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S.P., a 34-year-old cachectic woman, is admitted to the hospital with abdominal pain, nausea, vomiting, and diarrhea. She has a history of moderate Crohn’s disease diagnosed 4 years ago. She has had extensive treatment with medical therapy, but has not required surgical intervention since her diagnosis. She has experienced extraintestinal symptoms including skin lesions and joint pain. She presents to the hospital with increasing weight loss in the past 3 months, accompanied by regurgitation, vomiting, and poor appetite. Approximately 6 months ago, S.P. weighed 120 pounds. Her weight on admission is 92 pounds; height is 60 inches. Past medical history is also significant for peptic ulcer disease and occasional bouts of depression. Physical examination reveals a thin woman with wasting of subcutaneous fat in the temporal area and squared-appearing shoulders. She reports noticing recent hair loss. Attempts at increasing her oral intake with enteral supplements have not been successful owing to self-reported retching. Admission laboratory values are as follows: Sodium, 135 mEq/L Potassium, 4.0 mEq/L Chloride, 100 mEq/L Bicarbonate, 25 mEq/L Blood urea nitrogen, 4 mg/dL Creatinine, 0.6 mg/dL Glucose, 87 mg/dL Calcium, 8.2 mg/dL Magnesium, 1.7 mg/dL Phosphorus, 2.8 mg/dL Total protein, 6.0 g/dL Albumin, 3.5 g/dL Prealbumin, 14 mg/dL Her white blood cell count is 12,600/?L. Based on history and physical findings, S.P.’s working diagnosis includes Crohn’s disease exacerbation with cutaneous, joint, and GI involvement. What is her current nutrition status?

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