Nutritional intervention and arginine supplementation in a malnourished patient with peripheral vascular disease (PVD)1

Peer-reviewed | Manuscript received: August 22, 2013 | Revision accepted: January 06, 2014

A case study

Introduction

A 75-year old male patient with ulcerous, necrotic and gangrenous peripheral vascular disease (PVD; Fontaine stage IV) was admitted to hospital with recurrent diarrhoea, vomiting, loss of appetite and weight loss of 15 kg within the preceding 4 months. He also had a poorly healing ulcer on the ball of the foot after amputation of a toe.

Dietary treatment was included in the interdisciplinary therapeutic approach. As the nutritional team was aware, there have been few publications on the influence and prevalence of malnutrition or possible specific dietary recommendations for patients with PVD. However, PVD is linked to reduced perfusion and thus to impaired wound healing. Malnutrition is an additional important risk factor. Moreover, PVD often affects older patients, who are at increased risk of malnutrition [1–3]. Recommendations for wound healing include adequate supplies of energy, protein and fluid, together with nutritional screening, supported by high protein nutritional supplements if required [3–5]. The amino acid arginine is involved in wound healing through a variety of mechanisms – improved vascular function, tissue synthesis and the immune response – and it has been suggested that arginine supplementation could be used in wound treatment (
Box 1) [4, 6].

Summary

This case report describes a nutritional approach to the treatment of a patient with peripheral arterial occlusive disease (PVD), intestinal inflammation, weight loss, poor nutritional status and a poorly healing ulcer. The successful treatment was supported by nutritional interventions, including arginine supplementation.

Keywords: arginine, peripheral vascular disease (PVD), ulcer, nutritional deficiency, wound management, clinical nutrition

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