Therapeutic nutrition for infectious diseases. Proper nutrition in infectious diseases Stages of diet therapy in infectious disease

Indications: diet for acute infectious diseases.

The purpose of the appointment of diet number 13. Maintaining the general strength of the body and increasing its resistance to infection, reducing intoxication, sparing the digestive organs in a feverish state and bed rest.

General characteristics of diet number 13

Reduced calorie diet due to fats, carbohydrates and, to a lesser extent, proteins; increased content of vitamins and fluids. With a variety of food set, easily digestible foods and dishes that do not contribute to flatulence and constipation predominate. Sources of coarse fiber, fatty, salty, indigestible foods and dishes are excluded. Food is cooked in chopped and pureed form, boiled in water or steamed. Dishes are served hot (not lower than 55-60°С) or cold (not lower than 12°С).

The chemical composition and calorie content of dietary table No. 13 for infectious diseases:

• carbohydrates - 300-350 g (30% easily digestible),
• proteins - 75-80 g (60-70% animals, especially dairy),
• fats - 60-70 g (15% vegetable),
• sodium chloride (salt) - 8-10 g (increase with severe sweating, profuse vomiting),
• free fluid - 2 liters or more.

TO aloric content - 2200-2300 kcal.

Diet for diet number 13: 5-6 times a day in small portions.

Products and dishesDiet No. 13 according to Pevzner for infectious diseases

Sample diet menu number 13

First breakfast: milk semolina porridge, tea with lemon.

Second breakfast: soft-boiled egg, rosehip broth.

Lunch: mashed vegetable soup in meat broth (1/2 serving), steamed meat chops, rice porridge (1/2 serving), mashed compote.

Afternoon snack: baked apple.

Dinner: boiled fish, mashed potatoes (1/2 portion), diluted fruit juice.

• Features of metabolic disorders in the infectious process

  The infectious process is characterized by an increase in the processes of catabolism, pronounced metabolic disorders, especially protein, energy, water and electrolyte.

  In an acute infectious disease, hyperthermia (fever) occurs. As a result, the intensity of basal metabolism increases, the need for energy increases, which should primarily be provided by carbohydrates. However, the reserves of carbohydrates in the body are limited (glycogen reserves are enough for 12–24 hours with complete starvation), therefore, tissue proteins, primarily skeletal muscle proteins, are actively involved in energy metabolism. It has been proven that for 3 weeks of severe course of acute infectious enterocolitis, patients can lose up to 10-15% of the initial muscle mass. At the same time, there is also a loss of fat mass. However, with a normal initial body weight of the patient, fat reserves are enough for about 1 month of fasting.

  During the infectious process, not only catabolism (decay) increases, but protein synthesis in the patient's body is also inhibited. There is a negative nitrogen balance. In a number of infectious diseases accompanied by severe intoxication, fever, diarrhea, protein losses can be up to 150–200 g/day. Protein deficiency leads to a violation of the synthesis of digestive enzymes, antibodies, a decrease in the bactericidal activity of blood serum, a decrease in thymus function up to its degeneration and atrophy, and exhaustion of the endocrine system.

  In acute infectious diseases, a violation of water and electrolyte metabolism is 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 with an increase in body temperature. Dehydration is especially pronounced in acute intestinal infections.

  There are 4 degrees of dehydration of the body: I ​​degree - loss of 3% of body weight, II degree - 4-6%, III degree - 7-9%, IV degree - 10% or more.

  In most infectious patients, against the background of intoxication and fever, there is a decrease in appetite up to the development of anorexia. In this regard, the intake of nutrients and energy is reduced. A shift in the acid-base state of the body towards acidosis is possible.

  In connection with a decrease in the intake of vitamins with food, a deterioration in their absorption from the intestines and an increased need for them in the body, vitamin deficiency develops.

  Anemia of various origins may also develop.

  Thus, the most important principle of therapeutic nutrition in infectious diseases is the replenishment of increased energy costs, the full provision of the body with basic nutrients, vitamins and minerals.

  Any infectious diseases are more likely to develop in people with malnutrition. The course of the infectious process in patients with deficient conditions is more severe and the prognosis is more doubtful.

• Therapeutic nutrition for acute intestinal infections

  Acute intestinal infections include diseases that occur with diarrhea syndrome (diarrhea).

  Diarrhea is understood as rapid (usually more than 2-3 times a day) bowel movements with the release of liquid and mushy stools. The water content in feces during diarrhea increases to 85-95% and the mass of feces is more than 200 g / day. Sometimes with diarrhea, the frequency of stool does not exceed 1-2 times a day, but the stool has a more liquid than normal consistency. It is customary to talk about acute diarrhea syndrome in cases where its duration does not exceed 2-3 weeks.

  According to ICD-10, the group of intestinal infections includes cholera, typhoid fever, paratyphoid fever, other salmonellosis, shigellosis (dysentery), escherichiosis, campylobacteriosis, yersiniosis, clostridium and other bacterial infections, as well as a number of intestinal infections caused by viruses and protozoa.

  Acute intestinal infections are characterized by the development of organic and functional changes in the gastrointestinal tract.

  Acute intestinal infections are characterized by secretory or hyperexudative diarrhea with different pathogenetic mechanisms. With secretory diarrhea, there is an increase in the secretion of water and sodium into the intestinal lumen, while the stool is watery and plentiful. Such diarrhea occurs with cholera, escherichiosis, Klebsiellosis. With hyperexudative diarrhea, sweating of plasma, serum proteins, blood, mucus into the intestinal lumen occurs; the stool in patients is liquid, with an admixture of mucus and blood. This type of diarrhea is observed in inflammatory processes in the intestines, including dysentery, campylobacteriosis, salmonellosis, clostridium.

  There are different opinions on the nutrition of patients in the early days of the development of acute intestinal infections: a number of authors recommend starvation to patients, while other scientists do not restrict patients in nutrition.

