Therapeutic nutrition for infectious patients. Diet therapy for infectious diseases
NUTRITION FOR INFECTIOUS PATIENTS
Appropriate diets for infectious diseases are an essential component of complex therapy for patients. This is especially important to know when treatment is carried out at home.
A nutritious and balanced diet is an essential addition to the treatment of infectious patients, because along with disruption of many body functions, protein, fat, carbohydrate, mineral and vitamin metabolism almost always suffer. According to accepted physiological nutritional standards for an adult, the most favorable ratio of proteins, fats and carbohydrates is 1:1:4, i.e. for 1 g of protein there should be 1 g of fat and 4 g of carbohydrates. In diseases, this ratio changes, because...
The needs for certain substances change. The balance of mineral salts is often disturbed, and there is an increased need for vitamins, especially vitamins A, C, PP, group B. Timely replenishment of nutrients and sufficient energy supply to the suffering body also has a beneficial effect on the treatment of an infectious patient with specific methods. For example, the effect of antibiotics can be either insufficient or distorted in conditions of protein and vitamin deficiency.
In case of infectious diseases, special attention must be paid to replenishing the lack of vitamins, which is quite possible by taking foods containing them.
Essential vitamins and some foods high in them.
Name of vitamin Main source of vitamin in foods
Vitamin C (ascorbic acid) Rose hips, black currants,
Parsley, red bell pepper, pine extract, fresh and
Sauerkraut
Vitamin B1 (thiamine) Cereal products, wholemeal bread,
Unpolished rice, legumes, brewer's yeast Vitamin B2 (riboflavin) Cottage cheese, cheese, liver, kidneys, yeast Vitamin B6 (pyridoxine) Liver, kidneys, meat, fish, legumes Vitamin B12 (cyanocobolamine) Liver, kidneys, beef, egg yolk Folic acid Spinach, asparagus, legumes, liver Vitamin P Tea, red bell pepper, citrus fruits Vitamin A Milk, cream, sour cream, butter, liver, kidneys Provitamin A Carrots, tomatoes, pumpkin, apricots, lettuce, spinach,
Vitamin K (antihemorrhagic) Peas, tomatoes, spinach, cabbage, liver
Vitamin E (tocopherol) Vegetable fats (corn, soybean, sea buckthorn and other oils)
For nutrition of infectious patients in the acute period of the disease, when there is an increase in body temperature (flu, acute respiratory infections, tonsillitis, pneumonia, etc.), diet N2 is recommended.
For acute intestinal diseases accompanied by severe diarrhea, it is advisable to prescribe diet N4.
After suffering from viral hepatitis, leptospirosis, infectious mononucleosis and other infections with liver damage, the N5 diet is indicated.
The diets have corresponding numbers for the purpose of a unified approach to the selection of food products for various diseases (not only infectious ones) in different medical institutions in Russia. Of course, it is difficult to follow a precisely defined diet at home. However, the approximate composition of products, the technology for preparing a particular diet, and contraindications for taking certain products for certain infectious diseases can be learned at home. Diet N2
A physiologically complete diet contains a sufficient amount of proteins, fats, carbohydrates with a high content of vitamins (especially ascorbic acid) with a limitation of milk and coarse fiber. Power mode 4 – 5 times a day
This diet helps normalize gastric secretion, reduces intestinal motor function, and suppresses fermentation processes in the gastrointestinal tract.
With this diet, dishes with varying degrees of grinding and various heat treatments are allowed. When frying, the formation of a rough crust is not allowed (fry without breading). Temperature of hot dishes – 55-60 C; cold - not lower than 15 C.
According to the chemical composition and calorie content, diet N2 is determined as follows: proteins - 90-100 g, fats - 90-100 g, carbohydrates - 400-450 g. Calorie content - 3000-3200 kcal. Table salt up to 15 g.
Bread and bakery products – white and gray wheat, yesterday’s baked goods, unsweetened varieties of cookies.
Soups - with low-fat meat and fish broths, with vegetable broths with pureed vegetables and cereals.
Meat and fish dishes - meat, fish, lean, minced, baked and fried (not rolled in breadcrumbs), boiled chicken.
Milk and dairy products - milk with tea, cottage cheese, kefir, fermented baked milk.
Vegetables and greens - puree from various vegetables, vegetable cutlets (without crust), cauliflower with butter, zucchini, pumpkin, tomato salad. Add early greens to dishes.
Fruits, berries - mashed compotes, purees, sweet varieties of apples, berries. Sugar, honey
Cereals and pasta - porridge, puddings, cereal cutlets (without crust); boiled pasta, vermicelli.
Fats – butter, sunflower oil.
Egg - soft-boiled, omelette.
Drinks – tea with milk, cocoa and water coffee, fruit juices (half and half with water).
Fresh bread, fatty meats, canned snacks, raw vegetables, lard, smoked meat, goose, very cold and very hot dishes, and carbonated drinks are prohibited.
The intended purpose of the diet is to provide maximum mechanical and chemical sparing of the intestinal mucosa, prevent fermentation and putrefactive processes, and reduce the inflammatory state of the intestinal mucosa.
The diet limits the content of fats and carbohydrates. The protein content is normal. The amount of table salt has been reduced. Products that enhance fermentation and have an irritating effect on the intestinal mucosa (milk, coarse fiber, spices, etc.) are excluded. The diet is split - 5-6 times a day. All dishes are mashed and boiled.
