Blood loss: types, definition, acceptable values, hemorrhagic shock and its stages, therapy

What is blood loss is best known in surgery and obstetrics, since they most often encounter a similar problem, which is complicated by the fact that there was no single tactic in the treatment of these conditions. Every patient needs individual selection optimal combinations medicinal products because blood transfusion therapy is based on the transfusion of donor blood components that are compatible with the patient's blood. Sometimes it can be very difficult to restore homeostasis, since the body reacts to acute blood loss with a violation of the rheological properties of blood, hypoxia and coagulopathy. These disorders can lead to uncontrolled reactions that threaten to end in death.

Hemorrhage acute and chronic

The amount of blood in an adult is approximately 7% of its weight, in newborns and infants this figure is twice as high (14-15%). It also increases quite significantly (on average by 30-35%) during pregnancy. Approximately 80-82% takes part in blood circulation and is called volume of circulating blood(OTsK), and 18-20% is in reserve in the depositing authorities. The volume of circulating blood is markedly higher in people with developed muscles and not burdened overweight. In full, oddly enough, this indicator decreases, so the dependence of BCC on weight can be considered conditional. BCC also decreases with age (after 60 years) by 1-2% per year, during menstruation in women and, of course, during childbirth, but these changes are considered physiological and, in general, do not affect the general condition of a person. Another question is if the volume of circulating blood decreases as a result of pathological processes:

• Acute blood loss caused by traumatic impact and damage to a vessel of large diameter (or several with a smaller lumen);
• Acute gastrointestinal bleeding associated with human diseases of ulcerative etiology and being their complication;
• Blood loss during operations (even planned ones), resulting from a surgeon's mistake;
• Bleeding during childbirth, resulting in massive blood loss, is one of the most severe complications in obstetrics, leading to maternal death;
• Gynecological bleeding (uterine rupture, ectopic pregnancy and etc.).

Blood loss from the body can be divided into two types: acute And chronic, and chronic is better tolerated by patients and does not carry such a danger to human life.

Chronic (hidden) blood loss is usually caused by persistent but minor bleeding(tumors, hemorrhoids), in which the compensatory, protective mechanisms of the body have time to turn on, which does not occur with acute blood loss. With a hidden regular loss of blood, as a rule, the BCC does not suffer, but the number of blood cells and the level of hemoglobin drops markedly. This is due to the fact that replenishing the volume of blood is not so difficult, it is enough to drink a certain amount of liquid, but to produce new ones. shaped elements and the body does not have time to synthesize hemoglobin.

Physiology and not so

The loss of blood associated with menstruation is a physiological process for a woman, negative impact does not affect the body and does not affect health, if it does not exceed allowed values. The average blood loss during menstruation ranges from 50-80 ml, but can reach up to 100-110 ml, which is also considered the norm. If a woman loses more blood than this, then one should think about it, because a monthly blood loss of approximately 150 ml is considered abundant and in one way or another will lead to and in general can be a sign of many gynecological diseases.

Childbirth is a natural process and physiological blood loss will definitely take place, where acceptable norm values ​​around 400 ml are considered. However, in obstetrics everything happens and it should be said that obstetric bleeding are quite complex and can become unmanageable very quickly.

At this stage, all the classic signs are clearly and clearly manifested. hemorrhagic shock:

• Cold extremities;
• Paleness of the skin;
• acrocyanosis;
• Dyspnea;
• Muffled heart sounds (insufficient diastolic filling of the heart chambers and deterioration of the contractile function of the myocardium);
• Development of acute renal failure;
• Acidosis.

Distinguishing decompensated hemorrhagic shock from irreversible is difficult because they are very similar. Irreversibility is a matter of time, and if decompensation, despite treatment, continues for more than half a day, then the prognosis is very unfavorable. Progressive organ failure, when the function of the main organs (liver, heart, kidneys, lungs) suffers, leads to the irreversibility of shock.

What is infusion therapy?

Infusion therapy does not mean replacing lost blood with donor blood. The slogan “a drop for a drop”, which provides for a complete replacement, and sometimes even with a vengeance, has long gone into oblivion. - a serious operation involving the transplantation of foreign tissue, which the patient's body may not accept. It is even more difficult to deal with blood transfusion reactions and complications than with acute blood loss, therefore whole blood and do not overflow. In modern transfusiology, the issue of infusion therapy is solved differently: blood components are transfused, mainly fresh frozen plasma, and its preparations (albumin). The rest of the treatment is supplemented by the addition of colloidal plasma substitutes and crystalloids.

