Denielle Saitta

NCP
GI and Polydipsia
I.

Introduction: Patient Profile

Mr. B is a 32 year old Caucasian male diagnosed with schizophrenia, gastroesophageal
reflux disease (GERD) and psychogenic polydipsia.
II.

Disease Process

Gastroesophageal reflux disease (GERD) is a digestive condition that affects the lower
esophageal sphincter, the ring of muscle between the esophagus and stomach. Many suffer from
heartburn or acid indigestion affected by GERD. In most cases, GERD can be relieved through
diet and lifestyle changes but some may require medication or surgery. Heartburn is the most
common symptom of GERD. Heartburn usually feels like a hot chest pain beginning behind the
breastbone and upward to the neck and throat, and can last as long as 2 hours. This pain is
usually worse after eating, but lying down or bending over can also result in heartburn. Many
people get relief by standing upright or by taking an antacid.
Dietary and lifestyle choices may contribute to GERD. Certain foods and beverages,
including chocolate, peppermint, fried or fatty foods, coffee, or alcoholic beverages, may trigger
reflux and heartburn. Obesity can also play a role in GERD complications. Many overweight
people find relief when they lose weight. Lessening the size of portions at mealtime can also help
control GERD symptoms. Eating at least 2 to 3 hours before bedtime may lessen reflux issues
within the stomach.
Polydipsia is excessive thirst, while psychogenic polydipsia is an excessive water intake
mostly seen in patients with mental illnesses such as schizophrenia. Should be taken very
seriously, as the amount of water consumed surpasses the amount that can be filtered by the
kidneys can then on unusual cases be life-threatening due to the body's serum sodium level. This
can cause seizures and cardiac arrest.
Patients with polydipsia will need to have their fluid levels monitored to make sure they
are not consuming to much liquid. It is important to get Sodium levels back up to normal for
these patients. Offering beverages such as Gatorade or Powerade may be a good way to increase
levels. Consistent weight checks is also important to check for water retention and sodium levels.
III.

Patient history: Mr. B is predisposed to hyponatremia and subsequent medical issues

secondary to his psychogenic polydipsia. Mr. Bs risk for hyponatremia and subsequent
medical issues is perpetuated by his inability to manage his fluid intake in unstructured
settings. Medical findings included normal esophagus, normal duodenum, and Erythema
in the Antrum and body of the stomach, compatible with non-erosive Gastritis.

IV.
V.

Course of hospital treatment N/A

Nutrition Care
a. Nutrition Assessment

Weight
o 155 lb = 70.45 kg
Height
o 5 9 = 97 in = 1.7526 m
BMI
o ((70.4545)/((1.7526)) / 1.7526 = 29.9 kg/m2
o Normal
Ideal Body Weight
o 106 + 6(9) = 160 lb
o 155/160 = 96.875%
Labs
o Albumin: 4.5 (Normal 3.0 5.0)
o Calcium: 9.2 (Normal 8.5
10.5)
o Alkaline Phosphate: 81 (Normal
38 126)
o Potassium: 4.7 (Normal 3.5
5.1)
o Creatinine: 0.81 (Normal 0.50
1.25)
o
Medications
o Lamictal (Lamotrigine)
Do not drink alcohol
o Milk of magnesia
o Levbid 0.375 MG PO
BID
o Align
o Pepcid (Famotidine)
o Pepto Bismol (Bismuth
Subsalicylate)
o Prilosec (Omeprazole)

o Total Protein: 7.3 (Normal 6.0

8.4)
o Glucose: 80 (Normal 74 106)
o Sodium: 130 (Normal 137
145)
o BUN: 14.0 (Normal 9.0 21.0)
o HGB: 15.1 (Normal 12.6 17.4)
o HCT: 45.6 (Normal 37.0 51.0)

o Tylenol
(Acetaminophen)
o Zocor (Simvastatin)
No grapefruit and
grapefruit juice. No
alcohol
o Zoloft (Sertraline
Hydrochloride)
o Zyprexa Zydis
(Olanzapine) increase
appetite

o
o
o
o
o
o
o

Nutrition Needs
o Kcal: 2100 2450 kcal (30 35 kcal/kg)
o Protein: 70 g protein (greater than or equal to 1 g/kg)
o Fluid: 2100 cc
Diet order
o Regular diet, normal texture and consistency, larger portions (extra
protein, starches, and vegetables), Boost TID, Gatorade TID. Fluid
restriction for polydipsia.
Other:
b. Diagnosis (PES) Statement
Altered GI function related to GERD as evidenced by medical record
Altered nutrition related lab values (Na 130) related to psychogenic polydipsia as
evidenced by lab values.

c. Intervention Plan & Implementation

Nutrition related to health/disease: Nutrition education on GERD diet, diet
designed to prevent or reduce acid reflux. Consume small and frequent meals.
Avoid citrus fruits and juices, coffee, caffeinated beverages, spicy, and acidic
foods.
Patient will drink Gatorade TID with meals, will education patient on polydipsia
and fluid restriction.
o
o d. Monitoring/Evaluation
Will monitor weight, monitor fluid restriction, patient reported intakes, lab values,
maintain nutritional status until end of treatment
e. Documentation
Completed