The temperature of hot dishes is 55-60 C, cold - not lower than 15 C. Protein content 80-100 g, fat - 80 g, carbohydrates 300 g. Calorie content - 2400 kcal. Table salt – up to 10 g.
Bread and bakery products – premium crackers made from white bread, untoasted.
Soups - based on low-fat meat and fish broths with the addition of rice and buckwheat broths. Boiled meatballs, egg flakes, pureed boiled meat.
Meat and fish dishes - beef, poultry in the form of steam cutlets. Low-fat boiled fish (navaga, pike perch, etc.).
Eggs - no more than one per day, add to dishes.
Milk and dairy products – fresh cottage cheese; fresh milk is excluded. Fats – butter, fresh.
Drinks - sweet tea, juices in the form of jelly, blueberry jelly, bird cherry, dried black currant.
Prohibited: legumes, vegetables, herbs, fruits, berries, spices, snacks, natural eggs, honey, sweets, confectionery, all carbonated drinks.
The purpose of this diet is to help normalize impaired liver and biliary tract function, stimulate the biliary system and intestinal motor functions.
This diet contains a normal amount of protein with limited fat (without lamb, goose, internal fat). Reducing the amount of foods that promote fermentation. The amount of vegetable products, fruits, and melons (watermelons) has been increased.
You need to eat 4-5 times a day. Food is served boiled and baked. Frying is not allowed. The food temperature is normal.
Proteins in this diet are 100-200 g, fats 120-130 g, carbohydrates - 350-400 g. Calorie content - 3500 kcal. Free liquid up to 1.5 l. Table salt until
Bread and bakery products – gray, coarse bread. The cookies are inconvenient.
Soups - with vegetable broth or milk (with water). Cereals – buckwheat, oatmeal, pasta. Fruit soups.
Meat and fish dishes - lean meats, boiled chicken. They don't make cutlets. Low-fat fish (cod, navaga, pike) - boiled.
Egg - white omelet (without yolk) no more than 2 times a week.
Milk and dairy products - sour cream in dishes. Low-fat cottage cheese,
One-day yogurt, low-fat kefir.
Vegetables and greens - cabbage, potatoes, carrots, beets raw and boiled, onions are added after boiling.
Fruits, berries, sweets - ripe varieties of fruits and berries, raw and boiled, lemon with sugar, watermelons, soy chocolate, sugar.
Fats – butter, sunflower in ready-made dishes.
Cereals and pasta – various cereals, pasta. Drinks, juices - rosehip decoction, various juices (with water), tea with milk, tea with lemon, dried fruit compotes. Prohibited: mushrooms, beans, peas, peppers, sorrel, spinach,
Fried foods, egg yolks, canned food, alcohol (!), beer, carbonated drinks.
In the treatment of infectious diseases, a special role is given to the organization of therapeutic nutrition for patients.
A distinctive feature of the nature and course of pathogenetic processes in febrile patients is:
Increased metabolism
Increased breakdown of protein structures,
Intoxication of the body
Decrease in mineral content,
Development of hypovitaminosis,
Loss of fluid
Inhibition of the secretory function of the digestive glands,
Weakening of the activity of the excretory organs.
Goals of diet therapy for this category of patients:
Compensation for increased energy costs,
Correction of metabolic disorders,
Detoxification of the body,
Stimulation of protective forces,
Improving the secretory function of the digestive glands,
Creating favorable conditions for the rapid normalization of the activity of affected organs and systems.
Nutritional therapy should be prescribed taking into account the etiological factor, stage of the disease, the presence of complications and concomitant pathology.
The starvation diet, widespread in previous years, did not justify itself. Only in severe cases of the disease with impaired consciousness is diet No. 0 (15-20 g of protein, 10-20 g of fat and 200-250 g of carbohydrates) prescribed for a short time. The patient receives mucous decoctions from cereals, weak meat broth, fruit and berry juices, beaten eggs, kefir, yogurt, mashed compotes, rosehip decoction, tea with sugar.
Feverish patients need a diet that is complete in composition, with culinary processing of food products appropriate to the patient’s condition. The diet includes at least 70 g of complete proteins per day. The carbohydrate content is limited to 300-350 grams due to their ability to potentiate fermentation processes in the intestines. The amount of fat is limited to 60-70 g due to the fact that they reduce appetite and cause dyspeptic symptoms. It is better to use butter or vegetable oil when adding them to ready-made dishes.
For detoxification purposes, it is recommended to increase the amount of liquid in the daily diet to 2 liters. To prevent hypovitaminosis, it is necessary to increase the consumption of appropriate foods. Enriching the diet with ascorbic acid, retinol and B vitamins helps improve immunity. We must not forget about the loss of mineral salts by the body. These should be promptly and more than compensated for, taking into account the results of a dynamic study of the electrolyte composition of the blood. At the same time, the content of table salt in the diet is limited to 8-10 g per day due to the fact that sodium helps maintain the inflammatory process.
When constructing a therapeutic diet for most infectious diseases, diet No. 13 is taken as a basis.
Allowed:
Cereal soups, vegetable soups in weak meat or fish broth, dairy soups;
Minced meat and fish of low-fat varieties (mashed potatoes, soufflés, dumplings, meatballs, meatballs, steamed cutlets);
Mashed cottage cheese, sour cream;
Scrambled eggs,
Steam omelette;
Steamed porridges and cereal puddings;
Vegetable puree;
Boiled or baked berries and fruits, fruit jellies and mousses;
Wheat crackers, dry biscuits.
