos with renal disorders?thanks a lot. 		04/27/08  Hello: Infants with renal disorders often have below average growth and weight gain, and may have an increased caloric need. Besides possibly increasing calories as indicated, I do not have ...  
Betsy Oriolo
Post was submitted on DietitianCentral.com 		Diabetes Posted on DietitianCentral.com by honeyb (04/25/08)
Article 1417— hello betsy..what suggestions you can offer for a newly diagnosed child like 1 y.o regarding their diet? I'm including the milk supplement the pt is taking as part of CHO allowance.thanks a lot. 		04/25/08  Hello. Pediatrics is not my area of expertise. I would try to get them in to your closest Children's Hospital to be managed by a team including an RD or CDE. They would need to count their ...  
Valerie M. Weir
Post was submitted on DietitianCentral.com 		Pediatric Nutrition Posted on DietitianCentral.com by honeyb (04/25/08)
Article 1415— Hi Valerie,Im working as clinical dietitian in one of the govt hospital here in jeddah,saudi arabia. I hope you can suggest some references for my metabolic patients in Saudi arabia.I only had ... 		05/05/08  Honeyb, Thank you for the questions. I do not the info you have requested but have referred this question to the dietitian who manages clinical nutrition at a well known hospital here in Abu ...  
Mansi Shah
Post was submitted on DietitianCentral.com 		GI Disorders Posted on DietitianCentral.com by Krissy (04/24/08)
Article 1413— Hi Mansi- I have a few questions regarding gastrectomy patients. I know that sometimes at my hospital, the surgeons will place a temporary Jejunostomy feeding tube during surgery just in ... 		04/28/08  Krissy, Thank you for your very well thought and great questions! The practice of placing a J-tube during surgery is wonderful, to make it possible to feed patients who may have ...   Krissy (04/29/08):
HI Mansi- Thank you so much ! I am getting to be a regular on your forum! I appreciate your ...  
Sophia Medinsky
Post was submitted on DietitianCentral.com 		Cancer & Nutrition Posted on DietitianCentral.com by mitu (04/24/08)
Article 1412— Hi Sophia thank you for answering my question. I also want to know,what kind of menu we can follow in a cancer hospital which is situated in India.As we have patients which are on ... 		04/24/08  Dear mitu, Thank you for your question. Patient’s menu is usually tailored to patient’s diet. If patient is on a Neutropenic diet, the staff should provide the patient with the foods allowed ...  
Mansi Shah
Post was submitted on DietitianCentral.com 		Enteral and Parenteral Nutrition Posted on DietitianCentral.com by abc0806 (04/23/08)
Article 1411— Can you recommend any resources for electrolyte management in ... 		04/28/08  Thank you for your question. Sorry for the delay in response. It took me a while to look up my references on this topic. Here you go: 1) Fluid and Electrolyte Management in Parenteral ...  
Mansi Shah
Post was submitted on DietitianCentral.com 		Enteral and Parenteral Nutrition Posted on DietitianCentral.com by dwalton (04/23/08)
Article 1410— I am a clinical dietitian in a small community hospital. We rarely do TPN/PPNs. Maybe 1-2 a month. The pharmacist is considering going to standard formulas. I need to know what standards ... 		04/24/08  dwalton, Thanks for your question. When you say "Standard formulas", do you mean a) only a specific (one type) of formulation, eg: D20,AA4.25, 20%IL 250mL @ 60ml/hr, or b) only defined ...  
Mansi Shah
Post was submitted on DietitianCentral.com 		Enteral and Parenteral Nutrition Posted on DietitianCentral.com by yfy5671 (04/23/08)
Article 1409— Hi Mansi. I have a question regarding pts on a ventilator who also have skin breakdown.What calorie level would you recommend? I use 30-35 for pts with pressure sores, however if they are on a ... 		04/24/08  hello, Your first question is not very easy to answer. I'll try to be brief though. When patients are on a ventilator, the goal should be "not to overfeed calories" so as to prevent increased ...   yfy5671 (04/24/08):
Thanks Mansi for your prompt response. With the first question I guess what I was getting at is ...  
Sophia Medinsky
Post was submitted on DietitianCentral.com 		Cancer & Nutrition Posted on DietitianCentral.com by mitu (04/21/08)
Article 1408— Hi Sophia, I want to know ,can a breast cancer patient drink milk? And also ,I heard that soya bean and its products is not safe for patient suffering from breast cancer. How far is this true? ... 		04/21/08  Dear mitu, Thank you for your question. Some researchers contend that consumption of dairy products may increase the risk of breast cancer. Still, there is not enough scientific evidence to ...  
