Medical conditions and desired diet

1. Dr.ANJANA.K.S

2. DIET IN DIARRHOEAL DISEASES
 Assessment of dehydration and categorisation into plan A, B
and C for ORT is the cornerstone in the management of ADD

3.  Ensure user-friendly ORS.
 ORS with increased sugar leads to osmotic diarrhoea.
 Continued breastfeeding and early feeding from the family
pot
-reduce the duration and severity of diarrhoea
- prevent malnutrition.
 Convalescing children need an extra meal/day for two weeks.
 Acute dysentery requires drug therapy for 5 days
-Nalidixic acid, erythromycin, tetracycline, furazolidone,
or metronidazole.
 Infestations like whip worm a need Mebendazole.

5.  In severe and prolonged diarrhoea, hypo-osmolar super ORS
(or rice based) should be tried.
- one with sodium 75 and glucose 75 mmol/L
- better accepted
- it decreases stool output by 25% and
- also improves nutrition of the child.
 Low milk, then milk-free and then starch-free diet can be
tried in succession.
 In osmotic diarrhoea, disaccharide (lactose, sucrose) free
diets are rewarding.
 In cow’s milk protein intolerance (CMPI), milk protein
should be avoided and soya protein can be tried

8. Diet in Acute Glomerulonephritis (AGN)
 a) Fluid:
- Restrict fluid to insensible loss plus last day’s output
when oliguria is present.
- Oliguria is defined as urine output less than 1 ml/kg/hour
- Insensible loss of water is 400 ml/m2/day.
- Normal glomerular filtration rate (GFR) is 25 ml/nr/minute
or 10.20 ml/m2/min.
- i) Mosteller's formula for calculation of surface area:

9.  If there is oedema and oliguria, give frusemide 1-2 mg/kg.
 If there is vomiting, give IV fluid.
 b) Calories:
-Give liberal calories, RDA for age plus 10% extra for
infection
 c) Protein:
- Give RDA for age if blood urea is normal.
- In renal failure, restrict to 0.5-1.25 g/kg body weight.
 d) Sodium:
-Restrict sodium during oliguria and gradually add 1-2
g/day during diuretic phase and slowly increase to 10 g/day.

10.  e)Potassium:
-Potassium is avoided and fruits should not be given
during oliguria.
-During peritoneal dialysis, fluid and diet restriction are
not strictly essential

11.  The fluids that can be given are kanji water, butter milk
and dilute milk (50-100 ml of milk made up to 1 glass).
 The food items that can be given are salt-restricted items like
rice, kanji, idli, dosai, rice flakes, sugar, jaggery, honey,
glucose, oil/ghee, unsalted butter and vegetables.
 Other items that can be substituted are rice flakes, ragi,
nestum, custard powder, honey, jaggery etc.
 Avoid high protein, extra sodium and fruits.

12. Diet in Acute Renal Failure (ARF)
 a) Fluids in ARF:
- IVF if oral is not tolerated. Quantity—insensible loss +
last day's output.
-Type of fluid—insensible loss as 10% dextrose and
output, 50% as N.saline and 50% as 10% dextrose
 b) Sodium:
- No extra sodium when there is oligo-anuria and
hypertension.
 c) Protein:
-Restrict protein intake to 0.5-1.25 g/kg/day.
-Provide essential amino acids.

13.  Recovery phase: During recovery phase, slowly increase
fluids, protein and sodium.
 Model diet in ARF : 4 year-old with 15 kg weight, hypertension and ARF.
Output 100 ml.

14.  SAT mix – a precooked, ready to mix cereal, pulse, sugar
mixture
 For nutritional rehabilitation – SAT mix, coconut oil,
vitamin and mineral supplements and family pot feeding

15. DIET IN HEART DISEASE WITH CONGESTIVE
CARDIAC FAILURE (CCF)
 10-30% extra calories may be needed due to infection and the
hypermetabolic state.
 Weight gain is essential to control infection and to plan
surgery as well.
 Fluid and salt restriction are required in CCF.

16. Goals
 a) Fluid:
-In oedema, restrict to insensible loss + last day’s output
or two- third maintenance.
 b) Calories:
-RDA for age + 10-30% extra.
 c) Protein:
-RDA for age or up to 10-15% of total calories as protein
of high biological value.
 d) Sodium:
- Restrict to V2-I g/day

17.  Model diet in CCF
- 2-year child with 8 kg weight and oedema, output 300
cc.
- a) Fluid: 20 x 8 = 160 ml + 300 ml = 460 ml or 2/3
maintenance—500 ml
- b) Calories: RDA 1100 kcal + 20% extra = 1320 kcal
- c) Protein: RDA or up to 10% of calories = 120 kcal = 30 g
d) Sodium: Restricted to Vi g/day.

19. DIET IN HEPATIC DISEASES
 GOALS
 To provide adequate calories and electrolytes and to prevent
hypoglycaemia, hypoalbuminaemia, hypokalaemia.
 Liberal carbohydrates and fruits, adequate protein and fat
according to tolerance are given in mild diseases.
 High fat decreases gastric emptying and may aggravate nausea.
 MCT is better tolerated when there is decreased bile flow.
 Phospholipid extracts from soyabeans is found to help in liver
regeneration and to improve appetite.

20.  L- ornithine-L-aspartate (Hepamerz) orally or IV is beneficial
in liver disorders.
 Ursodeoxycholic acid (UDLIV) is effective in cholestatic
jaundice.
 In Hepatic encephalopathy
The aim is to reduce ammonia level and to support the liver.
a) Avoid protein by mouth.
b) Sterilize the gut by oral ampicillin or neomycin.
c) Lactulose 1-2 ml/kg/day in divided doses or till there is
diarrhoea (up to 30 ml/dose)
d) Lactisyn or lactobacilli may be given orally.
e) Ryle’s tube aspiration and bowel wash.

21.  f) Calorie requirement is RDA for age plus 10-20% extra
calories.
- As much calories as possible should be given as 10%
glucose enriched with 25% dextrose.
 g) Blood transfusion and albumin.
 h) Supplement vitamin K and fresh frozen plasma .
 i) Give hepatic drip to supply fluid and calories
 j) Glucagon 0.03 mg/kg/day up to 1 mg/dose for 3 days helps
in liver regeneration and to prevent hypoglycaemia.
 i) Supplement branched chain amino acids valine, leucine,
isoleucine which help in liver regeneration

22.  Chronic liver disease
 Ensure RDA plus 10-20% extra calories for malabsorption
and altered liver function
 Protein enough to meet RDA can be given unless in hepatic
coma.
 Supply MCT and fat-soluble vitamins in view of decreased
bile flow.
 Restrict fat if there is cholestasis.
 Prolonged cholestasis associated with fat malabsorption
leads to deficiency of fat- soluble vitamins and calcium.
 Vitamin K injections should be given twice a month.
 High dose of vitamin A, D and E also should be
supplemented.
 Water-soluble preparation of vitamin E up to 15-25 IU/kg/day
and vitamin D up to 1000 IU/kg/day may be needed in some.

23.  Liver disease with ascites and oedema
 Salt and fluid should be restricted and N. saline may be
avoided in hepatic drip.
 Aldactone (aldosterone antagonist) can be given 3-5 mg/kg/
day in 4 divided doses.
 Plasma and albumin infusion are beneficial.

24. THANK YOU........