HMT May 22, 2017. Sorry for hijacking your comment but you are the only place there’s a post comment option on my device (??) I’m on high protein/high fat diet. Includes: suggested foods for 1800 calorie diabetic diet plan, tips for success, sample 1800 calorie menu, make smart food choices, and seek help. Looking for the most comprehensive muscle building guide on the internet? Well good thing you stopped by, I’ve got you covered. This guide will take you through. Background The possible advantage for weight loss of a diet that emphasizes protein, fat, or carbohydrates has not been established, and there are few studies that. Dietary factors that influence lipid levels include modification of nutritional components, consumption of specific foods, use of food additives and supplements, and. I have been listening to your talk on the Diet Doctor You Tube video. Thanks so much! I have been vegetarian for 26 years. I was put on the vegetarian diet for my. Dehydration Treatment & Management: Medical Care, Diet, Prevention. Hydration and nutrition are the interventions with the greatest impact on the course of acute diarrhea. Sodium and glucose in the correct proportions can be passively cotransported with fluid from the gut lumen into the circulation. Rapid oral rehydration with the appropriate solution has been shown to be as effective as intravenous fluid therapy in restoring intravascular volume and correcting acidosis. Table 3. Composition of Appropriate Oral Rehydration Solutions (Open Table in a new window)All of the commercially available rehydration fluids are acceptable for oral rehydration therapy (ORT). They contain 2- 3 g/d. L of glucose, 4. 5- 9. Eq/L of sodium, 3. Eq/L of base, and 2. Eq/L of potassium. Osmolality is 2. 00- 3. Osm/L. In children with severe acute malnutrition and diarrhea, low osmolarity oral rehydration solution (ORS) (osmolarity: 2. Eq/L) with added potassium (2. L) appears to be equally effective for successful rehydration as modified World Health Organization–recommended rehydration solution (Re. So. Mal) (osmolarity: 3. Eq/L) but achieves rehydration more quickly. These findings indicate that the low osmolarity ORS may be an option in regions where Re. So. Mal is not available (eg, India). Composition of Inappropriate Oral Rehydration Solutions (Open Table in a new window)Solution. Carbohydrate (g/d. L)Sodium (m. Eq/L)Potassium (m. Eq/L)Base (m. Eq/L)Osmolality. Apple juice. 12. 0. Ginger ale. 93. 5. Milk. 4. 9. 22. 36. Chicken broth. 02. Traditional clear fluids are not appropriate for ORT. Many contain excessive concentrations of CHO and low concentrations of sodium. The inappropriate glucose- to- sodium ratio impairs water absorption, and the large osmotic load creates an osmotic diarrhea, further worsening the degree of dehydration. ORT for mild or moderate dehydration. Mild or moderate dehydration can usually be treated very effectively with ORT. If evidence of bowel obstruction, ileus, or acute abdomen is noted, then intravenous rehydration is indicated. Calculate the fluid deficit. Physical findings consistent with mild dehydration suggest a fluid deficit of 5% of body weight in infants and 3% in children. Moderate dehydration occurs with a fluid deficit of 5- 1. Table 1 and Table 2). The fluid deficit should be replaced over 4 hours. The oral rehydration solution should be administered in small volumes very frequently to minimize gastric distention and reflex vomiting. Generally, 5 m. L of oral rehydration solution every minute is well tolerated. Hourly intake and output should be recorded by the caregiver. As the child becomes rehydrated, vomiting often decreases and larger fluid volumes may be used. If vomiting persists, infusion of oral rehydration solution via a nasogastric tube may be temporarily used to achieve rehydration. Intravenous fluid administration (2. L/kg of isotonic sodium chloride 0. According to a Cochrane systematic review, for every 2. ORT for dehydration, one fails and requires intravenous therapy. The underlying cause of the dehydration must be determined and appropriately treated. Phase 1 focuses on emergency management. Severe dehydration is characterized by a state of hypovolemic shock requiring rapid treatment. Initial management includes placement of an intravenous or intraosseous line and rapid administration of 2. L/kg of an isotonic crystalloid (eg, lactated Ringer solution, 0. Additional fluid boluses may be required depending on the severity of the dehydration. The child should be frequently reassessed to determine the