  One of the most important goals of therapeutic nutrition in the development of acute intestinal infections is rehydration and correction of water and electrolyte imbalance. For this, the patient is given glucose-electrolyte solutions, salted meat broth, strained cereal broth. Sometimes drinking these liquids in small sips can help stop vomiting. A rehydration solution can be prepared at home: 1/2 teaspoon of table salt and 1 teaspoon of baking soda are added to 1 glass of orange juice (a source of sugars and potassium), after which the total volume of the solution is brought to 1 liter with boiled water. This solution should be drunk 1 glass every hour. WHO recommends the use of a standard oral rehydration solution of the following composition (g / l): sodium chloride - 3.5; potassium chloride - 1.5; sodium citrate - 2.9; glucose - 20.0.

  Instead of glucose or sugar, you can use drinking mixtures of rice and other cereals in the form of powder with the addition of potassium and sodium salts. Such mixtures help to increase the effectiveness of oral rehydration solutions and reduce the need for them. The volume of fluid drunk should be at least 2-3 l / day, but in case of severe dehydration (loss of more than 10% of body weight within 24 hours), intravenous administration of polyionic crystalloid solutions (rehydron, citroglucosalan, glucosalan) is necessary, which can also be taken through mouth. Oral and parenteral rehydration solutions prevent the effects of dehydration, but they do not reduce stool frequency.

  • Classification of foods according to their effect on intestinal motility

    When compiling a diet for patients with acute intestinal infections, it is necessary to take into account the effect of foods and dishes on intestinal motility.

    All products are divided into three groups:

    1. Products that enhance intestinal motility - black bread, raw vegetables and fruits, dried fruits, especially prunes, dried apricots and apricots, bread containing bran, legumes, oatmeal, buckwheat and barley cereals (compared to semolina and rice), sinewy meat, pickles, pickles, canned snacks, smoked meats, carbonated drinks, beer, kvass, fatty foods, very sweet dishes, especially in combination with organic acids, fermented milk drinks, koumiss, sour varieties of berries and fruits, cold food.
    2. Products that weaken intestinal motility - products rich in tannin (blueberries, bird cherry, strong tea, cocoa on the water, Cahors), viscous substances (mucous soups, pureed cereals, jelly), warm and hot dishes.
    3. Indifferent products - steam dishes from low-fat and non-synthetic varieties of meat and poultry (soufflés, dumplings, cutlets), boiled low-fat fish, wheat bread from stale flour of the highest grade or in the form of crackers, freshly prepared unleavened cottage cheese.
  • Stages of diet therapy for acute intestinal infections

    On the first day, in case of acute intestinal infections of moderate severity with mild diarrhea, tea unloading is traditionally recommended: 5-6 glasses of freshly brewed strong tea with sugar (up to 20 g per glass) or jam syrup. You can use a decoction of wild rose, dried blueberries, bird cherry, black currant. Some experts propose instead of tea to prescribe 1.5 kg of fresh apple puree, explaining the therapeutic effect of apples with a large amount of pectin substances contained in them.

    After a fasting day, a mechanically and chemically sparing diet No. 4a or diet No. 4b is prescribed.

    At the same time, milk and lactic acid products, all vegetables and fruits, sauces, spices, snacks, vegetable oil, as well as all foods that increase intestinal motility and stimulate the stomach, liver, and pancreas are excluded from the diet for 3–5 days.

    After 3-5 days, a physiologically complete diet No. 4 or diet No. 4c is prescribed.

    The diet reduced the consumption of table salt to 6–8 g and products that enhance intestinal motility, fermentation and putrefaction in it, as well as strong stimulants of other digestive organs. Such a diet is prescribed for 8-10 weeks for enteritis and for 6 weeks for colitis.

    The clinical recovery of the patient is always ahead of the morphological recovery, so there is no need to rush to expand the diet in the absence of complaints from the patient. The transition to the normal diet of a healthy person should be gradual. Non-compliance with the diet during this period often leads to the resumption of intestinal disorders and the formation of chronic enteritis or colitis.

    If the patient has constipation during treatment, then one should not resort to laxatives, as this can lead to a chronic course of the disease. In such cases, the diet includes products that have a laxative effect (boiled beets, dried fruits, vegetable oil, vegetable puree).

• Therapeutic nutrition for infectious-toxic syndrome without damage to the gastrointestinal tract

  The principles of therapeutic nutrition in infectious diseases that occur with an infectious-toxic syndrome cause controversy to this day. Some clinicians argue that increased nutrition is needed to cover the high protein consumption in an acute infectious process. Other experts recommend reducing nutrition to a minimum, taking into account autointoxication and weakening of the functions of the digestive and excretory systems in patients. However, in the future, extensive statistical data have emerged indicating that adequate nutrition in acute infectious diseases does not increase mortality.

  • Basic rules for therapeutic nutrition of an infectious patient

    The founder of Russian dietology, M. I. Pevzner, developed diet No. 13 for infectious patients, and recommended that the following rules be followed when compiling a diet for an infectious patient:

    • A febrile patient should not be allowed to starve. He should receive enough food, but in small portions at a time.
    • Any overfeeding is contraindicated, even if the patient has an appetite.
    • If possible, food that mechanically strongly irritates the digestive organs should be excluded from the diet.
    • It is necessary to monitor the function of the excretory organs and, in case of constipation, include in the diet products that act in a laxative way (sugar, honey, juices of raw vegetables, fruits and berries), and in case of diarrhea, exclude milk in its pure form, cold drinks and limit the amount of sugar.
    • With renal symptoms, it is necessary to exclude strong broths, extractives, spices from the diet.
    • It is necessary to take into account the state of the patient's nervous system, allowing the introduction into the diet of only a small amount of nutrients that irritate the nervous system (strong coffee, tea, very strong broth), or even completely excluding them.

