While attending a conference a several weeks ago, I ran into a colleague whose passion and expertise, like mine, is wound care. Our conversation centered upon the topic of nutrition and how often as doctors, we omit the patient’s dietary habits in our treatment strategies. We are so focused on healing the wound that we may overlook the basics that would assist the healing process.

Typically as physicians, when we treat an ulcer, we are focused on the wound bed itself. In these situations, the patient often has several comorbidities typically including uncontrolled diabetes, which may translate into a poor diet and eating habits. While patients should be monitoring their blood glucose level daily, we need to monitor their nutritional status.

I currently am a physician panelist at a Healogics wound care center in the Washington, DC area. In addition to the standard lab tests, while not mandatory, I have started a new process of ordering baseline nutritional markers to establish a baseline with my patients.

Standard lab tests 
● Basic blood work
● Complete blood cell (CBC) with differential
● CHEM-7 panel
● HbA1c

Additional nutritional markers
● Albumin (normal 3.4-5.4 g/dL)
● Prealbumin (normal 15-36 mg/dL)
● Any additional labs depending on the patient’s medical history

A serum albumin test measures the amount of albumin in the clear liquid portion of the blood. This test can help determine if a patient has liver disease or kidney disease, or if the body is not absorbing enough protein.

The body uses prealbumin as a building block to make other proteins. You might order this test if the patient appears to be malnourished or if you want to follow the patient’s nutritional progress.

One should monitor the results of these tests periodically and discuss them with patients to educate them on how their nutritional diet impacts their health and the wound healing process. When there are abnormal nutritional results, the patient should get a referral to an endocrinologist or nutritionist for further evaluation.

In addition to focusing on the wound, we need to remember to evaluate what is feeding the wound for total patient care. Looking at the whole picture and leveraging a more expanded team approach to include nutrition, in my opinion, is the missing link in wound treatment.

Suggested Reading

1. Available at http://www.nlm.nih.gov/medlineplus/ency/article/003480.htm . Published Feb. 13, 2013. Accessed April 22, 2014.
2. Available at http://blog.beckydorner.com/2013/12/use-of-serum-albumin-and-prealbumin-… . Accessed April 22, 2014.
3. Available at http://www.webmd.com/a-to-z-guides/total-serum-protein . Published Nov. 4, 2011. Accessed April 22, 2014.

Original Posted on Podiatry Today.