Dietary

manageme
nt in
disease
conditions

DIARRHOEA, FEVER,
H E A RT D I S E A S E

D T. S W A I C H C H H A B A S N E T
DIARRHOEA
• Diarrhoea is defined as the passage of three or more loose or liquid stools per day (or more
frequent passage than is normal for the individual).
Types of diarrhoea
• Acute watery diarrhoea – If an episode of diarrhoea lasts less than 14 days, it is acute
diarrhoea.
• Persistent diarrhoea - If the diarrhoea lasts 14 days or more, it is persistent diarrhoea.
• Chronic diarrhoea – it is recurrent or long-lasting diarrhoea due to noninfectious causes
such as sensitivity to gluten or inherited metabolic disorder.
• Dysentery - Diarrhoea with blood in the stool, with or without mucus, is called dysentery.
The most common cause of dysentery is Shigella bacteria.
Causes
• Infection
– Bacterial agents: Escherichia coli, Campylobacter, Shigella species, Vibrio cholera,
Salmonella
– Viral agents: Rotavirus, Human caliciviruses (HuCVs), Adenovirus infections
– Parasites: Giardia intestinalis, Entamoeba histolytica, and Cyclospora cayetanensis
• Early weaning
• Malnutrition
• Sensitivity of food components
• Stress and fear
 Physiological disturbances in the body

• Body fluid is lost  reduction in blood volume  fall in blood

pressure. Body extremities appear cold.
• Low hydrostatic pressure in the renal glomeruli  the filtration of
urine is reduced
• Dehydration impairs skin elasticity
• Excessive sodium may be lost in the stools  hyponatremia
• Potassium lost from stools hypotonia of muscles
• Bicarbonate is lost in stools  may cause metabolic acidosis 
breathing becomes deep and rapid
Fluid management

• Initial management with any fluid available:

– Plenty of fluid (salted rice water, soup, yoghurt drink, ORS) should be given early
in the illness
– Avoid high sugar containing drinks, tea, coffee
• Note: In presence of dehydration, Oral Rehydration Therapy HAS to be
started.

– ORT homemade solution

– Oral rehydration salts solutions
• If the child is under 6 months old and is not taking solid food, ORS
solution or water can be given instead of food-based fluid
 Fluid management (plan A)

• Volume of ORS given after each stool (in absence of dehydration)

Age Amount of ORS to give after each loose stool
Less than 24 months 50-100 ml (a quarter to half a large cup)
2 up to 10 years 100-200 ml (a half to one large cup)
10 years or more As much as wanted

Besides that
• A teaspoonful should be given every 1-2 minutes for a child under 2 years
• Frequent sips from a cup for an older children
• If the child vomits wait 10 mins. Then give the solution more slowly (spoonful
every 2-3 mins)
• Continue giving until diarrhea stops
Fluid management (plan B)
• Volume of ORS given to treat dehydration

• In absence of age ORS vol can be estimated by multiplying the child's weight in kg times
75 ml.
• If a child wants more than it can be given.
• A teaspoonful should be given every 1-2 minutes for a child under 2 years
• Frequent sips from a cup for an older children
• If the child vomits wait 10 mins. Then give the solution more slowly (a spoonful every 2-3
mins)
Fluid management
• After 4 hours if there is no signs of dehydration one can go back to plan A of fluid
management
• If dehydration, continue plan B, along with milk, juice and food (soup, rice water,
yoghurt drink).
Fluid management (plan C)
• In case of severe dehydration, consider giving the ORS solution via a nasogastric
tube (if they are unable to drink it or if they vomit persistently).
• Consider intravenous fluid therapy if the child persistently vomits the ORS solution,
given orally or via a nasogastric tube and is severely dehydrated.
• In case of persistent diarrhea fluid management is done by ORT, NGT or IV
rehydration.
Dietary management
 Acute diarrhea in infants
Milk
• Infants of any age who are breastfed should be allowed to breastfeed as often and if they
want.
• In infants under 6 months exclusive breastfeeding should be continued (increased
breastfeeding)
• Infants below 6 months of age who take breastmilk and other foods should receive
increased breastfeeding. If the child is very week to suckle milk, then breast milk should be
expressed and fed.
• Infants who are not breastfed should be given their usual milk feed (or formula) at least
every three hours, if possible, by cup.
• Milk intolerance is only clinically important when milk feeding causes a prompt increase in
stool volume and a return or worsening of the signs of dehydration, often with loss of weight
 Acute diarrhea

