Intestinal infections are characterized by a significant effect on the metabolism in the body, when due to the development of vomiting, diarrhea, fever and loss of appetite, significant dehydration of the body occurs, the supply of energy and nutrients decreases. To restore the patient's strength, it is necessary to follow the stages of diet therapy and choose the right products.
Peculiarities of the course of an acute infectious process in the intestine
The infectious process is characterized by an increase in catabolism processes, pronounced metabolic disorders, especially protein, energy, water and electrolyte.
In acute illness, 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.
In acute intestinal infections, 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 patients with acute intestinal infections, 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.
Thus, the most important principle of therapeutic nutrition for infectious diseases is the replenishment of increased energy costs, the full supply of the body with basic nutrients, vitamins and minerals.
Therapeutic nutrition for acute intestinal infections
Acute intestinal infections include diseases that occur with diarrhea syndrome (diarrhea).
Diarrhea is understood as frequent (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 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 fasting 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:
Foods that increase 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, marinades, 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.
Foods that weaken intestinal motility - foods rich in tannin (blueberries, bird cherry, strong tea, cocoa on the water, Cahors), viscous substances (mucous soups, pureed cereals, jelly), warm and hot dishes.
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 suggest that instead of tea, 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 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.
In the diet, the consumption of table salt is reduced to 6-8 g and products that increase intestinal motility, fermentation and putrefaction in it, as well as strong stimulants of other digestive organs. This 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 a patient develops 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 with a laxative effect (boiled beets, dried fruits, vegetable oil, vegetable puree).
According to smed.ru
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