Mr. James chest X-Ray shows cardiomegaly and pulmonary edema. Click on the image for a bigger view.

His admitting labs were remarkable in a few areas.

• His albumin is decreased at 2.3 g/dl
• His Na and K are both at lower limits of normal
• His creatine kinase (CK) is 195 U/L
• His ALT, AST and LDH are mildly elevated.
• He has a mildly elevated serum glucose at 112
• His HbA_1C was 7.0%
• His CBC and clotting studies were not abnormal.
• Normal values?

Take a look at Mr. James' completed SGA form. His score is substantially past 9, the figure indicating need to for nutritional intervention.

Mr. James was started on enteral feeding, but it was stopped at his request.

• Enteral feeding refers to the delivery of liquid feedings through a tube that is placed directly into the gastrointestinal tract. Click here to learn more.

Mr. James requested the tube be removed and that he be given oral feedings and that he wanted no extraordinary measures taken to prolong his life.

He died ten days after admission.

Mr. James had end-stage congestive heart failure and cardiac cachexia.