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Celiac Disease Case Study

The following is a scenario of a 19 year-old female, Liz Gavin, who came into the Emergency Department by the ambulance in the morning with complaints of diarrhea and vomiting for a week, abdominal pain, weight loss of 15 pounds in one month, fatigue, dehydration, severe thirst, and paralysis of her lower extremities. She has a family history of Diabetes type 1, Celiac Disease, Rheumatoid Arthritis, and Psoriasis. She has a personal history of Celiac Disease, chronic constipation, weight loss, and abdominal pain associated with her Celiac Disease diagnosis. In the Emergency Department, her labs were taken and she had a hemoglobin of 9, a diagnosis. In the Emergency Department, her labs were taken and she had a hemoglobin of 9, a hematocrit of 32, a potassium of 2.8, a total protein f 5.0, a calcium of 8., a magnesium of 1.0, and metabolic acidosis. Her vitals in the emergency department were heart rate of 103, respiratory rate of 20, blood pressure of 85/50, oxygen saturation of 98%, temperature of 98.7 degrees fahrenheit, and stabbing pain of 8 in her abdomen. Liz was diagnosed with Celiac Crisis. Celiac Crisis is a life threatening form of Celiac Disease that starts with the classic gastrointestinal symptom of diarrhea that leads to dehydration and electrolyte imbalances (Hijaz, Bracken, & Chandratrem, 2014).

She was transferred to the ICU for care. In the ICU she was treated for her dehydration, fluid and electrolyte imbalances, hypotension, nausea/vomiting, and her overall Celiac Crisis. This was done with intravenous lactated ringers, supplements of potassium, magnesium, and calcium. She was also given norepinephrine to increase her blood pressure, Zofran for her nausea, dapsone for her skin rash, and prednisone to treat the overall Celiac Crisis. Upon assessment the primary nurse found that the cause of Liz’s Celiac Crisis was due to nonadherence to her dietary regimen. She is a freshman in college and though she was compliant to her gluten free diet previously, the pressures of fitting into a new school and environment led her to stop her diet. She was educated by the nurse on the signs of Celiac Crisis in the future in order to get help immediately. She was also referred to a dietician, case management, and tele psych in order to help her cope with her disease process and prevent complications in the future.

Discussion Questions

1. What are some relevant nursing diagnosis to this patient?
2. What are some relevant laboratory results for this patient?
3. What is the appropriate treatment for this patient?

Answer Key

Question 1: Risk for imbalanced nutrition, risk of infection, ineffective coping, anxiety, fluid and electrolyte imbalances

Question 2: Potassium, PT and PTT, Hemoglobin and Hematocrit, Magnesium, Calcium, Protein

Question 3: Corticosteroids, gluten-free diet, fluids, support group, vitamins