This is a 61-year-old woman with Lupus who presented with huge non-healing ulcers on both knees, thought to be related to vasculitis. However, her BMI (Body Mass Index) is only 13.8 — which is lower than patients I treated in Haiti. She weighs only 83 lbs. None of her physicians have mentioned this issue and malnutrition is not included as a diagnosis in her chart.

I started her on Arginaid (Nestle) as well as multivitamins, and counseling her extensively about her calorie and protein intake. I did NOT debride her wounds until her nutrition was improved. She healed with nutritional supplementation.

Why had no one addressed her malnutrition when she weighed 83 lbs?

The answer is not that we don’t care, but we always seem to have other priorities and if your electronic health record (EHR) doesn’t incorporate a validated nutritional assessment tool, it’s darn hard to implement consistently.

I am going to talk about how I overcame that barrier in a future post.