• usual diet should be continued. No withholding and no dilution of child’s usual food
• Small frequent meals
• If the child is at least 6 months old or is already taking soft foods, he or she should be
given cereals, vegetables and other foods, in addition to milk.
• If the child is over 6 months and such foods are not yet being given, they can be started
during the diarrhoea episode or soon after it stops.
• Food should be well cooked and mashed or ground to make them easy to digest;
fermented foods are also easy to digest.
• 5-10 ml of vegetable oil should be added to each serving of cereal.
• Meat, fish or egg should be given, if available.
• Foods rich in potassium (bananas, green coconut water and fresh fruit juice) are
beneficial.
Acute diarrhea

• Zinc supplements should be given for 10 days

• 2 to 6 months = 10 mg/day; once a day
• 6 to 5 years = 20 mg/day; once a day
• reduce the severity and duration of the episode and prevent
further occurrences in the next 2-3 months.
• After the diarrhoea stops, continue giving the same energy-rich foods and provide
one more meal than usual each day meal, for at least two weeks.
Persistent diarrhea
In infants below 6 months
• Encourage exclusive breastfeeding as often and as long as the child wants.
• If animal milk must be given, replace it with yoghurt. If this is not possible, give a lactose-free milk
formula.
In older infants and children
• Continue breastfeeding as often and as long as the child wants.
• Sufficient fluid intake
• Daily intake of at least 110 calories/kg.
• Give other foods that are appropriate for the child's age, as described above.
• Give frequent small meals, at least six times a day.
• Use standard diets prepared from local ingredients.
• If yoghurt is available, give it in place of any animal milk usually taken by the child. Otherwise, limit
animal milk to 50 ml/kg/day.
Diarrhea and lactose
Standard diets
The first diet: reduced lactose

• The diet should contain at least 70 Kcal/100g, provide milk or

yoghurt as a source of animal protein, but no more than 3.7 g
lactose/kg body weight/day, and provide at least 10% of calories as
protein.
The first diet: reduced lactose

Example:
• full-fat dried milk =11 g (or whole liquid milk: 85 ml)
• rice =15 g (uncooked rice)
• vegetable oil = 3.5 g
• cane sugar = 3.0 g, and
• water to make 200 ml
 Provides: 83 Kcal/100g, 3.7g lactose/kg body weight/day and 11% of calories as
protein
 With this diet, 130 ml/kg provides 110 Kcal/kg.
The second diet: lactose-free with reduced
starch
• Started if no improvement with 1st diet
• Should provide at least 10% of calories as protein.
• whole egg =64 g
• rice =3 g
• vegetable oil =4 g
• glucose =3 g, and
• water to make 200 ml
 provides 75 Kcal/100g
 With this diet, 145 ml/kg provides 110 calories/kg.
 If finely ground, cooked chicken meat (12 g) is used in place of whole egg, the diet
provides 70 Kcal per 100 g.
Other consideration

• The first diet should be given for seven days, unless signs of dietary
failure occur earlier, in which case the first diet should be stopped
and the second diet given, also for seven days.
• After seven days' treatment with the effective diet, an appropriate
diet for age should be resumed, including milk, that provides at
least 110 Kcal/kg/day.
Other recommendations (Acute/Persistent)
– Do not give hard, dry solid food.
– Soft diet with less fiber is recommended.
– Avoid giving sugary juices and carbonated drinks.
– Rice based solutions, potato and other cereals reduce the number and volume
of stools. Cereals also provide some potassium.
– Fermented milk (butter milk), probiotic curd has a beneficial effect.
– All children with persistent diarrhoea should receive supplementary
multivitamins and minerals
– Zinc supplementation (10-20 mg/day) for 10 days for children with diarrhoea can
reduce the severity and duration of the episode and prevent further occurrences
in the next 2-3 months.
– After the diarrhoea stops, continue giving the same energy-rich foods and
provide one more meal than usual each day meal, for at least two weeks.
THANK YOU