Norhaishah H1, Tan SP1, Roslee R1
1Universiti Kebangsaan Malaysia
A 55-years old married Chinese gentleman was diagnosed with Fournier’s Gangrene with Nectrotizing Fascitis of perineum, bilateral lower abdomen and thigh. He was newly diagnosed with T2DM on basal bolus insulin. Patient underwent multiple wound debridement at certain area and was plan to have secondary suturing at right inguinal and medial thigh with split skin grafting (SSG) in 1 month. He was referred for high protein and diabetic diet. The patient experienced weight loss of 7% within 1 month. Current BMI was 20 kg/m2. He was also found to have low albumin and uncontrolled blood glucose. Weight loss reflected his inadequate energy (58% adequacy) and protein intake (0.8g/kg). Patient was having on/off feverish day which may have an effect on his oral intake adequacy.
Inadequate protein-energy intake related to physiological causes requiring increased needs as evidenced by diet history
Nutritional intervention aimed for at least 75% of energy requirement, protein intake 1.5-2.0 g/kg to consolidate protein losses through wound exudate. Immuno-modulating formula (ONS) was included as strategies to increase protein-energy intake and promote wound healing. Dietary counselling was done towards patient and family members focusing on tips to increase protein-energy intake and for better glycemic control. Supplemental of multivitamins and minerals was also suggested. Personalized menu plan was also prescribed for better outcomes.
Monitoring & Evaluation
Patient achieved adequate energy and protein intake as per recommendation with good glycemic control. Improvement of albumin value was seen after 1 month prior to SSG. Wound inspection was showing no deficient, infection and no advancing wound edge.
Lesson Learnt: Patient condition improved following dietary intervention. Thus, dietitian plays an important role in providing good nutrition and utilize nutrients that has specific role in wound healing and practice evidence-based dietary recommendations for better outcomes in wound care.