The task of infusion therapy in acute blood loss:

1. Restoration of the normal volume of circulating blood;
2. Replenishment of the number of red blood cells, as they carry oxygen;
3. Maintaining the level of clotting factors, since the hemostasis system has already responded to acute blood loss.

It makes no sense for us to dwell on what the tactics of a doctor should be, since for this you need to have certain knowledge and qualifications. However, in conclusion, I would like to note that infusion therapy provides various ways its implementation. Puncture catheterization requires special patient care, so you need to be very careful slightest complaint patient, because here, too, complications may occur.

Acute bleeding. What to do?

As a rule, first aid in case of bleeding caused by injuries is provided by people who are nearby at that moment. Sometimes they are just passers-by. And sometimes a person has to do it himself if trouble has caught him far from home: fishing or hunting, for example. The very first thing to do - try with the available improvised means or by finger pressing the vessel. However, when using a tourniquet, it should be remembered that it should not be applied for more than 2 hours, so a note is placed under it indicating the time of application.

In addition to stopping bleeding, first aid also consists in carrying out transport immobilization, if there are fractures, and make sure that the patient falls into the hands of professionals as soon as possible, that is, it is necessary to call a medical team and wait for her arrival.

Provide emergency assistance medical workers, and it consists of:

• Stop the bleeding;
• Assess the degree of hemorrhagic shock, if any;
• Compensate the volume of circulating blood by infusion of blood substitutes and colloidal solutions;
• Conduct resuscitation in case of cardiac and respiratory arrest;

Blood loss is the irretrievable loss of blood by a person as a result of injury or disease. Death from blood loss is the most common cause of death in humans.

Causes of blood loss

The causes of blood loss, as a rule, are two: traumatic and non-traumatic.

As the name implies, the first group includes bleeding resulting from rupture of blood vessels from injuries caused by external forces. Especially dangerous bleeding occurs when open fractures and damage to the central vessels. In such cases, blood loss occurs rapidly and often the person does not even have time to help.

Non-traumatic bleeding occurs due to a failure in the hemostasis system, which ensures the preservation of blood in a liquid state on the one hand and the prevention and blocking of bleeding on the other. In addition, they may occur when pathological conditions heart and blood vessels, liver, gastrointestinal tract, with oncological diseases and hypertension. The danger of this type of bleeding is that they are difficult to diagnose and difficult to treat.

Common signs of blood loss

Bleeding is external and internal. External are easily determined, because. it is difficult not to notice such bleeding, especially abundant. Arterial bleeding is more dangerous, when bright blood spurts from the wound in a fountain, it is difficult to stop it and dangerous state can happen very quickly. With venous bleeding, the blood is dark and flows out of the wound calmly, it is easier to stop it, with minor injuries it can stop on its own.

There are also capillary bleeding, when blood oozes through damaged skin. If capillary bleeding is external, then, as a rule, it does not lead to a large loss of blood, but with the same internal bleeding blood loss can be significant. There are cases when all three types of bleeding are combined and this is very bad for the victim.

Internal bleeding can occur in hollow organs: intestines, stomach, trachea, uterus, bladder, as well as in internal cavities: scull, abdominal cavity, pericardium, chest. The danger of this bleeding is that it may not be noticed for a long time and waste precious time.

Signs of bleeding include

Blood loss leads to a decrease in the nutrition of organs, primarily the brain. Because of this, the patient feels dizziness, weakness, darkening of the eyes, tinnitus, anxiety and a feeling of fear, his facial features are sharpened, fainting and loss of consciousness may occur.

With further blood loss, the arterial pressure spasm occurs blood vessels, so the skin and mucous membranes turn pale. Because of the compensatory reaction of the heart, tachycardia occurs. From the lack of oxygen in respiratory system shortness of breath occurs.

Signs of blood loss depend on the amount of blood lost. It is better to measure it not in milliliters, but as a percentage of the BCC - the volume of circulating blood, because. the body weight of people is different and the same amount of blood lost will be tolerated differently by them. In an adult, about 7% of the blood in the body, in young children, about twice as much. BCC, which takes part in the processes of blood circulation, is about 80%, the rest of the blood is in reserve in the depositing organs.