    M. I. Pevzner is the only author who raised the issue of the use of alcohol in acute infectious diseases. He recommended that patients who tolerate alcohol well give 30-40 ml of cognac, adding it to tea or water with sugar and lemon, Cahors, natural red or white wines mixed with water. In the absence of good natural wines, vodka or 25% alcohol can be used.

  • Principles of building a diet for an infectious disease
    • The daily amount of proteins in infectious diseases is given approximately at the rate of 1 g / kg of body weight. In the basic standard diet, it is 85–90 g, of which 50–60% are animal proteins. The amount of proteins is increased in case of protein-energy deficiency.
    • The fat content is reduced to the lower limit of the physiological norm, since fats are indigestible products and can cause dyspepsia and metabolic acidosis. The basic standard diet contains 70–80 g of fats, of which 25–30% are vegetable. Animal fats enter the patient's body as part of dairy products and butter, and butter and vegetable (up to 10 g) oils should be added to ready meals, and not used for frying.
    • The total amount of carbohydrates should correspond to the physiological norm, and it is advisable to increase the proportion of simple carbohydrates (mono- and disaccharides). Complex carbohydrates in the diet are represented by vegetables, fruits, cereals and flour products. Limit only products that enhance the processes of fermentation in the intestines and contain coarse fiber.
    • Table salt is limited to 8-10 g / day, but with significant losses of sodium (with sweat), the amount of table salt is increased to 12-15 g / day.
    • It is necessary to introduce a large amount of fluid (2-2.5 liters) for the purpose of detoxification.
    • In acute infections, the body's need for vitamins increases significantly. Of particular value are vitamins, which in one way or another affect the state of immunity. The richest in vitamin C are rose hips, black currants, citrus fruits, and sea buckthorn. Food sources of vitamin A: liver, granular beluga caviar, egg yolk, butter, hard cheeses. Vitamin B2 (riboflavin) is found in large quantities in offal, yeast, almonds, cheeses, eggs, cottage cheese. Vitamin B6 (pyridoxine) is found in offal, meat, beans, soybeans, rice, millet, potatoes. D improves the state of antituberculous and antifungal immunity. Food sources of vitamin D: fish and marine animal liver oil, salmon, herring, mackerel, caviar, tuna, egg, cream, sour cream.
    • Among microelements, the most important for the state of the immune system is zinc, the deficiency of which develops in enteritis, especially in patients who abuse alcohol. Food sources of zinc: shellfish, mushrooms, egg yolk, liver, meat. Legumes, sesame, peanuts also have a lot of zinc, but it is associated with phytic acid. The daily requirement for zinc is 15–25 mg.
  • Stages of diet therapy for an infectious disease
    • Against the background of high fever, it is quite acceptable to drink thirst-quenching drinks for 1-2 days, you should not force the patient to eat. If fever persists for more than 5–7 days, enteral or parenteral nutrition should be given.
    • With the improvement of the patient's condition after a drop in body temperature, an increase in appetite is often noted. However, one should not strive to fully satisfy it from the very beginning, since in the first 3-4 days temperature fluctuations are noted for some time, the production of enzymes of the gastrointestinal tract is disrupted. That is why in these 3-4 days you should not drastically expand the diet used.
    • With further expansion of the diet, the greatest attention should be paid to replenishing protein and vitamin deficiencies. Apply either diet number 11 or diet number 15. The amount of protein in the diet should be 1.5 g / kg of ideal body weight, while the quota of fats and carbohydrates corresponds to the norms of rational nutrition. Convalescents are prescribed a diet with a restriction of products that stimulate the central nervous system (strong coffee, tea, strong broths, spices, chocolate) and products containing coarse fiber and essential oils (rutabaga, turnip, garlic, radish, radish). Cakes, pastries, shortbread dough products are not shown. All types of cooking are allowed: boiling, stewing, baking and frying without breading. Diet 3-4 times a day.
    • Sometimes in convalescents, against the background of a rapid expansion of the diet, dyspeptic symptoms may occur. In this case, it is necessary to appoint a fasting day (boiled vegetables without salt and oil, baked apples) and check whether the diet is correct, whether the patient has concomitant chronic diseases of the digestive system, and, if necessary, make appropriate adjustments.

• Therapeutic nutrition for infectious diseases with a primary lesion of the central nervous system

  In acute infectious diseases with a predominant lesion of the central nervous system (encephalitis, meningoencephalitis, botulism, etc.), due to the severe (sometimes unconscious) condition of patients, the usual way of eating is simply impossible. Often, patients with severe acute intestinal infections and other infectious diseases at a certain stage cannot naturally receive an adequate amount of food. In these cases, it is necessary to prescribe artificial nutrition: parenteral or enteral.

  The main task of enteral and parenteral nutrition is to meet the plastic needs of the body and compensate for the energy and water-salt balance.

  At the first stage of treatment, the main goal is to normalize the central and peripheral hemodynamics, correct the content of blood gases, and improve the rheological properties of the blood. In order to avoid dehydration of the body, controlled hydration is carried out.

  At the second stage of therapy, replenishment of energy expenditure and normalization of plastic processes is required. Treatment begins with infusion therapy, supplemented by the introduction of media for parenteral nutrition and, further, enteral nutrition.

  With parenteral nutrition, the protein requirement of an infectious patient ranges from 0.8 to 1.5 g / kg of body weight, and in some cases up to 2 g / kg. Ensuring the water-salt balance in the body is achieved by the introduction of appropriate electrolyte solutions. Widely used for dehydration and replenishment of salt losses in the body isotonic (0.9%) sodium chloride solution, as well as 5% glucose solution.

  When the patient's condition improves, they are transferred to diet No. 13. With further expansion of the diet, the greatest attention should be paid to replenishing protein and vitamin deficiencies. Apply either diet number 11 or diet number 15.

