Objectives

To maintain adequate nutrition To provide relief from symptoms To correct and maintain water and electrolyte balance To provide enough proteins

Dietary modifications Energy: In fevers the basal metabolic rate (BMR) increases, thus enhancing the energy needs. Restlessness also increases the energy expenditure. Therefore, it is recommended to increase the energy intake. But initially, a patient may be able to consume only 1000 1200 kcal/day. But it should be gradually increased with recovery and improved tolerance. Protein: Protein intake should be increased with the use of foods such as milk and eggs. Carbohydrates: A liberal intake of carbohydrates is suggested to meet the increased energy intake. Well cooked, easily digestible carbohydrates like starches, glucose, honey and cane sugar. should be included as they are easily digestedand are well absorbed by the body. Dietary fibre: In typhoid since there is injury to the digestive tract, all forms of irritants and harsh foods should be restricted from the diet. Fats: Fats are required mainly to increase the energy intake. In case diarrhoea is present, fats need to be restricted. It is the quality of fat that is more important than the quantity. Emulsified fats such as butter, cream and milk fat are easily digested. Minerals: There is excessive loss of electrolytes like sodium, potassium and chloride due to increased sweating. Salty soups, broths, fruit juices and milk help compensate the loss. Vitamins: Infection and fevers increase the requirement for vitamin A, B and C. Moreover, the use of antibiotics and drugs interferes with the synthesis of vitamin B in the intestines. So, vitamin supplements may have to be given along with other medicines. Fluids: In order to compensate for the losses through the sweat and also to ensure adequate volume of urine for excreting waste, a liberal intake of fluids is very essential. A daily intake of 34 litres is desirable. Fluids may be taken as water, tea, milk, juices and soups. Sample diet plan Meal Early morning Breakfast Menu Milk / tea in milk Biscuits / rusk Suji porridge / sewian kheer Boiled egg

Mid morning Lunch Evening tea Dinner Bedtime To remember

Paneer sandwich Vegetable khichri Potato raita / plain curd Milk Biscuits / bread butter / bread jam Tomato soup / chicken soup Chapatti / boiled rice Washed moong dal Custard with soft fruits

Small meals should be given at frequent intervals. Sufficient intake of fluids and salt should be ensured. Diet should be bland, low fibre, soft diet (easy to digest and absorbed). As the condition improves larger meals may be given.

Foods to be restricted or avoided

High fibre foods like whole grain cereals and their products, whole pulses and pulses with husk. All raw vegetables and fruits excluding banana and papaya. Fried and fatty foods such as samosas, pakoras, ladoos and halwas. Irritants such as spices, pickles, chutneys and strongly flavoured vegetables like cabbage, capsicum, turnip, radish, onion and garlic.

Foods to be included

Plenty of fluids like juices and soups. Milk and milk based beverages. Low fibre foods such as refined cereals (maida, suji, etc.) and their products, washed pulses, well-cooked vegetables in soft puree form and boiled potatoes. Foods providing proteins such as eggs, soft cheese, paneer, fish and chicken.