What is acute blood loss

Acute blood loss is called the body's reaction to a decrease in BCC. How faster body loses blood and the greater the volume of blood loss, the more severe the condition of the victim and the worse prognosis for recovery. Age and general health affect the possibility of recovery, a younger person without chronic diseases quickly cope with blood loss, even significant. And the temperature environment exerts its influence, at a lower temperature, blood loss is more easily tolerated than in the heat.

Classification of blood loss

In total, there are 4 degrees of blood loss, each of which has its own symptoms:

1. blood loss mild degree . In this case, the loss of BCC is 10-20% (from 500 to 1000 ml.) And this is quite easily tolerated by patients. The skin and mucous membranes almost do not change color, they just become paler, the pulse can become more frequent up to 100 beats per minute, the pressure can also slightly decrease.
2. blood loss moderate . In this case, the loss of BCC is 20-40% (up to 2000 ml.) And a picture of shock of the 2nd degree appears: the skin, lips, subungual beds are pale, the palms and feet are cold, the body is covered with large drops of cold sweat, the amount of urine decreases. The pulse quickens to 120 beats. per minute, the pressure drops to 75-85 mm Hg.
3. severe blood loss. The loss of BCC is 40-60% (up to 3000 ml), shock of the 3rd degree develops: the skin becomes sharply pale with a grayish tint, the lips and subungual beds are bluish, there are drops of cold sticky sweat on the body, consciousness is almost lost, urine is not excreted. The pulse quickens up to 140 beats. per minute, the pressure drops to 70 mm Hg. and below.
4. Extremely severe blood loss occurs when the loss of BCC is more than 60%. In this case, a terminal state occurs - the transition from life to death due to irreversible changes in brain tissues and impaired acid-base balance in organism. The skin is cold and wet, sharply pale color, subungual bed and lips are gray, consciousness is absent. There is no pulse on the extremities, it is determined only on the carotid and femoral arteries, blood pressure is not determined.

Diagnosis of acute blood loss

In addition to diagnosing the above signs that everyone can see, medical institutions carry out additional examinations to more accurately determine the degree of blood loss. For example, according to the "shock index" - the ratio of the pulse rate to the pressure indicator. In addition, blood is taken for analysis to determine the number of red blood cells, hemoglobin levels, acid-base balance. They also perform X-ray examination, MRI, ultrasound and a number of others.

Internal bleeding is diagnosed when there is additional features: hemoptysis with lung injury, vomiting " coffee grounds» with bleeding in the digestive tract, tension of the anterior abdominal wall with bleeding into the abdominal cavity.

The body reacts to the loss of blood by releasing blood from the depot in the liver and spleen, in the lungs arteriovenous shunts open - direct connections of veins and arteries. All this helps the victim to ensure the flow of blood to the vital important bodies within 2-3 hours. The task of relatives or eyewitnesses of the injury is to provide timely and correct first aid and call an ambulance.

Principles of treatment of blood loss

In acute blood loss, the main thing is to stop bleeding. For external bleeding, a tight tourniquet should be applied above the wound and the time recorded. Depending on the type of wound, you can still apply a pressure bandage or at least attach a tampon and fix it. The easiest temporary way is to press the damaged area with your finger.

Therapy for blood loss consists in replenishing the amount of lost blood by transfusion. With blood loss up to 500 ml. this is not required, the body is able to cope with the task of replenishing the lost blood volume. With more profuse blood loss not only blood is transfused, but also plasma substitutes, saline and other solutions.

In addition to replenishing blood loss, it is important to restore urination within 12 hours after injury, because. may arise irreversible changes in the kidneys. For this, special infusion therapy is carried out.

When damaged internal organs the most common is surgery.

If a person has lost up to 10% of blood, this is acceptable, the body will be able to cope with its restoration. Acute blood loss is observed in a situation where this percentage is higher. This condition is life-threatening and measures should be taken immediately to restore the desired volume of blood. How to make up for the loss, read further in the article.

Symptoms of acute blood loss

The bleeding clinic consists of local (due to the outflow of blood during external environment or inside tissues and organs) and general signs of blood loss. It's unifying clinical sign for all types of bleeding. The severity of these symptoms and the body's response to blood loss depend on many factors. Blood loss is considered fatal when a person loses half of all circulating blood. But this is not an absolute statement.