• Therapeutic nutrition for tuberculosis

  Tuberculosis is a chronic relapsing infectious disease caused by Mycobacterium tuberculosis (MBT), which is characterized by the formation of specific inflammatory granulomas in various organs and tissues (mainly in the lungs), as well as a polymorphic clinical picture.

  Tuberculosis is called a social disease. Most often, tuberculosis occurs in places of deprivation of liberty, because the conditions of being in them correspond to the factors contributing to the development of the tuberculosis process in the body.

  Only complex therapy (a combination of therapeutic nutrition and antibiotic therapy that affects the pathogen) with an increase in the quality of life will effectively and radically solve the difficult problem of recovery.

  The most serious problem in the treatment of tuberculosis is the problem of a complete, pathogenetically balanced diet, both in the process of treating the disease and at the stage of rehabilitation. The disease has a chronic, relapsing course, so there is always a danger of resuming the activity of the process.

  When developing diet therapy, the following factors should be taken into account: gender, age, initial body weight and height of the patient, degree of weight loss, occupation. It is necessary to calculate the basal metabolism and the required amount of energy consumed. An assessment of the nutritional status (nutritional status, anthropometric data and body composition) and an assessment of the patient's energy needs are necessary.

  It should be borne in mind that with tuberculosis, the amount of energy consumed increases significantly due to a long illness, an increase in catabolism processes, protein breakdown and a deterioration in the metabolism of fats and carbohydrates, and a prolonged febrile reaction. This explains the need to increase the energy value of food.

  The nature of the diet therapy of patients with tuberculosis is determined by the peculiarity of the course of the tuberculosis process, the stage of the disease and the general condition of the patient, as well as complications from other organs. Of course, you need to know whether the disease developed primarily (at the first penetration) or secondarily. The forms of the disease in these two cases are different. The degree of disease activity, the general condition of the patient, the functional state of the gastrointestinal tract, concomitant diseases and complications can also make their own adjustments to the diet.

  • Tasks of therapeutic nutrition in tuberculosis
    • Providing the body with good nutrition in the conditions of protein breakdown, catabolism of fats and carbohydrates, increased consumption of vitamins and minerals.
    • Increasing the body's resistance to infection and intoxication. Diet therapy of patients with tuberculosis should be aimed at increasing the body's defenses.
    • Normalization of metabolism.
    • Assistance in the restoration of tissues affected by tuberculosis infection.
  • Principles of clinical nutrition of patients with tuberculosis
    • The food regimen should be varied and in its chemical composition and energy value - adequate to the dynamics of the tuberculous process and the general condition of the body.
    • Strict regimes and limited diets can be prescribed only for a short time (with complications and exacerbations of the disease).
    • At all stages of treatment (inpatient, sanatorium, outpatient) nutrition should be differentiated depending on the nature and stage of the tuberculosis process, the state of the digestive system, the presence of complications and concomitant diseases.
  • Basic requirements for therapeutic nutrition for tuberculosis
    • Patients should eat every 3 hours in small portions.
    • Food should be taken in small portions, 5-6 times a day. Spicy, fried, indigestible foods are excluded from the diet.
    • The energy value of the diet depends on the characteristics of the course of the disease, body weight and concomitant diseases. With an exacerbation of tuberculosis and bed rest, 2500-2600 kcal / day is enough. With half-bed rest - 2700 kcal; when the exacerbation subsides - 3000-3400 kcal. In case of pulmonary tuberculosis with a chronic course, especially in young people, a high-calorie diet is recommended - 3600 kcal. Food with more calories is not healthy. Rapid and large weight gain may not improve, but worsen the patient's condition.
    • Patients with tuberculosis should be given with food an increased amount of protein (at least 120-140 g), the consumption of which is increased in patients with tuberculosis. Recommend easily digestible protein foods (milk, fish, eggs, meat).
    • The amount of fat should be within the physiological norm (100–120 g). Fats should be given easily digestible, rich in vitamin A (butter, cream, sour cream), about a third - in the form of vegetable fat.
    • The amount of carbohydrates is within the physiological norm (450–500 g).
    • In some cases, in the presence of concomitant pathology (allergic diathesis, bronchial asthma, chronic eczema, overweight, diabetes mellitus), patients need to limit carbohydrate intake mainly due to easily digestible (sugar, honey, jam, syrup).
    • With an exacerbation of the tuberculosis process, foods rich in minerals (milk, cheese, cottage cheese, eggs, figs, dried apricots, raisins, meat and fish products, nuts) are additionally introduced into the diet.
    • With exudative pleurisy, transudate, tuberculous meningitis, with an increase in secretions into the bronchi, kidney damage leading to edema, a hyposodium diet is prescribed, that is, food is prepared without adding salt. This diet contributes to increased diuresis, resorption of fluid accumulated in the cavities, and subsidence of the inflammatory process. The liquid is administered in an amount of 900-1000 ml.
    • With a large loss of blood, repeated vomiting, diarrhea, excessive sweating, the amount of table salt is increased to 15 g / day.
    • Patients need vitamin therapy (C, A and group B).
    • Alcohol is contraindicated in patients with tuberculosis.

  In medical institutions for tuberculosis, diet number 11 is traditionally used.

  Currently, according to the system of standard basic diets, a variant of the diet with an increased amount of protein (high protein diet) is recommended.

  The diet of tuberculosis patients with concomitant changes in the digestive system must necessarily be subjected to appropriate correction.

• Therapeutic nutrition for HIV infection

  The goal of nutritional support for patients with HIV infection and AIDS is to provide adequate levels of all essential nutrients, prevent weight loss and reduce symptoms of malabsorption.

  Severe malnutrition is often seen with the progression of HIV infection and can lead to death.

  Reasons for the development of protein-energy deficiency in HIV-infected: malabsorption; anorexia; reduced food intake due to pathology of the oral cavity; stomach, intestines; drug-nutrient interactions.