Mansi Shah
Post was submitted on DietitianCentral.com 		Enteral and Parenteral Nutrition Posted on DietitianCentral.com by heartRD (04/20/08)
Article 1407— Mansi, Thank you for the quick response to my recent question about 50/50 TPN (50% lipid/50% amino acid) for post CABG DM patient (no dextose). After talking with the prescriber of the TPN, she ... 		04/22/08  I believe the prescriber is misinformed. We know that the brain exclusively uses glucose as its source of energy. The brain needs a minimum of 130gm carbohydrate daily (Institute of Medicine) ...   heartRD (04/22/08):
Mansi, Thank you so much for you thorough response! I really appriciate that you shared your ...  
Mansi Shah
Post was submitted on DietitianCentral.com 		Enteral and Parenteral Nutrition Posted on DietitianCentral.com by SEMINOLERD (04/18/08)
Article 1406— Hi Mansi, I just have a quick question. At the hospital where I work, physicians have recently been ordering blue dye to run with the tube feeding. I know I was taught that this was not ... 		04/18/08  SeminoleRD, Thanks for your question. Isn't this just frustrating? I've had to address this issue may times in my own practice and what has worked for me is to actually print out that warning ...  
Sophia Medinsky
Post was submitted on DietitianCentral.com 		Cancer & Nutrition Posted on DietitianCentral.com by mitu (04/15/08)
Article 1405— Hi Sophia, I been told by the doctor, that cancer patient should avoid raw vegetables, fruits with edible skin & non veg especially during chemotheraphy and radiation as there are more ... 		04/15/08  Dear mitu, Thank you for your question. The physician is talking about Neutropenic diet. During chemotherapy and radiation therapy patients may become immuno-compromised. Thus, it is beneficial ...   mitu (04/16/08):
Thank you sophia for your valuable information, the link you gave me is really helpful.  
Mansi Shah
Post was submitted on DietitianCentral.com 		Enteral and Parenteral Nutrition Posted on DietitianCentral.com by twilliamson (04/15/08)
Article 1404— Hi Mansi, What do you recommend as a maximum rate for NJ feeds. It has been recommended to me to use 125 ml/hr as a goal rate as the jejunum is not a reservoir but I am unable to find a ... 		04/18/08  twilliamson, Thank you for your question. I could not find a reference that says that the maximum amount to feed via small bowel is 125 ml/hr. This is what the ASPEN Nutrition Support ...  
Mansi Shah
Post was submitted on DietitianCentral.com 		Enteral and Parenteral Nutrition Posted on DietitianCentral.com by heartRD (04/13/08)
Article 1403— Mansi, I have a question regarding TPN and a patient who is diabetic. We had a recent issue at our hospital where a patient was given a 50/50 TPN mix of lipid and protein....little to no dextrose. 		04/13/08  heartRD, Thanks for your question. You are correct, that the amount of lipid should ideally not exceed 30%. ASPEN recommends that lipid infusion be limited to a maximum of 1gm/kg/min. Also, ...  
Janet M Litwack
Post was submitted on DietitianCentral.com 		General Nutrition Posted on DietitianCentral.com by NutritionSway (04/12/08)
Article 1402— What is LDN and how do you obtain it How do you obtain CLC? Is this certification specifically through WIC? I am an unregistered dietitian with a BSN. I am pursuing liscensure as an RD. I ... 		04/12/08  Hi NutritionSway, 'LDN' stands for 'licensed dietitian/ nutritionist' and it is only offered in states that require licensure. Once you've passed the RD exam (thus becoming a ...  
Mansi Shah
Post was submitted on DietitianCentral.com 		General Nutrition Posted on DietitianCentral.com by rachita (04/04/08)
Article 1401— hi,mansi how r u?my mother is 56years,weight 74kg,ht5.3inch she is having thyroid since 12yrs,also high cholesterol,high blood pressure and now with high level of uric acidi.e 7.42mg/dl can ... 		04/04/08  Rachita, Thank you for your question. You have identified many medical conditions and each of them have a different nutritional component. I do not have the ability to go into details about ...   rachita (04/08/08):
thank you so much it really helped me .  
Mary Ellen Hansson
Post was submitted on DietitianCentral.com 		Renal Nutrition Posted on DietitianCentral.com by catygett (04/03/08)
Article 1400— Hello Mary Ellen... I have three questions for you. 1. What is your take on an opinion-based calcium range of 8.4- 9.4 mg/dL as opposed to KDOQI guidelines (may be out of date) of 8.4-10.2 ... 		04/11/08  Dear Catygett, The recommended KDOQI guidelines are really promoting 8.4 to 9.5 for calcium range, with that "gray" area between 9.6 and 10.2 causing movement away from calcium load with ...  
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