Question: CLINICAL CASE STUDY Marisa, A 27-year-old Female, Reports Increased Symptoms Of Restless Leg Syndrome, Fatigue, And Painful Abdominal Bloating And Heavy Men- Ses For The Past Year. A Physical Examination Reveals Inflammation And Tenderness Around Her Knee And Ankle Joints. MEDICATIONS: None HT: 5’5″ WT: 215 Lb LABORATORY VALUES: Client Normal Range …

CLINICAL CASE STUDY Marisa, a 27-year-old female, reports increased symptoms of restless leg syndrome, fatigue, and painful abdominal bloating and heavy men- ses for the past year. A physical examination reveals inflammation and tenderness around her knee and ankle joints. MEDICATIONS: None HT: 5’5″ WT: 215 lb LABORATORY VALUES: Client Normal Range WBC 8.3 3.8 – 10.5 KUL RBC 4.86 3.8 – 5.20 Mul HGB 10.8 L 12.0-16.0 g/dL HCT 32.7L 34.5 -45.0 % MCV 74.1 L 80.0 – 100.0 fi MCH 24.3L 27.0 – 34.0 pg MCHC 30.4 L 32.0 – 36.0 gm/dL IRON 28 L 40 – 160 ug/dL UIBC 429 H 110 – 370 ug/dL TIBC 508 H 220 – 430 ug/dL % Saturation, 12 L 14-50 % Iron Transferrin 435 H 200 – 400 mg/dL Ferritin 12 L 15-150 ng/mL C-Reactive 0.96 H 0.00 -0.40 mg/dL Protein Vitamin D 14.6 L 30.0 – 100.0 ng/ml Nutrition Diagnostic Statements Increased nutrient needs (iron) related to heavy menses and suboptimal intake of dietary iron as evidenced by multiple low iron status labs including HCT, HGB and ferritin. Altered nutrition related laboratory value related to predicted pro- inflammatory diet pattern as evidenced by low intake of omega-3 fatty acids and bioactive compounds, elevated C-reactive protein (CRP) and painful joints. Nutrition Care Questions: 1) How should Marisa be further evaluated? 2) What vitamin/mineral supplements, if any, should be part of her treat- ment plan?