  Correction of protein-energy deficiency and restoration of reduced body weight in patients with AIDS is possible only after adequately diagnosed and treated infections.

  Nutrition can be represented by special diets with dietary supplements, enteral feeding through a tube, in some cases - parenteral nutrition.

  When conducting enteral and parenteral nutrition in such patients, the risk of infectious complications is high. Oral enteral nutrition products can be used to increase the energy and nutritional value of the diet. The energy value of the diet should exceed the due calculated value by 500 kcal. At the same time, patients can add 3 kg of body weight in 2 months. With severe malabsorption or the inability to take food through the mouth, total parenteral nutrition is performed. Dementia and end-stage disease are two conditions in which nutritional support via an overlay gastrostomy is often used.

  • Principles of nutritional support for HIV-infected patients
    • Assessment of nutritional status should be performed in all HIV-infected patients in the asymptomatic stage.
    • In AIDS patients with unexplained weight loss, the energy value and dietary chemistry should be calculated to provide appropriate nutritional support.
    • The main causes of protein-energy malnutrition should be diagnosed and, if possible, eliminated.
    • Medical nutrition should be part of the overall treatment plan. Dietary recommendations and nutritional supplements may vary depending on the stage of the disease: oral diet, tube feeding, parenteral nutrition.
    • The risk of developing infectious complications during enteral and parenteral nutrition should be minimal.

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In the complex therapy of infectious diseases, therapeutic nutrition is of great importance.

In most infectious patients, against the background of intoxication and fever, anorexia develops, and therefore the supply of nutrients and energy is sharply reduced.

A shift in the acid-base state of the body towards acidosis is possible.

The infectious process is characterized by an increase in the processes of catabolism, 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 secrets and excretions (sputum, sweat, feces, vomit).

In an acute infectious disease, due to an increase in the intensity of basal metabolism, the need for energy increases, which is primarily provided by carbohydrates.

However, carbohydrate reserves in the body are limited (glycogen reserves are enough for 12-24 hours with complete starvation), so 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 mass). Fat mass is also lost, however, with a 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. There is a negative nitrogen balance. So, in a number of infectious diseases accompanied by severe intoxication, fever, diarrheal syndrome and other manifestations of the infectious-toxic process, protein losses can reach 150-200 g/day.

Protein deficiency leads to a violation of the synthesis of digestive enzymes, antibodies, a decrease in the bactericidal activity of blood serum, a decrease in thymus function up to its degeneration and atrophy, and exhaustion of the endocrine system.

In acute infectious diseases, a violation of water-electrolyte metabolism is 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, while 4 degrees of dehydration are 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 phenomena of polyhypovitaminosis are noted, which is associated with a decrease in the intake of vitamins from food, an increased need for them by 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.

In acute infections, anemia of various origins can develop.

Organic and functional changes in the gastrointestinal tract are characteristic mainly of intestinal infections. However, the enzymes of the gastrointestinal tract are thermolabile, that is, they are not resistant to an increase in body temperature, therefore, with a fever of any genesis, the breakdown of proteins, fats and carbohydrates of food is disturbed.

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 of nutritional disorders in acute infections is an increase in the body's energy consumption due to an increase in thermogenesis and metabolic stress.

Currently, clinical nutrition of 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 with a predominant lesion of the digestive organs (dysentery, typhoid fever, salmonellosis, viral hepatitis, leptospirosis, yellow fever).

3. Diseases with a primary lesion of the central nervous system (meningitis, meningoencephalitis, botulism, tetanus).

Any infectious diseases are more common in malnourished individuals and tend to have a severe course.

Nutrition in infectious diseases with a primary lesion of the central nervous system

Often, patients with severe acute intestinal infections and other infectious diseases at a certain stage cannot naturally receive an adequate amount of food. In these cases, it is necessary to prescribe artificial nutrition: parenteral or enteral.

The main task of parenteral nutrition is to meet the plastic needs of the body and compensate for the energy and hydroionic balance in case of organic or functional insufficiency of enteral nutrition.

At the first stage, the solution to this problem is achieved by normalizing the central and peripheral hemodynamics, correcting the content of blood gases, improving its rheological properties and transport functions.

At the second stage (or simultaneously), in order to reduce the catabolic reaction of the body, replenish energy expenditure and normalize plastic processes, infusion therapy is supplemented with the introduction of media for parenteral nutrition.

With parenteral nutrition, the protein requirement of an infectious patient ranges from 0.8 to 1.5 g / kg of body weight, and in some cases up to 2 g / kg.

In order to avoid dehydration of the body, controlled hydration is carried out. In the acute period of the course of infectious diseases, it is sometimes difficult to take into account perspiration water losses associated with shortness of breath or fever.

In febrile conditions, for example, only due to increased sweating, the body can lose up to 3-5 liters of fluid per day. Therefore, to resolve the issue of the required volume of hydration therapy, it is important for the doctor to control the content of fluid in the patient's body, in particular, located in the extracellular space.

Its amount is usually 20-27% of a person's body weight. In infectious diseases, the amount of extracellular water can change significantly due to inhibition of the excretory function of the kidneys, metabolic acidosis, a high level of intoxication of the body and due to excessive fluid intake.

According to most researchers, patients with infectious pathology, in case of injuries, burns and wounds, it is necessary to inject 40-50 ml of liquid per 1 kg of body weight per day.

Ensuring the hydroionic balance in the body is achieved by the introduction of appropriate electrolyte solutions. Until now, the classical solutions of Ringer and Ringer-Locke have not lost their significance, which served as the basis for many modifications.

From simple crystalloid solutions, isotonic (0.9%) sodium chloride solution, as well as 5% glucose solution are widely used for dehydration and replenishment of salt losses in the body.

Enteral nutrition in acute infectious diseases with impaired consciousness (encephalitis, meningitis, botulism) is carried out through a probe installed in the proximal small intestine.

