Diarrhoea and Fever: Dietary Management

you are already aware that both diarrhoea and fever are not diseases;  they are symptoms of diseases. So they will not disappear completely unless the underlying cause is identified and treated. Otherwise we may continue to give "symptomatic treatment" with no permanent Cure e.g. tablets for bringing down fever. 

However we must emphasize that diarrhoea and fever need special attention in terms of management. If this is  not done the patient's condition can become quite serious. So let's begin with dietary management of diarrhoea.

Diarrhoea

You were introduced to the basic principles in dietary management of diarrhoea. In the previous section treatment and dietary management of diarrhoea in association with PEM was discussed. 

It you recall, the  major steps in controlling the ill effects of diarrhoea are 

• correct dehydration 
• maintain fluid and electrolyte balance

Dehydration occurs when body cells begin to  lose far too much water. This is corrected using rehydration therapy and involves replacing the losses due to diarrhoea plus the losses of water and electrolyte  from body cells. Once  the water and electrolyte are replaced in the body cells (i.e. once symptoms of dehydration disappear) we have to continue giving fluid and electrolyte to replace  the losses taking place because of continued  diarrhoea. This is called maintenance therapy. 

Do you remember the signs of dehydration? These are: 

• little or no pine, the urine passed is of dark yellow colour 
• sudden weight loss 
• dry mouth 
• sunken, tearless eyes 
• sagging of be anrerior fontanelle or "soft spot'' on  the head in  the case of infants 
• loss of elasticity of  the skin 

If dehydration is very severe the following signs usually 

• rapid, weak pulse 
• fast, deep breathing 

It is important to convince people that plenty of fluids should be given from the beginning: ORS is useful and should be given as frequently as possible in  small sips. Infants  and young children with diarrhoea need careful attention. Diarrhoea can be dangerous if  not corrected soon. 

Sometimes people feel that giving fluid will only make the dimhoea more "watery". They may be convinced hat fluid should actually  be restricted. Breast  may also be stopped.This can kill the infant or young child and all effort should be made to correct this notion, Breast feeding in particular  must be encouraged during diarrhoea.Diarrhoea with vomiting can be very dangerous because chances of dehydration are high.

Also you must remember to tell people when they must seek medical help. The situations which are difficult to tackle at home are: 

• if diarrhoea lasts more than four days and is not getting better or more  than one day in a small child with severe diarrhoea 
• if the person is dehydrated and getting worse  
• if the child vomits everything he/she drinks or drinks nothing 
• if be child begins to have fits (convulsions), or if the and feet swell
• if the person was very sick, weak, or malnourished before the diarrhoea began (especially a little child or a  old Person) 
• if  there is much blood in the stools. this can be dangerous even if there is little diarrhoea 

Fever

Fever, like diarrhoea is a symptom. It goes hand in hand with infections because it is one of the mechanisms evolved by the body lo deal with infections. Fever, by definition, is an "elevation in  body temperature above the normal which may occur in response to infection. inflammation, or unknown causes". 

We have already mentioned that fever is associated with infections. However certain other factors such as antigen-antibody reactions (reaction  involved in our immune system), malignancy or rejection of a graft can also cause fever. 

Fevers may be of two types i.e. short duration/acute (e.g. typhoid) or long duration/chronic (e.g. tuberculosis). Fever can also be intermittent as in the case of malaria. 

To understand the principles of diet therapy we need to understand the metabolic changes in fever and infections. In general the higher  the temperature and the longer the duration, the  more the ill effects. For fever, the effects are:  

an increase in the metabolic rate amounting to 13 per cent for every degree celsius rise in body temperature (7% for each degree Fahrenheit). This pushes up energy needs. decreased glycogen stores and decreased stores of adipose tissue increased breakdown or catabolism of proteins especially in the case of diseases such as malaria, typhoid; this results in production  of excess amounts of nitrogenous wastes-a burden on the kidneys accelerated loss of body water owing to increased perspiration and the excretion of body wastes increased excretion of sodium and potassium The metabolic consequences of infection include catabolism of proteins including body tissues fall in blood glucose; blood ketones are elevated and nitrogen excretion is reduced 

The diet  in fevers depends upon the kind of pathological condition and how severe the condition is. The length of convalescence short or long-also  makes a difference. The general dietary considerations focus on a high energy (especially high carbohydrate) and high protein diet. A liberal intake of fat is desirable but very rich foods are avoided because they cannot be easily digested. There has to 'be emphasis on sources of sodium and potassium as well as vitamins. B Complex vitamins are used up more in fever because of the higher metabolic rate. However patients on oral therapy with antibiotics and certain other drugs should be given extra B Complex vitamin supplements. This is because these drugs kill intestinal bacteria. These bacteria provide us useful amounts of vitamins since they synthesize some B-complex vitamins. In such cases faking B complex supplements is essential. Is there anything else? There h one very important point to add. Fluid and electrolyte intake must be liberal. Fluid  intake should range from 2500 to 5000 ml daily. Why is this necessary? The reason is, of course, the need to make up for the heavy losses of fluid and electrolytes through the skin (as perspiration) and to allow for adequate volume of urine to get rid of  the wastes. 

It is important to give a bland diet including readily digested foods. Why do you think this is necessary? The answer is: to help in digestion and absorption and prevent any irritation. 

Now, what about the consistency of food? In acute fever when the patient becomes very weak and  even chewing is an exertion, a full fluid diet is given.  Once the acute phase is over and  the patient is recovering, a soft diet is given.  Although fluid diets points. However the usual decision is for giving a full fluid diet in  the acute phase of illnesses associated  with high fever. 

The meal frequency is also an important point to  consider. Small quantities of fad at intervals of 2-3 hours will permit adequate nutrition without overtaxing the digestive system at any one time. With improvement, many patients consume more food if given three meals and a bed time feeding. This is also important because the patients appetite is initially poor  but improves gradually. 

An example of a diet for a typhoid patient is as follows: 

Milk                          1000 ml 

Barley water              1000 ml 

Glucose                     200 g 

Cane sugar                100 g 

Orange juice              500 ml 

Dextrimaltose            200 g 

Multivitamin tablet     One 

Now let us turn our attention to diets for chronic fevers. In chronic fevers such as tuberculosis the fever is low  and there is increased circulation. Since the illness is prolonged, tissue wasting takes place. So what kind of diet would be suitable? A high caloric, high protein diet is best.

A suitable dietary guideline is as follows: 

Cereals                               400 g 

Pulses                                 50 g 

Roots and tubers                100 g 

Green leafy vegetables        200 g 

Other vegetables                 200 g 

Eggs/paneer                        2/60 g 

Fruits                                  200 g 

Milk and milk products       One litre 

Fats and oils                       25 g 

Sugar                                 50 g 

Tea or coffee                     7/15 g

Drug therapy also creates problems. Isoniazid is an antagonist of Vitamin B. This means that isoniazid should be  given with vitamin B, supplements or tablets.