Geriatric Quick Consult      Pressure Ulcers      Don't #1

Don't underestimate protein needs
Knowledge Action
Pressure ulcers can indicate malnutrition.

Serum albumin alone is not a reliable indicator of nutritional status, especially in the acute care setting.

A complete assessment is needed.

Other lab values such as total lymphocyte count and transthyretin (prealbumin) are useful.

One study1 found that high protein diets may increase pressure ulcer healing in malnourished nursing home patients.

For most patients positive nitrogen balance is attained with intake of 30-35 cal/kg/d and 1.25-1.50 gm protein/kg/d2 although as much as 2 gm protein/kg/d may be needed3.

  • Complete assessment


  • Measure total lymphocyte count


  • Measure transthyretin (prealbumin)


  • Feed patient 30-35 cal/kg/d


  • Feed patient 1.25-1.50 gm protein/kg/d

References:

  1. Breslow RA, Hallfrisch J, Guy DG, Crawley B, Goldberg AP. The importance of dietary protein in healing pressure ulcers. J Am Geriatr Soc 1993; 4(4): 357-62.
  2. Bergstrom N, Bennett A, Carlson CE, et al. Clinical Practice guidelines Number 15: Treatment of pressure ulcers.
  3. Mulholland, JH, Tui C, Wright AM, Vinci V, Shafiroff B. Protein metabolism and bedsores. Ann Surg 1934; 118: 108-23.
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