Prohibited:
Beans, peas, soybeans, lentils;
Cabbage;
Rye bread;
Dishes fried in oil and especially breaded in breadcrumbs or flour;
Fatty meats and fish; pork, lamb, duck, goose, sturgeon, stellate sturgeon;
Fatty canned food, smoked meats;
Hot seasonings and spices: pepper, mustard, horseradish, etc.
Substances that have a stimulating and stimulating effect on the nervous system are limited: strong meat and fish broths, gravies, strong tea, coffee.
For febrile patients, split meals are recommended 5-6 times a day. The serving size can be slightly increased if appetite appears during the hours when the temperature drops. Adding a small amount of dill or parsley to dishes helps improve appetite. The menu of patients with intestinal infections includes only mechanically gentle food.
During treatment, against the background of improvement in well-being and condition, patients are transferred to diet No. 2, which provides mechanical sparing of the mucous membrane while maintaining chemical irritants. The energy value of the diet increases to 12142 kJ (2900 kcal) due to the normal content of protein (100 g), fat (100 g) and carbohydrates (400 g). Grated cheese, boiled meat and fish, beef jelly, jellied fish, meat and fish sauces, and soaked herring are allowed.
After suffering severe infectious diseases, in order to optimally restore the body’s vital functions, diet No. 11 is recommended, which provides enhanced nutrition. The high energy value of the daily diet (3220-3460 kcal) is ensured by an increase in the amount of proteins in it to 130-140 g, the inclusion of a normal amount of fat (up to 100 g) and carbohydrates (450-500 g). It is recommended to eat protein-rich foods, at least half of which are of animal origin. The menu includes: meat, eggs, fish; dairy products (cottage cheese, kefir, yogurt, cream); butter and vegetable oil; raw vegetables, fruits, herbs, etc. A variety of culinary treatments are allowed. Food is taken 4-5 times a day.
For diarrhea, cold drinks, whole milk, raw vegetables and fruits (especially prunes, apricots, carrots, etc.) are prohibited. To eliminate constipation, the diet includes one-day lactic acid products (kefir, yogurt), apricot and beet juices, raw vegetables, berries, fruits, honey.
The correct organization of therapeutic nutrition for patients with infectious diseases primarily affecting the digestive system is extremely important.
More on the topic HEALING NUTRITION FOR INFECTIOUS DISEASES:
- TOPIC No. 19 PREGNANCY AND BIRTH WITH CARDIOVASCULAR DISEASES, ANEMIA, KIDNEY DISEASES, DIABETES MELLITUS, VIRAL HYPATITIS, TUBERCULOSIS
Infectious diseases are a group of diseases caused by the penetration of pathogenic (disease-causing) microorganisms into the body. In order for a pathogenic microbe to cause an infectious disease, it must have virulence (toxicity; lat. virus - poison), that is, the ability to overcome the body's resistance and exhibit a toxic effect. Some pathogenic agents cause poisoning of the body with exotoxins released by them in the process of life (tetanus, diphtheria), others release toxins (endotoxins) during the destruction of their bodies (cholera, typhoid fever).
One of the features of infectious diseases is the presence of an incubation period, that is, the period from the time of infection until the appearance of the first signs. The duration of this period depends on the method of infection and the type of pathogen and can last from several hours to several years (the latter is rare). The place where microorganisms enter the body is called the entry gate of infection. Each type of disease has its own entrance gate, for example, Vibrio cholera enters the body through the mouth and is not able to penetrate the skin.
There are a large number of classifications of infectious diseases. The most widely used classification of infectious diseases by L. V. Gromashevsky:
Intestinal (cholera, dysentery, salmonellosis, escherichiosis);
Respiratory tract (influenza, adenoviral infection, whooping cough, measles, chicken pox);
- “blood” (malaria, HIV infection);
External integument (anthrax, tetanus);
With various transmission mechanisms (enteroviral infection).
Depending on the nature of the pathogens, infectious diseases are classified into:
Prion (Creutzfeldt-Jakob disease, kuru, fatal familial insomnia);
Viral (influenza, parainfluenza, measles, viral hepatitis, HIV infection, cytomegalovirus infection, meningitis);
Bacterial (plague, cholera, dysentery, salmonellosis, streptococcal, staphylococcal infections, meningitis);
Protozoans (amoebiasis, criticalosporidiosis, isosporiasis, toxoplasmosis, malaria, babesiosis, balantidiasis, blastocystosis);
Fungal infections, or mycoses, (athlete's foot, candidiasis, cryptococcosis, aspergillosis, mucormycosis, chromomycosis).
Main signs of infectious diseases:
A specific pathogen as the direct cause of the disease;
Contagiousness (infectiousness) or the occurrence of several (many) diseases caused by a common source of infection;
Often prone to widespread epidemic spread;
Cyclicity of the course (consecutive change of periods of illness);
Possibility of developing exacerbations and relapses, protracted and chronic forms;
Development of immune reactions to pathogen Ag;
Possibility of developing carriage of the pathogen
Medical nutrition
Most acute infectious diseases are characterized by intoxication of the body with toxins of microorganisms - infectious agents and protein breakdown products, a feverish state, and changes in the functions of a number of organs and systems. Changes in metabolism are observed: energy - due to increased energy expenditure of the basal metabolism, protein - due to increased breakdown of proteins, water-salt (loss of fluid and mineral salts due to excessive sweating, vomiting, diarrhea), vitamin - due to increased consumption of vitamins . A shift in the acid-base state of the body to the acidic side (metabolic acidosis) is possible. The functions of the digestive organs are often suppressed.