This reduces the risk of aspiration of gastric contents and formula. When the patient is conscious and has no disturbances in the motor function of the stomach, the probe is inserted into the stomach. In both cases, the probe should not be used for more than 3 weeks. In some cases, nutrient mixtures can be drunk in small sips.

With a pronounced lesion of the gastrointestinal tract, to ensure the functional rest of the stomach, pancreas, liver, intestines, nutrition begins with elemental diets, and as the function of the digestive organs is restored, you can switch to the use of oligomeric and balanced diets, then a sparing version of the standard diet.

When considering issues of parenteral and enteral nutrition, it should be borne in mind that these two types of therapeutic nutrition cannot be opposed. We should talk about their reasonable combination, sequence of appointment, due to which, with appropriate metabolic control, optimal compensation of plastic and energy costs in infectious patients can be achieved.

It is extremely important to control the metabolic needs of the body of patients with severe infectious diseases, to determine their energy consumption and protein losses.

An analysis of the energy demand and anabolic activity of the drugs used will allow in each specific case to individually model adequate doses of the drugs (nutrients) used.

Patients with infectious diseases with a predominant lesion of the central nervous system, as well as patients with a severe course of other acute infectious diseases in the period of convalescence, should receive dietary nutrition corresponding to the list of dishes and products for patients of the first group, taking into account nutritional status indicators.

Features of nutrition in HIV infection

Severe malnutrition is often seen with the progression of HIV infection and can lead to death. The total content of potassium in the body is an indicator of the stock of somatic protein and cell mass, and on the basis of this indicator it was found that in AIDS patients immediately before death, the cell mass of the body is 54% of the norm, and the total body weight is 66% of the norm.

Reasons for the development of protein-energy malnutrition in HIV-infected people:

Malabsorption;
- anorexia;
- reduced food intake due to pathology of the oral cavity, stomach, intestines;
- drug-nutrient interactions.

Recovery of reduced body weight in AIDS patients is possible only after adequately diagnosed and treated infections. Nutrition can be represented by special diets with biologically active additives, enteral nutrition through a tube, in some cases - parenteral nutrition.

An appropriate dietary regimen should be initiated before the end stage of the disease occurs.

When performing enteral (through a tube or through a percutaneous gastrostomy) and parenteral nutrition in such patients, there is a high risk of infectious complications (bacterial contamination of the small intestine during tube feeding, bacteremia from a catheter during parenteral nutrition).

Oral enteral nutrition products can be used to increase the energy and nutritional value of the diet. The energy value of the diet should exceed the due calculated value by 500 kcal. In this case, patients for 2 months can add 3 kg of body weight.

With severe malabsorption or the inability to take food through the mouth, total parenteral nutrition is performed, after 14 weeks of which the weight gain is an average of 3 kg. Weight gain is more due to fat, less - due to cell mass. This suggests that it is completely impossible to stop protein catabolism in AIDS patients even with "aggressive" nutritional support.

Dementia and end-stage disease are two conditions in which nutritional support is often used (more often via a percutaneous gastrostomy).

The basic principles of nutritional support for HIV-infected patients can be formulated as follows:

1. Assessment of nutritional status should be carried out in all HIV-infected patients in the asymptomatic stage.

2. In AIDS patients with unexplained weight loss, the energy value and dietary chemistry should be calculated to provide appropriate nutritional support.

3. The main causes of protein-energy malnutrition should be diagnosed and, if possible, eliminated.

4. Medical nutrition should be included in the overall treatment plan. Dietary recommendations and nutritional supplements may vary depending on the stage of the disease: oral diet, tube feeding, parenteral nutrition.

5. The risk of developing infectious complications during enteral and parenteral nutrition should be minimal.

A.Yu. Baranovsky

Sometimes it is worth eating certain foods just to get better. But not in terms of weight or extra centimeters at the waist, but with the sole purpose of defeating the disease. What is so special about the flu, cold, or other acute infectious disease diet? And how quickly does it help restore health? Karlygash Omarova, a therapist of the highest category, head of the Department of Prevention and Psychosocial Assistance of the State Enterprise on the REM City Polyclinic No. 6, will tell us about this.

Most acute infectious diseases are characterized by intoxication of the body with toxins of microorganisms - infectious agents and protein breakdown products, fever, changes in the functions of a number of organs and systems. Changes in metabolism are observed: energy - due to an increase in energy consumption due to an increase in basal metabolism, protein - due to increased protein breakdown, water-mineral (loss of fluid and mineral salts, especially sodium and potassium, with profuse sweating, vomiting, diarrhea), vitamin - due to the increased consumption of vitamins. A shift in the acid-base state of the body to the acid side (acidosis) is possible. Often the functions of the digestive organs are inhibited.

Below are the basic principles of nutrition in the acute period of many infectious diseases (influenza, acute respiratory viral infections, cystitis, scarlet fever, measles, infectious mononucleosis, Brill's disease, etc.), excluding acute intestinal infections.

In the acute period of the disease the diet should ensure the supply of a sufficient amount of nutrients and energy to maintain the strength of the patient, prevent further disruption of metabolic processes and replenish the loss of nutrients, especially proteins, vitamins and mineral salts. In connection with a feverish state and a decrease in the 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. Food is cooked in chopped or pureed form, boiled in water or steamed.

The diet should be 60-70 g of protein (65% of them– animals), and with a satisfactory appetite - up to 80 g. Use mashed or finely chopped meat dishes, boiled fish, soft-boiled eggs, in the form of steam omelettes and soufflé, cottage cheese, acidophilus, kefir, yogurt, yogurt, and also with tolerance (if not causes gas and 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 can be included in the diet. A higher fat intake is undesirable. Carbohydrates are slightly limited - up to 289-300 g, of which 25-30% are easily digestible due to sugary drinks, jellies, mousses, honey, jams, etc. A sufficient amount of carbohydrates is necessary to cover energy costs and prevent the consumption of proteins to replenish energy losses and to reduce the symptoms of acidosis. However, an excess of carbohydrates can enhance the fermentation processes in the intestines. In connection with bed rest, the energy value of the diet is reduced due to fats and, to a lesser extent,– carbohydrates.

