DIET DURING FEVERS - DR KARISHMA MANE In previous articles, we talked of fever, care during fever and how we can help our doctor diagnose fever. Commonly another dilemma that patients and their families face is what to eat and drink during fever. Diet to be followed during fevers especially those of acute nature where the patient's desire to eat is poor, there is hardly any appetite for food is always a confusion. Experts in the field of Dietetics talk of the metabolic changes that occur during fever--- q An increase in metabolic rate amounting to almost 13 percent for every degree Celsius rise in body temperature (7 percent for every degree Fahrenheit rise) the increase is due to restlessness. Thus there is a greatly increased caloric need q Decreased glycogen stores and adipose tissue stores q Increased catabolism of protein places an additional burden upon the kidney q Accelerated loss of body water owing to increased perspiration and excretion of body q Increased excretion of Sodium and potassium Thus the diet given during fever should pay attention on the following---- Ø Energy---Patient can initially ingest only about 600 to 1200 kcal daily in fever but this should be increased as fever reduces and patient's condition improves. Ø Protein---Adequate intake is advised. In case of prolonged fever, 100g or more of protein is advised. Ø Carbohydrates--- Glycogen stores are replenished with liberal intake of carbohydrate Ø Fats---Fried food and rich pastries to be avoided Ø Minerals --- Sufficient intake of salt (NaCl) is accomplished by use of soups and salt in food. Ø Vitamins---Fevers increase requirement for Vitamin A and C. Oral antibiotics and drugs interfere with synthesis of some B complex vitamins by intestinal bacteria So supplementation is indicated. Ø Fluids--- Intake must be liberal to replace the loss from sweat and permit adequate volume of urine for excreting wastes. Daily intake of 2500-5000 ml of fluids in various forms is necessary. Ø Ease of digestion--- Bland (without spices) readily digested food should be used to facilitate digestion and rapid absorption. Food should be soft easy to chew and well cooked. Fluid diets can also be used. Ø Intervals of feeding and quantity of food--- Small quantities of food at intervals of 2 to 3 hrs will permit adequate nutrition without causing a burden. It should be remembered that fluid diet increases abdominal distension i.e. cause bloating of abdomen to the point of discomfort. For patients experiencing nausea, vomiting it is better to give solid dry food like biscuits, bread toast etc. In prolonged fever i.e. is fever lasting for more than a few days it becomes essential to feed the patient a high protein, high calorie diet to prevent weight loss. Foods to be included in diet in fevers------ v Whole fruits like apples, seasonal fruits available locally. To soften they can be steamed if necessary. v Fruit juices freshly prepared at home v Clear soups made out of vegetables without the cream v Steamed vegetables can also be ground into a puree to make soft diet v Cooked thin dals (pulses) (or excess water in cooked dals) (good source of proteins) v Coconut water v Bland cooked food as appetite improves v Bread toasts without butter v Water plain or with glucose added to it. v Steamed Rice cooked in excess water to make a soft paste for easy ingestion. v Skimmed milk can be consumed if comfortable. v Adequate amount of salt should be added to the food Avoid the following food during fever----- v Spicy food v Ghee, butter, vegetable oils v Fried foods v Rich cream pastries, cakes v Beverages like tea coffee v Outside food
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