During the acute period of illness, the diet must ensure the supply of sufficient amounts of nutrients and energy to maintain the patient’s strength, prevent further disruption of metabolic processes and replenish the loss of nutrients, especially proteins, vitamins and mineral salts. Due to the febrile state and decreased functions of the digestive system, the diet should consist of easily digestible foods and dishes, which requires culinary processing that provides mechanical and moderate chemical sparing of the digestive organs.
The diet should contain 60-70 g of protein (65% animals), and with a satisfactory appetite - up to 80-90 g. Use steamed pureed meat dishes, boiled fish, soft-boiled eggs, in the form of steamed omelettes and soufflés, cottage cheese, acidophilus, kefir, yogurt; only if tolerated (if it does not cause bloating) - milk. Fats (50-70 g) should consist mainly of easily digestible milk fats (butter, cream, sour cream); if tolerated - 10 g of refined vegetable oil. Higher fat intake is undesirable given the possibility of metabolic acidosis.
Carbohydrates are slightly limited - up to 300 g, of which 25-30% are easily digestible through sweet drinks, jellies, mousses, honey, jam, etc. A sufficient amount of carbohydrates is necessary to cover energy costs and prevent the consumption of proteins to replenish energy losses, for reducing the effects of acidosis. However, excess carbohydrates can enhance fermentation processes in the intestines and contribute to allergies and inflammation. To regulate intestinal activity, it is necessary to include sources of dietary fiber in the diet through pureed vegetables, fruits and berries. The drinking regime is of particular importance: up to 2-2.5 liters per day with tea with lemon or milk, rosehip decoction, fruit drinks, jelly, compotes, juices, low-fat fermented milk drinks, table mineral waters. Abundant administration of fluid replenishes fluid losses and promotes better elimination of toxins and metabolic products from the body.
The content of table salt in the diet is moderately limited (10 g), but not in case of severe sweating, vomiting, or diarrhea. To improve appetite, low-fat meat and fish broths, fermented milk drinks, sweet and sour fruit and berry juices diluted with water, tomato juice and other digestive stimulants are indicated. Food is given fractionally, in small portions, weighing no more than 300-400 g at a time, 6 or more times a day. The bulk of food should be given during the hours when the temperature drops. Food should be hot or cold, but not lukewarm.
All these requirements during the acute period are met by diet No. 13, which is the basis for infectious diseases (influenza, acute pneumonia, scarlet fever, measles, Brill's disease, infectious mononucleosis, etc.), excluding intestinal infections. Diet No. 13 can be changed in case of complications from the liver, kidneys, cardiovascular and digestive systems. As the patient's condition improves, the diet is gradually expanded. During the recovery period, nutrition can be structured according to the type of diet No. 2 with moderate mechanical sparing and moderate stimulation of the digestive organs. Subsequently, switch to a balanced diet (diet No. 15), if there are no complications caused by infection that require therapeutic nutrition. After a long and severe infectious disease with depletion, enhanced nutrition according to the type of diet No. 11 is indicated. However, one should not overfeed a convalescent person and strive to very quickly replenish lost body weight and, especially, excess fat deposition.
The nutritional principles discussed are applicable to many acute infectious diseases. In case of severe acute infection, zero diets are used, and in case of unconsciousness of patients, tube diets are used. During this period, special dietary products should be used in the diet - enpits, inpitan, ovolact, etc. It is necessary to take into account the sharp increase (by 20-50%) of the basal metabolism in severe acute infections. In addition, when the body temperature is above 37 °C, for every 0.5 °C temperature increase, 100 kcal should be added to the daily energy value of the diet. Therefore, the energy value of diets during the acute period should be aimed at an average of 2100-2300 kcal, followed by a gradual increase to 2500-2800 kcal. For example, in patients with purulent meningitis, the energy value of the prescribed diet should be about 2400 kcal during the acute period of the disease, and the amount of proteins, fats and carbohydrates in the diet should be at least 1.1 and 4 g per 1 kg of body weight per day, respectively. During the acute period, these patients are fed with liquid nutritional mixtures, including through a tube.
For acute dysentery characterized by damage to the large intestine (colitis), intoxication of the body, and often worsening of the secretion of the stomach and pancreas. In severe or moderate forms of dysentery, they begin with a fasting tea day: only strong, hot semi-sweet tea, at least 1 liter, in sips. Next add slimy soups (rice, rolled oats, semolina), weak broths without fat, freshly squeezed juices of fruits and berries and warm rosehip decoction. Sometimes good results are obtained when prescribing an “apple diet” for 1-2 days: 5 times a day, 200-300 g of thoroughly grated raw ripe apples of sweet and sour varieties, without peel and core. If there are no apples, use very well grated carrots in the same quantities, having lightly boiled them first. Then diet No. 4 is prescribed for 2-4 days, and after the elimination of acute phenomena and partial normalization of stool - diet No. 4B, which, if physiologically complete, provides chemical and mechanical sparing of the gastrointestinal tract.
After normalization of stool, diet No. 4B or No. 2 is indicated. Currently, dysentery most often occurs in a mild form, which allows you to immediately use nutrition according to the type of diet No. 4 or 4B. In some cases, and with moderate dysentery, you can start eating not with the “tea diet”, but with diet No. 4. The transition to normal balanced nutrition should be gradual - 2-3 months after dysentery. However, a long-term mechanically gentle diet, in particular No. 4B, can lead to intestinal sluggishness and constipation. Thus, the diet for acute dysentery provides for a gradual, “stepwise” expansion of the diet at the expense of increasingly less sparing foods and dishes.