To regulate the motor function of the intestine, it is necessary to include sources of dietary fiber in the diet due to pureed vegetables, ripe soft fruits and berries. Of particular importance is the drinking regimen: up to 2-2.5 liters per day (tea with lemon, honey or milk, rosehip broth, fruit drinks, kissels, compotes, juices, low-fat sour-milk drinks, table mineral water). The abundant introduction of fluid replenishes its losses and contributes to a better release of toxins and metabolic products from the body. The content of table salt in the diet is on average 8-10 g, but with heavy sweating, profuse vomiting, salt intake is increased.

To improve appetite, low-fat meat and fish broths, sour-milk drinks, sweet and sour juices of fruits and berries diluted with water, tomato juice and other digestive stimulants are shown. Food is given fractionally, in small portions, weighing no more than 300-400 g per meal 5-6 times a day. The main part of the food should be given during the hours when the temperature drops. Food should be hot or cold, but not tepid.

- bread and flour products . Wheat bread from flour of the highest and 1st grade, dried or crackers; dry lean cookies and biscuit. Exclude: rye and any fresh bread, muffins, baked goods;

- soups. Weak, fat-free meat and fish broths with egg flakes, quenelles; meat soups; mucous decoctions from cereals with broth; soups on broth or vegetable broth with boiled semolina, rice, oatmeal, vermicelli, allowed vegetables in the form of mashed potatoes. Exclude: fatty broths, cabbage soup, borscht, bean soups;

- meat and poultry. Low fat varieties. The meat is cleaned from fat, fascia, tendons, skin (poultry). In finely chopped form; steam dishes from beef, chickens, turkeys; boiled - from veal, chickens, rabbits. Souffle and mashed boiled meat; meatballs, steamed meatballs. Exclude: fatty varieties, duck, goose, lamb, pork, sausages, canned food;

- fish. Lean types. The skin is removed. Boiled, steam fish in the form of a cutlet mass or a piece. Exclude: fatty species, salted, smoked fish, canned food;

- dairy. Kefir, acidophilus and other fermented milk drinks. Fresh cottage cheese and dishes from it (pasta, souffle, steam cheesecakes), sour cream 10-20% fat. Grated cheese. Milk, cream in the form of an additive to dishes. Exclude or limit: whole milk, fatty sour cream, spicy, fatty cheese;

- eggs. Soft-boiled, steam, protein omelets. Exclude: hard-boiled and fried eggs;

- cereals. Pureed, well-boiled semi-liquid and semi-viscous porridges with the addition of broth or milk, steam puddings and soufflés from semolina, rice, ground buckwheat and Hercules. Boiled vermicelli. Exclude: legumes;

- vegetables. Potatoes, carrots, beets, cauliflower in the form of mashed potatoes, soufflés, steam puddings. Early zucchini and pumpkin can not be wiped. Ripe tomatoes. Exclude: white cabbage, radish, radish, onion, garlic, cucumbers, turnips, legumes, mushrooms;

- snacks. Aspic of mashed meat, fish. Fish caviar. Forshmak from soaked herring. Exclude: fatty and spicy snacks, smoked meats, canned food;

- fruits, sweet dishes and sweets. Raw ripe, soft fruits and berries - sweet and sour-sweet, partly pureed; baked apples; dried fruit puree, kissels, mousses, compotes, sambuca, jelly; cream and milk jelly; meringues, snowballs with jelly. Sugar, honey, jam, jam, marmalade. Exclude: fruits rich in fiber, with a rough skin, cakes;

- sauces and spices. White sauce on meat broth, vegetable broth; milk, sour cream, vegetarian sweet and sour, Polish. The flour for the sauce is dried. Exclude: spicy, fatty sauces, mustard, horseradish, spicy ketchups;

- beverages. Lemon tea, tea, coffee and cocoa are weak with milk. Diluted juices of fruits and berries, vegetables; rosehip broth, fruit drinks;

- fats. Butter in its natural form and in dishes. Up to 10 g of refined vegetable oil per meal. Exclude: other fats.

Sample diet menu

1st breakfast: milk semolina porridge, tea with lemon.

2nd breakfast: soft-boiled egg, rosehip broth.

Dinner: pureed vegetable soup in meat broth (1/2 portion), steamed meat chops, rice porridge (1/2 portion), pureed compote.

afternoon tea: baked apple.

Dinner: boiled fish, mashed potatoes (1/2 portion), fruit juice diluted with water.

For the night: kefir and other fermented milk drinks.

In acute infectious diseases, it is mandatory to take multivitamins or vitamin-mineral complexes. A popular remedy among part of the population and doctors was considered to be taking large doses (from 2000 to 5000 mg) of ascorbic acid for influenza and acute respiratory viral infections. The effectiveness of such techniques in relevant studies has not been confirmed. There are no grounds to support the opinion of some physicians about the usefulness of 2-3-day fasting in acute infections of the upper respiratory tract and in the acute period of other infectious diseases. However, if a patient with severe fever and appetite suppression refuses to eat and consumes only thirst-quenching drinks for 1, maximum 2 days of illness, he should not be forced to eat.

In severe cases of acute infection, special dietary products - nutrient mixtures - can be used in the diet. It is necessary to take into account a sharp (by 20-50%) increase in basal metabolism in severe acute infections. In addition, for every 0.5°C of body temperature above 37°C, 100 kcal should be added to the daily energy value of the diet. Therefore, the energy value of diets in the acute period of such infectious diseases should be oriented at an average of 2000-2200 kcal, followed by a gradual increase to 2400-2500 kcal.