Second an important factor, which determines the body's response to blood loss, is its rate, i.e., the rate at which a person loses blood. When bleeding from a large truncus arteriosus death can also occur with smaller amounts of blood loss. This is due to the fact that the compensatory reactions of the body do not have time to work at the proper level, for example, when chronic blood loss in volume.

General clinical symptoms are the same for all bleeding:

There are complaints of dizziness, weakness, thirst, flies before the eyes, drowsiness.

Skin pale, with a high rate of bleeding can be observed cold sweat.

Not uncommon orthostatic collapse, development fainting.

An objective examination reveals tachycardia, a decrease in blood pressure, and a pulse of small filling.

With the development of hemorrhagic shock, diuresis decreases.

In the analysis of red blood, there is a decrease in hemoglobin, hematocrit and the number of red blood cells. But a change in these indicators is observed only with the development of hemodilution and in the first hours after blood loss is not very informative.

expressiveness clinical symptoms blood loss depends on the rate of bleeding.

Signs of blood loss in anemia

Still need to say a few words about anemia. This word translates as "without blood." What are the symptoms associated with this disease? This:

general weakness from lack of strength,

sometimes dizziness,

low pressure, but high frequency pulse.

anemia in more women suffer. In general, anemia is not even a disease, but a symptom that not everything is in order in the body. If the human body does not receive enough iron, which is necessary for the formation of hemoglobin, its energy capacity is reduced. During menstruation, women are deficient in iron. Pregnant women also suffer from iron loss in the blood as they share incoming iron with their growing baby.

Degrees of blood loss and their manifestations

There are several degrees of severity of acute blood loss.

With a deficit of circulating blood volume (BCC) of 5-10%. General state relatively satisfactory, there is an increase in the pulse, but it is of sufficient filling. Arterial pressure (BP) is normal. When examining blood, hemoglobin is more than 80 g / l. On capillaroscopy, the state of microcirculation is satisfactory: against a pink background, fast blood flow, at least 3–4 loops.

With a deficiency of BCC up to 15%. General condition of moderate severity. There is tachycardia up to 110 in 1 min. Systolic blood pressure drops to 80 mm Hg. Art. In the analysis of red blood, a decrease in hemoglobin from 80 to 60 g / l. Capillaroscopy reveals fast blood flow, but on a pale background.

With a deficiency of BCC up to 30%. General serious condition patient. The pulse is threadlike, with a frequency of 120 beats per minute. Arterial pressure drops to 60 mm Hg. Art. With capillaroscopy, a pale background, slowing of blood flow, 1-2 loops.

With a BCC deficit of more than 30%. A patient with symptoms of blood loss of this degree is in a very serious, often agonal condition. Pulse and blood pressure on the peripheral arteries are absent.

How to make up for the loss of blood with traditional methods?

This is done in a hospital. A person is given a plasma infusion or a direct blood transfusion. In urgent emergency situations, to make up for the loss of blood, administered intravenously various drugs, for example, saline, glucose solution, etc. If the blood loss is small, medical intervention is not required.

How to cure anemia with home remedies? As you know, blood consists of plasma (98% water) and blood cells. Cells, in turn, contain protein and iron. In addition, in the process of hematopoiesis involved folic acid and vitamin B12. So, in order to quickly replenish the loss of blood, you need to saturate the body:

liquid;

vitamin B12;

folic acid.

What foods have the most iron? Liver, lean meats, apples, walnuts, eggs. In the treatment of acute blood loss, you can still use the pharmacy Hematogen. It is also believed that a lot of iron contains foods that are colored red - liver, beets, carrots, apples, tomatoes. Liquids should be drunk at least 2.2 liters. This is ordinary water, various natural juices. In addition, doctors advise drinking red wine, preferably Cahors, a glass a day.

It must be remembered that foods rich in calcium reduce the absorption of iron. If you urgently need to make up for the loss of blood, you will have to give up dairy products for a while. If for some reason you can't do this, then at least don't take foods containing calcium and iron together. Iron absorption is also reduced bakery products, coffee Tea. To make up for the loss of blood, you need to eat foods that contain vitamin C - tomato and orange juices, citrus fruits, onions, Bell pepper, greenery. It is good to drink freshly squeezed pomegranate juice.

How to replenish blood loss with anemia?