At chronic dysentery the diet should help normalize intestinal function and increase the body's defenses to fight chronic infection. Diet No. 4B is recommended with a high content of animal proteins and the exclusion of foods and dishes that cause strong mechanical or chemical irritation of the intestines, enhance fermentation processes in it, causing increased gas formation (vegetables and fruits with coarse fiber, wholemeal bread, baked goods, legumes, whole milk, canned food, smoked meats, spices, fatty foods, meat rich in connective tissue, kvass, etc.). If you are prone to constipation, diet No. 3 is advisable.
At salmonellosis gastrointestinal form, i.e. with damage to the gastrointestinal tract, food poisoning caused by various microbes and their toxins (foodborne infections, staphylococcal toxicosis), viral gastroenteritis the principles of diet therapy generally correspond to those for acute dysentery. Nutrition is based on diets of group No. 4, i.e., through the sequential use of diets No. 4, 4B and 4B. Instead of diet No. 4B, you can use diet No. 2.
In the first 1-2 days of the acute period, with severe nausea and frequent vomiting, you can use a fasting “tea diet” (see “Fasting and special diets”). Although for these diseases clinical recovery can be rapid, the transition to normal nutrition must be gradual - on average after 1-2 months. Violation of the diet during this period often leads to the resumption of disorders of the gastrointestinal tract and the formation of chronic diseases of these organs - chronic gastritis or enterocolitis.
After salmonellosis, many foodborne toxic infections, and rotavirus gastroenteritis, insufficient digestive and absorption capacity of the intestine persists for a long time. Therefore, large meals, the inclusion of difficult-to-digest foods, very fatty foods in the diet can provoke stool disorders, bloating and other symptoms of the gastrointestinal tract. During this period, the diet in terms of energy value and chemical composition must correspond to physiological nutritional standards, but culinary processing of food should be with moderate sparing of the gastrointestinal tract according to the type of diet No. 4B or No. 2. Strict adherence to the diet is mandatory.
Cholera in typical cases, it occurs as acute gastroenteritis or gastroenterocolitis with profuse loose stools, repeated vomiting, a sharp disturbance of water-salt metabolism, depletion of the body in water and minerals, protein, vitamins, severe intoxication, a shift in the acid-base state of the body towards acidosis. There is no special diet for cholera patients. Nutrition should help normalize impaired metabolism, reduce intoxication and dehydration of the body. If the patient can take food by mouth, then in the first days of illness it is necessary to provide plenty of fluids, especially hot drinks. The volume of fluid consumed should be 1.5 times the volume of bowel movements.
To combat dehydration and impaired water-salt metabolism, drinking a glucose-mineral solution is recommended. 3.5 g of sodium chloride, 2.5 g of sodium bicarbonate (baking soda), 1.5 g of potassium chloride and 20 g of glucose are dissolved in 1 liter of drinking water (40 °C). The solution is given first in 15-20 ml doses at intervals of 3-5 minutes. Taking into account the degree of dehydration of the body and the patient’s body weight, give from 0.4 to 1 liter of solution per 1 hour. Taking the solution can then be alternated with meals. After vomiting stops, give jelly, compotes, juices of fruits, berries and vegetables, kefir and other fermented milk drinks. Approximately on the 3-5th day, and sometimes on the 2-4th day, diet No. 4 or 13 is prescribed, and then No. 2 or 15. For mild cholera, diet No. 15 is indicated on the 3-5th day of the disease. Diets are supplemented with multivitamin preparations.
Typhoid fever characterized by damage to the small intestine with the possible formation of ulcers (in the 3rd week of illness with healing of ulcers in the 5-6th week) and severe intoxication of the body. For mild and moderate forms of typhoid fever, diet No. 13 is used; in the presence of diarrhea, diet No. 4 is used. In an acute febrile period, the patient should receive 2-2.5 liters of fluid per day in order to reduce intoxication and eliminate dehydration. Due to the inhibition of the digestive organs and damage to the small intestine, food should be consumed in liquid, mushy and puree form. In order not to overload the activity of the food channel, food is taken in small portions - at least 5, and in severe cases - 6-7 times a day.
During this period, the diet includes low-fat meat broth, slimy cereal soups, semi-liquid porridges made from rice or semolina, meat, fish or egg soufflé, steam omelet, soft-boiled eggs, mashed boiled vegetables, pureed cottage cheese, sour cream, fermented milk drinks, cream (if tolerated), butter, pureed compotes, fruit jelly, jelly, honey, fruit and vegetable juices, rosehip decoction, tea, cocoa and coffee with milk (if milk is tolerated), 50-100 g of crackers made from premium flour. In severe general condition of a patient with a darkened consciousness, when eating solid food is impossible (1-2 days), only liquid food is used: mucous decoctions of cereals, weak meat broth, fruit and berry juices, rosehip decoction, tea with sugar.
In the 3rd week of illness, due to the formation of ulcers in the small intestine, in order to ensure maximum sparing of the latter, nutrition is based on diet No. 4 or No. 1A and 1B. Next, diet No. 4B is prescribed until the end of the 4th week of illness, sometimes longer. From the 5-6th week, diet No. 4B is used. If typhoid fever is complicated by cholecystitis, instead of diet No. 4B, diet No. 5A or 5 is given.