If a patient with severe fever and appetite suppression refuses to eat and consumes only thirst-quenching drinks for 1, maximum 2 days of illness, he should not be forced to eat.

When preparing an article

book materials were used

B.L. Smolyansky and V.G. Liflyandskogo

"Medicinal food"

Discipline "Nursing"

Homework for Lesson No. 9, IV semester 2017-2018 academic year year

for 2nd year students of the Faculty of Pediatrics

Venue: FESMU Department of Nursing with a course of social disciplines (dormitory No. 4)

Dress code: medical gown, shoe covers (replaceable shoes), cap, mask.

Student equipment:

Workbook with notes on Topics No. 17-18;

Algorithms for manipulations on the topics of the lesson;

Stationery;

Beginning of classes: according to the approved schedule

Lesson duration - 4 hours:

2 hours - Topic #17:

Main literature:

Chapter 19"Child Care for Infectious Diseases".

Chapter 1"Therapeutic and preventive care for children in Russia - Paragraph: Boxes of the children's department."

Chapter 3"Therapeutic department of the hospital - Paragraph: VBI"

2 hours - Topic #10: "Care and supervision of children with skin disease"

Main literature: 1. Zaprudnov A.M., Grigoriev K.I. General childcare. Textbook.- M.: GEOTR-Media, 2012. Chapter 13"Care and supervision of children with skin diseases"; Chapter 22 pp. 304-306: Rinsing of the mouth, throat and pharynx. Hygienic baths; Chapter 23 pp. 307-309: Therapeutic (common) bath. Hand, foot bath; Chapter 26 pp. 352-353: The introduction of drugs through the skin and mucous membranes (rubbing of drugs, lubrication, ointment dressings, wet-drying dressings).

To study and write Manipulation Algorithms: Additional literature:

1. Manipulations in nursing / Ed. A. G. Chizha, 2012.

2. Fundamentals of nursing: Manipulation algorithms: a tutorial / N.V. Shirokova and others - M. : GEOTAR-Media, 2010.

Homework for Lesson No. 9 :

1. Orally answer the control questions at the end of Chapters 19 and 13 (textbook Zaprudnov A.M., Grigoriev K.I.).

2. In the Workbook, from a new sheet, complete notes for Topics No. 17-18 according to the examples presented in the manual.

3. Prepare algorithms for nursing manipulations on the topics of the lesson, repeat algorithms from previously studied topics, see the list of algorithms (learn, write down in a manipulation sheet; those algorithms that have already been drawn up in 1 and 2 courses, supplement from new sources of educational literature if necessary) .

4. Repeat help for febrile patients:

Chapter 12"Care and supervision of patients with high body temperature"

2. Oslopov V.N., Bogoyavlenskaya O.V. General care of patients in a therapeutic clinic. Textbook.- M.: GEOTAR-Media, 2007.

Chapter 5"Body temperature"

The student should know Manipulation Algorithms on the topics of Lesson No. 9:

Parenteral (intravenous) nutrition;

Feeding a seriously ill patient (from a spoon, drinker, bottle);

Taking feces for general analysis (scatological examination), writing a referral to the laboratory;

Taking feces for helminth eggs and protozoa, writing directions to the laboratory;

Taking a scraping from the perianal folds to pinworm eggs, writing a referral to the laboratory;

Taking feces for bacteriological examination (a group of intestinal bacteria), writing a referral to the laboratory;

Taking feces for occult blood testing, writing a referral to the laboratory;

Taking stool for examination for dysbacteriosis, writing a referral to the laboratory;

Taking feces for research on Escherichia coli, writing a referral to the laboratory;

Preparation of a set of instruments for spinal puncture and the participation of a nurse during its implementation;

Submission of the vessel;

Washing away the patient (men/boy, women/girls);

Oral care (examination, rinsing, washing (irrigation), wiping the mouth and teeth, lubricating the oral cavity);

Rinsing the mouth, throat and pharynx;

Hygienic baths, showers;

Rubbing, washing;

Skin care;

Prevention and treatment of bedsores by stages;

Sanitary treatment of a patient with pediculosis;

Taking a swab from the nose, throat, nasopharynx;

Care for the natural folds of the patient's body;

Hair care;

Thermometry;

Filling out an emergency notification of an infectious disease;

Examination of the patient for pediculosis and carrying out pest control measures;

Filling the system for intravenous infusion;

Connecting the system for intravenous infusion to the patient and the actions of the nurse at the end of the intravenous drip;

The introduction of drugs through the skin and mucous membranes (rubbing drugs, lubrication, ointment dressings, wet-drying dressings, talkers, lotions);

Applying a hypertonic dressing;

Therapeutic baths;

Hand, foot bath;

Applying an ice pack.

The course of practical Lesson No. 9:

1. Analysis of topics Lessons No. 9, control of students' knowledge.

2. Checking and discussion of the summary of Topics No. 17-18.

3. Viewing video materials, slide presentations (at the discretion of the teacher).

4. Practicing practical skills in the phantom class.

5. Solving problem-situational problems.

6. Preparation of a report on the performed practical work.

Forms of control of assimilation of educational material:

1. Oral / written survey.

2. Test control.

3. Checking the theoretical knowledge of algorithms.

4. Checking the technique for performing practical skills.

5. Solution of situational problems.

6. Checking students' home independent work (SIW).

7. Checking reports.

Homework for the next Lesson No. 10:

1. Preparation for Lesson No. 10 - "Observation and Nursing care for sick adults and children with respiratory diseases"; "Surveillance and Nursing Care of Sick Adults and Children with Diseases of the Circulatory Organs".

2. Student's home independent work (SIW): notes, preparation of manipulation algorithms, reports on work in the study room.

An example of a summary in a workbook:

Lesson number 9

Topic #17:"Surveillance and Nursing Care of Children with Infectious Diseases".

Features of nutrition of patients with infectious diseases

Basic concepts

Box characteristics