To improve your well-being, do not drink coffee or tea immediately after a meal. Iron preparations do not need to be washed out. It is better to drink after dinner, which includes foods with a lot of iron, a glass of natural orange juice. Vitamin C helps iron to be better absorbed.

Very good home remedy for blood loss:

• raisin;
• walnuts;
• dried apricots;
• lemons.

1 glass of all products, 2 lemons. Lemons are used whole, with peel and zest. All products must be ground in a meat grinder, mixed with honey and put in the refrigerator. You can take the remedy several times a day if desired. Tasty and very useful in the treatment of anemia.

Causes of acute blood loss and its danger

Blood loss can be caused different reasons. These are various injuries, surgical intervention, diseases of internal organs, heavy periods in women, etc.

It is extremely important to make up for the loss of blood in a timely manner, since it performs a number of tasks in the body. important functions, which are mainly reduced to maintaining homeostasis. Thanks to the transport function of blood in the body, it becomes possible to constantly exchange gases, plastic and energy materials, hormonal regulation and others. The buffer function of blood is to maintain acid-base balance, electrolyte and osmotic balance. immune function also aimed at maintaining homeostasis. Finally, due to the delicate balance between the coagulation and anticoagulation systems of the blood, its liquid state is maintained.

The causes of blood loss can be various - trauma, surgical interventions, heavy periods in women, various diseases internal organs. It is believed that the loss of 10% of blood is possible: the body itself copes with the correction of its typical number. But if a person loses more, it is no longer safe for his health and life, and measures should be taken as quickly as possible to replenish it.

Instruction

1. In emergency situations, when a rapid replenishment of blood loss is needed, say, in case of injuries, intravenous administration is performed. different drugs- saline, polyglucin, reopoliglyukin, glucose solution, etc. Later, more closely in a hospital, a person is transfused with red blood cells, plasma, drugs blood or do a direct transfusion blood donor, depending on medical indications.

2. If the blood loss is small, it is possible to make up for the lack of erythrocytes and hemoglobin with the help of injections of iron preparations, which accelerate the production of erythrocytes by the body by 3-4 times, as well as the use of such medicines, as sulfate or iron gluconate, vitamin complexes containing this component.

3. Water consumption in this case should be a little larger. daily allowance- at least 2.2 liters per day.

4. To improve the composition and increase the number blood drink a glass of red wine every day.

5. In the process of hematopoiesis, proteins play a significant role, therefore, try to increase the consumption of veal, dairy products, fish, and beans in your diet. In order to increase the level of hemoglobin, increase the consumption of organ meats (liver, kidneys, tongue), buckwheat, beans, peas, chocolate, blueberries, beets, carrots, dried apricots, pomegranates - these products contain the largest amount of iron. A lot of it is also in beef, lamb, rabbit meat, eggs, oatmeal, millet, apples, pears, persimmons, spinach, nuts.

6. Remember that iron absorption is reduced by calcium-rich foods, so if you have low hemoglobin, give up milk and dairy products for a while. If this is unrealistic for some reason, divide the intake of foods containing steel and calcium over time. Eliminate from your diet also tea and coffee, bakery products, which reduce the absorption of iron.

7. In order to increase hemoglobin, add to your daily menu foods containing vitamin C - tomato and orange juice, lemons, cabbage pickle, onions, greens and sugary peppers.

8. In addition to iron, vitamin B12 is essential for the formation of red blood cells. You can find it in vitamin complexes and "energy" drinks, as well as in the liver. Folic acid is also involved in the construction of red blood cells. Its table of contents in the body can be replenished by using pharmacological preparations or fresh vegetables and fruits, exclusively corn, black currants, parsley, tomatoes, kiwi, cranberries.

Paleness, laziness, bad sleep, weakness, loss of appetite are signs of a decrease in the level of hemoglobin in the blood. Anemia is invariably secondary and may be associated with disease digestive tract, surgical intervention, hormonal disorders, oncological diseases etc. In any case, the treatment should be accompanied by the intake of iron-containing preparations.

You will need

• - "Feroplex", "Ferrum Lek", "Tardiferon retard";
• – foodstuffs with a high content of iron;
• - chicory, dandelion, birch leaf, shepherd's bag, plantain, sunflower leaf, elecampane root, nettle;
• - juices from beets, pumpkins, celery, carrots, onions, potatoes, apricots.