For typhoid fever complicated by intestinal bleeding, on the 1st day only drink is prescribed: cold tea in tablespoons and rosehip decoction - up to 0.6 liters. On days 2-3, liquid and jelly-like food is given: jelly, mousses, oatmeal and milk jelly, soft-boiled eggs, cream, butter in pieces or as part of dishes (type 0A diet). Up to 0.8 liters of liquid is prescribed per day. On the 3-4th day, add soufflé or puree from boiled fish, boiled pureed vegetables and fruits, slimy cereal soups with vegetable broth, steamed protein omelet (diet type No. 0B). From the 5th day they switch to diet type No. 0B or 4. In the future, diets No. 4B and 4B are used. In severe cases of the disease, mechanically and chemically gentle diet No. 4B should be followed for 1-2 months. If diets No. 4B and 4B are not available in the hospital, diet No. 1 or 2 is used, which is less desirable.
Related information.
The treatment regimen for infectious patients is determined by the attending physician in accordance with
the following conditions: severity of the disease, duration of infectious
process, the severity of the pathology of certain organs and systems, as well as the possibility of complications. The regimen prescribed to the patient is noted in the medical history.
Regime I - strictly bed rest. The patient is forbidden to sit down, much less stand up; caring for him, feeding and all medical manipulations are carried out with the patient in bed. For some infectious diseases (typhoid and typhus, etc.), strict bed rest is prescribed for a long time. It is necessary to explain to the patient the reasons for prescribing bed rest,
possible consequences of its violation and strictly monitor its compliance.
Mode II - semi-bed (ward). It is possible for the patient to independently visit the toilet, treatment room, and eat in the ward, but it is recommended to spend most of the time in bed.
Mode III - general. Prescribed when the patient is in good health and in satisfactory condition, if the risk of developing complications and consequences of the disease is completely excluded. The patient is allowed to care for himself independently.
The regime of the infectious diseases department also applies to medical personnel, who must try to eliminate as much as possible the factors that disturb the patient’s peace: an unrestrained and harsh tone in communicating with him, loud conversations in the wards and corridors. It is especially strictly necessary to maintain silence at night. The severity of the patient's condition should not be discussed in his presence, even if the patient is unconscious.
Caring for infectious patients
Qualified care for infectious patients contributes to their recovery, prevention of complications, and helps prevent infection of others.
It is very important to maintain an even, calm tone when communicating with patients.
It should be remembered that the patient’s irritability and rudeness can be caused not only by a low level of culture and moral principles, but also by a peculiar reaction to the environment, shifts in the psycho-emotional state caused by a long and severe infectious disease. The necessary measures should be persistently carried out and the patient should be forced to comply with the regime of the infectious diseases department. This requires a medical worker to know the basic principles of medical ethics and deontology, including features of subordination, professional behavior, even appearance, and the ability to apply them in everyday activities.
In the infectious diseases department it is necessary to systematically carry out wet
cleaning premises using disinfectants, ventilating rooms. Particular attention is paid to the cleanliness of the patient’s body and bed. Patients are washed in a bath or shower at least once a week. If this is contraindicated, wipe the patient’s skin daily with a towel moistened with warm water. Seriously ill patients are treated with oral and nasal cavity treatment, prevention of bedsores and congestive pneumonia, and physiological functions are monitored.
Nutrition of the sick
Nutrition of patients is carried out taking into account the specifics of the development of the infectious disease. Nutrition should be sufficiently high in calories and meet all the body's needs for food, liquid, vitamins and salts.
Infectious patients and those recovering are fed at least 4 times a day (breakfast, lunch, afternoon snack and dinner) at strictly defined times. Seriously ill patients are given food in small portions 6-8 times a day.
Products brought by visitors are checked in their presence and returned immediately if they do not comply with the prescribed diet. It is necessary to systematically monitor the storage conditions of food brought to the patient in bedside tables and specially designated refrigerators.
In general, the nutrition of infectious patients is carried out using certain types of diets that correspond to the identified pathology. The following types of diets are most often used in infectious diseases hospitals.
Diet No. 2 is prescribed for acute intestinal infections during the period of convalescence for a long period. It provides mechanical and thermal sparing of the gastrointestinal tract. The table is mixed, all dishes are prepared pureed and chopped. Exclude beans, beans, and green peas.
Diet No. 4 is recommended for diarrhea accompanied by significant irritation of the gastrointestinal mucosa (dysentery, salmonellosis, some forms of escherichiosis, etc.). Allowed are meat broths, slimy soups, boiled meat in the form of cutlets and meatballs, boiled fish, pureed cereals, jelly, jellies, fruit juices enriched with vitamins. Avoid foods that cause fermentation processes and increased intestinal motility: cabbage, beets, pickles and smoked meats, spices, milk, natural coffee,
A slightly modified diet No. 4 (in infectious diseases hospitals it is sometimes referred to as diet No. 4b). A mechanically and chemically gentle diet that reduces peristalsis and fermentation processes in the intestines. Allowed are low-fat beef or chicken broths, slimy cereal cutlets, boiled fish, soft-boiled eggs, and white bread crackers. The amount of liquid is 1.5-2 l/day (tea, cranberry juice, rose hip decoction). Limit fats, carbohydrates, coarse fiber.
