Case 8

Misou's laboratory findings (elevated ALP activity with normal gamma-glutamyltransferase [GGT] activity, hyperbilirubinemia, hypokalemia, and hypertriglyceridemia) and history (anorexia) are most suggestive of hepatic lipidosis. What you don't know, however, is if it is primary or secondary to an underlying disease. Thus, the workup and her treatment will need to continue.

QUESTION 3

In addition to continuing her intravenous fluid support, what is a logical treatment plan for Misou at this time?

a) Start an appetite stimulant and syringe feeding.

b) Immediately place an esophagostomy tube, calculate her daily caloric requirements, and feed this amount daily.

c) Start total parenteral nutrition to maintain her caloric requirements.

d) Place a nasoesophageal feeding tube, calculate her daily caloric requirements, start feeding 25% of this amount, and gradually increase it.

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