Instruction

1. If signs of anemia occur, contact medical institution where the attending physician, based on clinical blood tests, will identify the cause of anemia and prescribe adequate treatment. An increase in the hemoglobin tier can only be achieved complex treatment, which includes the intake of iron-containing preparations, healthy nutrition, herbal medicine, an energetic lifestyle.

2. To increase the level of hemoglobin, drugs are prescribed both in the form of tablets and drugs for intravenous or intramuscular administration. They are taken in courses of 2-3 weeks, in individual cases- up to 3 months. These include "Feroplex", "Ferrum Lek", "Tardiferon retard" and others. In addition to taking iron-containing drugs, the treatment of the underlying disease - the culprit - is rigorously iron deficiency anemia.

3. Despite the high performance drug treatment, in many patients, violations of the gastrointestinal tract- constipation, nausea, loss of appetite. Therefore, in unopened cases, it is recommended special diet. Include foods such as buckwheat, bran, dark varieties of honey, beef, liver, butter. Apricots, pomegranates, quince, prunes, dried apricots, walnuts are rich in iron. Beans, peas, all kinds of onions, carrots, peppers, garlic must be continuously present in the diet.

4. Seasonings such as Bay leaf, mustard and cumin help the body absorb steel better. But acetic acid alcoholic drinks, tea, coffee, lemonade, cocoa and cola interfere with the absorption gland. Also, you should not eat refined foods, fast food, semi-finished products. They are poor in vitamins and minerals.

5. For iron deficiency anemia, decoctions of the following should be taken. medicinal plants: chicory, dandelion, birch leaf, shepherd's purse, plantain, sunflower leaf, elecampane root, nettle. Of these herbs, in any combination, it is allowed to brew healing tea and take within 1.5-2 months. Pour 0.5 liters of boiling water over 1 tablespoon of the collection and cook for 5-7 minutes. After insisting 2 hours, strain. Take half a glass 3-5 times a day before meals.

6. At the same time, take juices from beets, pumpkins, celery, carrots, onions, potatoes, apricots for? glass 4 times a day 30 minutes before meals.

Helpful advice
The process of iron accumulation in the body takes more than one week, therefore it is recommended to periodically take a blood test for hemoglobin in order to control the rate of absorption of iron from foods.

Vegetarians and people who are on a diet may experience a lack of protein in the body. This causes important outcomes - muscle thinning, hair problems, anemia, metamorphosis of the color of the mucous membranes and snags with digestive system. Everyone has their own protein intake.

You will need

• - meat;
• - dairy products;
• - nuts;
• - legumes;
• - cereals;
• - Soy meat;
• - soy sprouts;
• - protein shakes.

Instruction

1. More than any protein deficiency is dangerous for people under the age of 21. Tea at this time a person grows and progresses especially richly. A construction material for muscles, bones and tendons, the body takes it from protein. Consequently, the lack of this suitable substance can lead to a delay in growth and development. If a person at this age has a lack of protein, it must be urgently replenished, despite diets and beliefs. Eat meat, exclusively red. It will quickly make up for the deficiency.

2. If you are over 21 years old and absolutely do not want to eat meat, replace it with other protein-rich foods. These include many dairy products: low-fat cottage cheese, hard cheeses, kefir, cream, sour cream. In the first 2 names, the amount of protein can reach 15 grams per hundred grams of product.

3. If you can't eat dairy either (many vegetarians don't allow them), look into nuts and legumes. Beans and peas also contain high number squirrel. It is allowed to eat peas raw, and it is allowed to cook various cereals from it or add it to soups. Make it a habit to eat a handful of nuts several times a day. This will help make up for the lack of protein.

4. Enter into the diet different cereals: barley, semolina, rice, buckwheat, millet. These products contain less protein, from 5 to 10 grams per hundred grams of product. But still, eating them, you will be able to replenish the amount of protein needed for the body.

5. Buy soy meat from the store. It is allowed to cook it in dozens various methods, and by appearance it looks like a normal one. Consume this product at least once a day. Also eat soy sprouts (you can eat them raw), they contain about 9 grams of protein.

6. Eat different protein shakes. These products are mostly recommended for bodybuilders, but they are amazing for people who suffer from protein deficiencies. Do not replace meals with protein shakes as recommended by athletes. Consume them in conjunction with your regular diet.

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Note!
Do physical labor and sports as little as possible. These activities consume protein.

Helpful advice
Later serious illnesses increased intake of foods containing protein is recommended.