Diet No. 5a is indicated in the acute stage of viral hepatitis and during exacerbation
chronic hepatitis. To minimize the load on the liver, limit animal fats and extractive substances, and exclude fried foods. Dishes are prepared mainly pureed. Day-baked bread, vegetable, cereal and pasta soups in vegetable or non-concentrated meat and fish broth, milk and fruit soups are allowed; boiled lean meat, fish and poultry; pureed porridge (especially buckwheat) with water or with the addition of milk; eggs, milk, butter and vegetable oil (as additives to dishes); fresh fermented milk products and cottage cheese (soufflé); fruits, berries, jam, honey, jelly, jelly, compotes, weak tea. Exclude snacks, mushrooms, spinach, sorrel, turnips, radishes, lemon, spices, cocoa, chocolate.
Diet No. 5 is prescribed during the recovery period for acute viral hepatitis or during the period of remission for chronic hepatitis. In addition to the products of diet No. 5a, soaked herring, non-acidic sauerkraut, vegetables and herbs are allowed, raw or in the form of salads, vinaigrettes; milk, cheese, omelettes. The food is not chopped.
Diet No. 15 (general table) is prescribed in the absence of indications for a special diet. A physiologically complete diet with a high content of vitamins.
When patients are unconscious or have swallowing paralysis
muscles (for example, with botulism, diphtheria), feeding is carried out through a nasogastric tube. Fluids and medications are also administered through the tube.
The calories needed by a seriously ill patient are partially compensated by parenteral
nutrition: intravenous administration of hydrolysates, amino acids, salts, vitamins, 5% glucose solution, special nutritional mixtures.
In febrile conditions and especially during dehydration, infectious
patients often need to drink plenty of fluids (up to 2-3 l/day). They recommend mineral waters, tea with lemon, fruit drinks (cranberry, blackcurrant, etc.), and a variety of fruit and berry juices. For dehydration and demineralization, oral and intravenous administration of polyionic crystalloid isotonic solutions is prescribed.
Drug treatment
Complex drug treatment of infectious patients is provided
takes into account the etiology and pathogenesis of the disease, a thorough analysis of the individual
al condition of the patient, his age and immunological characteristics,
period and severity of the infectious disease, the presence of complications and accompanying
common diseases.
One of the most important areas of complex treatment of infectious pain
nykh - etiotropic therapy, i.e. impact on the pathogen. With her
antibiotics and chemotherapy are used.
When choosing a drug, it is important to use the following rules:
· the pathogen must be sensitive to the agent used;
· the concentration of the chemotherapy drug (antibiotic) at the site of infection should be
sufficient to suppress the vital activity of the pathogen (bactericidal or
bacteriostatic);
The drug must be administered in such a way and at such an interval that
the required concentration was maintained at the site of infection;
· the negative effect of the drug on the macroorganism should be less
more than its healing effect;
· the drug should be administered for as long as required for complete
suppression of the vital activity of the pathogen;
It is impossible to reduce the dose of the administered drug during treatment, despite
apparent achievement of a therapeutic effect;
- The drug should not have a toxic effect;
- Compatibility of the drug with other drugs.
Preparations of the penicillin group (benzylpenicillin salts, phenoxymethyl-
penicillin, bicillin, ampicillin, semisynthetic penicillins - oxa-
cillin, ampicillin, carbenicillin, etc.) have a bactericidal effect
we eat against cocci (pathogens of meningococcal infection, pneumonia,
erysipelas), as well as pathogens of diphtheria, leptospirosis, anthrax, leaf
riosa. Cephalosporins of the I-IV generations are distinguished by pronounced bactericidal
action against gram-positive (staphylococci and pneumococci), and
also most gram-negative bacteria. The drugs are low toxic, but
at the same time, they can cause undesirable manifestations in the form of allergies
ical and dyspeptic reactions, hemorrhagic syndrome, phlebitis (with
parenteral administration). The widest spectrum of antimicrobial action
have carbapenems (imipenem, meropenem), related to antibiotics
reserve. Tetracyclines, chloramphenicol, rifampicin are used in the treatment of ersi-
niosis, rickettsiosis (typhus, Brill-Zinsser disease, Q fever
etc.), borreliosis, typhoid and paratyphoid fever, brucellosis, legionellosis, and
also chlamydia and mycoplasmosis. When pathogens are resistant to penicillin
lin, chloramphenicol and tetracyclines, aminoglycosides of various
generations -
gentamicin, tobramycin, sisomycin (2nd generation), netilmicin, amikacin
(III generation) and others, but their spectrum of action does not cover anaerobic
flora, and the toxicity is much higher. Aminoglycosides are active in
carrying gram-negative flora, staphylococci, Pseudomonas aeruginosa (pre
parathas of II-III generations). For coccal infections, as well as whooping cough, diphtheria
and campylobacteriosis, macrolides are prescribed.
The number of new antibiotics is constantly growing. To replace many teachers
Semi-synthetic antibiotics come to rats of natural origin
III and IV generations, with numerous advantages. However, after
It should be remembered that the widespread and unjustified use of antibiotics,
Long courses of antibiotic therapy may cause undesirable effects
consequences: development of sensitization with allergic reactions, dysbiosis
(dysbacteriosis), decreased activity of the immune system, increased resistance
viability of pathogenic strains of microorganisms and many others.
A relatively new group of drugs for the etiotropic treatment of infection
diseases - fluoroquinolones. They are finding more and more widespread use
tion in cases of severe forms of intestinal bacterial infections (abdominal
typhus, yersiniosis), mycoplasmosis and chlamydia.
Nitrofuran derivatives (furazolidone, furadonin, furagin, etc.) ef
effective in the treatment of many bacterial and protozoal diseases, including
including those caused by antibiotic-resistant flora. They have found application in
therapy of giardiasis, trichomoniasis, amoebiasis.
and mechanisms of action are used in the treatment of protozoal diseases (malya
ria, leishmaniasis, amoebiasis) and helminthiases
In the treatment of infections of viral etiology (influenza, herpes infection, HIV infection) antiviral drugs.
