II. Pathophysiology

  1. Malnutrition impedes Wound Healing
    1. Weight loss over 15 to 25% of body weight
    2. Protein depletion
  2. Vitamin Deficiency impedes Wound Healing
    1. Vitamin C Deficiency (Scurvy is a dramatic example)
    2. Vitamin A Deficiency
    3. Zinc Deficiency

III. Precautions

IV. Management: Assess Adequate Dietary Intake

  1. Adequate protein intake and calorie intake
  2. Adequate fluid intake

V. Management: Perform nutritional assessment every 3 months

  1. Serum Albumin <3.5 grams
  2. Lymphocyte Count <1500
  3. Low Total Cholesterol (<100 suggests malnutrition)
  4. Diminshed oral intake
  5. Weight change

VI. Management: Malnourished with continued inadequate intake

  1. Consider tube feeding for Positive Nitrogen Balance
  2. Calories: 30-35 kcal/kg/day
  3. Protein: 1.25-1.50 grams/kg/day
  4. Vitamin And Mineral supplementation

VII. Management: Unsupported Vitamin Supplementation (possible efficacy)

  1. Vitamin C 500 mg PO bid
  2. Iron Supplementation
  3. Zinc supplementation

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