This document discusses dietary guidelines for several gastrointestinal and liver diseases. It recommends continued breastfeeding and early refeeding for diarrheal diseases to reduce severity and prevent malnutrition. For acute glomerulonephritis, it advises restricting fluids and sodium during oliguria while providing liberal calories and protein. For acute renal failure, intravenous fluids are recommended if oral intake is not tolerated, with restricted sodium and protein intake. For congestive cardiac failure, it suggests fluid and sodium restriction with extra calories and protein. For hepatic diseases, it emphasizes providing adequate calories and nutrients to prevent complications while restricting fat, protein and fluids as needed.

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........