Lilly is a 3-year-old who was diagnosed with cystic fibrosis (CF) at 3 weeks of age through newborn screening, positive sweat test, genetic testing (mutations: two copies of deltaF508), and a fecal elastase (confirming pancreatic insufficiency).
At her last CF Center Clinic visit 3 months ago, she weighed 12 kg and her length was 92 cm. Her weight reflects a loss of 700 g since her last clinic visit. Lilly plots in the 10th percentile weight-for-age and 10th-25th percentile height-for-age. Her BMI is 14.1, which plots in the 5th10th percentile for age. She is showing signs and symptoms of malabsorption, including the following: loose, greasy stools; more frequent stools than her baseline; and complaints of abdominal pain that correlate with eating. She does take pancreatic replacement enzymes (PERT) with her meals and snacks. Lilly is also complaining of nausea and dizziness after playing outside. At the visit, the dietitian obtained information about oral intake using a 24-hr recall. Lilly was consuming approximately 1,250 calories, 25 g of protein, 900 mL of noncaffeinated fluids, and not adding salt to her foods. Further discussion revealed that Lilly’s caregivers had recently left the bottles of enzymes in the car on an extremely hot day. Lilly mentioned that the enzymes melted together; however, the caregivers peeled them apart and are still using those enzymes. The registered dietician assessed multiple issues including the following: Weight loss and current BMI in the 5th percentile (The Cystic Fibrosis Foundation recommends a BMI percentile greater than or equal to the 50th percentile.) Malabsorption 24-hr recall (Those affected with CF may need 150-200% more calories than those without CF.) Inadequate beverage and sodium intake Inappropriate enzyme storage Briefly, answer the following questions by typing your answer in the Assignment Submission area below. Select the Write Submission button and type your answer in the Text Submission box provided. 1. Why would Lilly still be losing weight if her current intake meets the RDA for kilocalories for her age?
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