D. Nutrition and Wounds: Selection of an Appropriate
     Nutritional Protocol

Three regimens are described, one of which should be selected, based on the degree of involuntary weight loss, the complexity of the wound, and evidence of an impairment in wound healing.

Nutritional Regimen (Protocol A) Wound Population

Healthy Patient

1. Weight loss less than 10% of preinjury (or normal body) weight
2. Uncomplicated uninfected wound
3. Stage I or stage II pressure sore
Calories Recommended daily requirement for moderate activity
(usually 30 kcal/kg/d)
Distribution 55% carbohydrates (preferably complex carbohydrates)
25% fat (preferably polyunsaturated)
20% protein (whole foods plus supplements)

Protein

At least 1 g/kg/d or 20% above RDA to maintain muscle mass after injury. If using supplements to add to regular food, milk protein hydrolysates and egg albumin are best. (MET-Rx ready-to-drink formulation has the highest protein content in a very palatable form)
Micronutrients Use 1 high-potency multivitamin with minerals per day plus
Vitamin C 500 mg, Vitamin A 5000 IU, and zinc. Need adequate
vitamins and microminerals
Fluid Intake Sufficient to maintain good skin turgor, urine output
Monitor Daily calories and protein intake, weekly weights, wound-healing rate

 

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