Also used in the treatment of infectious diseases drugs are specific
which immunotherapy- immune sera, immunoglobulins and γ-globulins, plasma of immunized donors. Immune sera are divided into antitoxic and antimicrobial. Antitoxic serums presented antidiphtheria, antitetanus, antibotulinum and antigangrenous serums of various types. They contain specific antitoxic ATs; they are used to neutralize pathogen toxins freely circulating in the blood in the corresponding diseases. The clinical effect of the use of antitoxic serums is most pronounced in the early stages of the disease, since serums are not capable of
neutralize toxins already bound by cells and tissues. Antimicrobial
ny serums contain AT to pathogenic pathogens, in infectious practice
tically they are used anti-anthrax globulin .
In the treatment of many infectious diseases (influenza, measles, leptospirosis,
herpes infection, anthrax, etc.) have found application immunoglo
bowlines, having a high concentration of AT, as well as plasma immunized
new donors (antistaphylococcal, antipseudomonas, etc. .).
Use of specific immunotherapy drugs requires medical attention
control and strict adherence to the rules set out in the instructions
on their use, since in some cases it can lead to the development complicated
In the complex therapy of infectious diseases, therapeutic nutrition plays a great role.
Most infectious patients develop anorexia against the background of intoxication and fever, and therefore the intake of nutrients and energy sharply decreases.
A shift in the acid-base state of the body towards acidosis is possible.
The infectious process is characterized by increased catabolism processes, pronounced metabolic disorders, especially protein, energy, water and electrolyte. Important causes of these disorders are the catabolic effect of adrenocorticotropic hormone and glucocorticoids, adrenaline and vasopressin, increased proteolysis in tissues, protein loss with secretions and excreta (sputum, sweat, feces, vomit). During an acute infectious disease, due to an increase in the intensity of the basal metabolism, the need for energy increases, which is primarily provided by carbohydrates. However, carbohydrate reserves in the body are limited (glycogen reserves last for 12-24 hours during complete fasting), therefore tissue proteins, primarily skeletal muscle proteins, are actively involved in energy metabolism. For example, in 3 weeks of severe acute enterocolitis, patients can lose up to 6 kg of muscle tissue (about 14% of the initial weight). Fat mass is also lost, but with normal body weight, the reserves of “energy” fat are enough for about 1 month of fasting.
Not only catabolism increases, but protein synthesis is also inhibited. A negative nitrogen balance occurs. Thus, in a number of infectious diseases accompanied by severe intoxication, fever, diarrhea syndrome and other manifestations of the infectious-toxic process, protein losses can reach 150-200 g/day. Protein deficiency leads to disruption of the synthesis of digestive enzymes and antibodies, a decrease in the bactericidal activity of blood serum, a decrease in thymus function up to its dystrophy and atrophy, and depletion of the endocrine system.
In acute infectious diseases, disturbances in water-electrolyte metabolism are often observed. With diarrhea, a large amount of potassium is lost, with vomiting - sodium and chlorine, in addition, dehydration of the body occurs due to increased sweating. Dehydration (exicosis) is especially pronounced in acute intestinal infections, with 4 degrees of dehydration distinguished: I degree - loss of 3% of body weight, II degree - 4-6%, III degree - 7-9%, IV degree - 10% or more .
As a rule, the phenomenon of polyhypovitaminosis is noted, which is associated with a decrease in the intake of vitamins from food, an increased need for them in the body, a deterioration in their absorption from the intestine, and in acute intestinal infections - a violation of the synthesis of vitamins in the intestine.
During acute infections, anemia of various origins can develop.
Organic and functional changes in the gastrointestinal tract are characteristic primarily of intestinal infections. However, the enzymes of the gastrointestinal tract are thermolabile, that is, they are not resistant to increases in body temperature, therefore, with fever of any kind, the breakdown of proteins, fats and carbohydrates in food is disrupted. This creates certain difficulties in providing the body of a sick person with the necessary amount of nutrients and forces one to resort to a combination of enteral and parenteral nutrition.
The most important factor in nutritional disorders during acute infections is an increase in the body’s energy consumption due to increased thermogenesis and metabolic stress.
Currently, therapeutic nutrition for infectious patients is organized in relation to three groups of diseases:
1. Diseases that occur with a pronounced infectious-toxic syndrome without damage to the gastrointestinal tract (influenza, acute respiratory infections, pneumonia, rickettsiosis, tularemia, ornithosis).
2. Diseases that primarily affect the digestive system (dysentery, typhoid-paratyphoid diseases, salmonellosis, viral hepatitis, leptospirosis, yellow fever).
3. Diseases primarily affecting the central nervous system (meningitis, meningoencephalitis, botulism, tetanus).
Any infectious diseases are more common in people with malnutrition and, as a rule, have a severe course.
More on the topic CHAPTER 38. THERAPEUTIC NUTRITION FOR INFECTIOUS DISEASES:
- Chapter 5 THERAPEUTIC PHYSICAL EDUCATION IN THE CLINIC OF INTERNAL DISEASES. THERAPEUTIC PHYSICAL ACTIVITY FOR DISEASES OF THE CARDIOVASCULAR SYSTEM
- ABSTRACT. HEALING NUTRITION FOR POSTCHOLECYSTECTOMIC SYNDROME2018, 2018