response to treatment. As intravascular volume is replenished, tachycardia, capillary refill, urine output, and mental status all should improve. If improvement is not observed after 6. L/kg of fluid administration, other etiologies of shock (eg, cardiac . Hemodynamic monitoring and inotropic support may be indicated. Phase 2 focuses on deficit replacement, provision of maintenance fluids, and replacement of ongoing losses. Maintenance fluid requirements are equal to measured fluid losses (urine, stool) plus insensible fluid losses. Normal insensible fluid loss is approximately 4. L/m. 2 body surface area and may be increased by factors such as fever and tachypnea. Alternatively, daily maintenance (not including pathologic ongoing loss) fluid requirements may be roughly estimated as follows: Less than 1. L/kg. 1. 0- 2. 0 kg = 1. L/kg for each kg over 1. Greater than 2. 0 kg = 1. L/kg for each kg over 2. Severe dehydration by clinical examination suggests a fluid deficit of 1. The daily maintenance fluid is added to the fluid deficit. In general, the recommended administration is one half of this volume administered over 8 hours and administration of the remainder over the following 1. Continued losses (eg, emesis, diarrhea) must be promptly replaced. If the child is isonatremic (1. Eq/L), the sodium deficit incurred can generally be corrected by administering the fluid deficit plus maintenance as 5% dextrose in 0. Potassium (2. 0 m. Eq/L potassium chloride) may be added to maintenance fluid once urine output is established and serum potassium levels are within a safe range. An alternative approach to the deficit therapy approach is rapid replacement therapy. With this approach, a child with severe isonatremic dehydration is administered 2. L/kg of isotonic sodium chloride solution or lactated Ringer solution over 1. As perfusion is restored, the child improves and is able to tolerate an oral rehydration solution for the remainder of his rehydration. This approach is not appropriate for hypernatremic or hyponatremic dehydration. Hyponatremic dehydration. Phase 1 management of hyponatremic dehydration is identical to that of isonatremic dehydration. Rapid volume expansion with 2. L/kg of isotonic (0. Ringer solution should be administered and repeated until perfusion is restored. Severe hyponatremia (< 1. Eq/L) indicates additional sodium loss. In phase 2 management, rehydration is calculated as for isonatremic dehydration. The additional sodium deficit must be calculated and added to the rehydration fluids. The deficit may be calculated to restore the sodium to 1. Eq/L and administered over 4. Sodium deficit = (sodium desired - sodium actual) X volume of distribution X weight (kg). Example: Sodium = 1. Sodium deficit = (1. X 0. 6 X 1. 0 kg = 4. Eq sodium. A simplified approach is to use 5% dextrose in 0. The sodium is closely monitored, and the amount of sodium in the fluid is adjusted to maintain a slow correction (about < 0. Eq/L/h, with a correction goal of 8 m. Eq/L over 2. 4 hours). Frequently reassessing the serum sodium level during correction is imperative. Rapid correction of chronic hyponatremia (> 2 m. Eq/L/h) has been associated with central pontine myelinolysis. Rapid partial correction of symptomatic hyponatremia has not been associated with adverse effects. Therefore, if the child is symptomatic (seizures), a more rapid partial correction is indicated. Hypertonic (3%) sodium chloride solution (0. Eq/m. L) may be used for rapid partial correction of symptomatic hyponatremia. A bolus dose of 4 m. L/kg raises the serum sodium by 3- 4 m. Eq/L. Hypernatremic dehydration. Phase 1 management of hypernatremic dehydration is identical to that of isonatremic dehydration. Rapid volume expansion with 2. L/kg of isotonic sodium chloride solution or lactated Ringer solution should be administered and repeated until perfusion is restored. Varied regimens may be successfully followed to achieve correction of severe hypernatremia (> 1. Eq/L). In phase 2 management, the most important goal is to reestablish intravascular volume and return serum sodium levels toward the reference range by not more than 1. Eq/L/2. 4h. Rapid correction of hypernatremic dehydration can have disastrous neurologic consequences, including cerebral edema and death. The most cautious approach is to plan a slow correction of the fluid deficit over 4. Following adequate intravascular volume expansion, rehydration fluids should be initiated with 5% dextrose in 0. Serum sodium levels should be assessed every 4 hours. If the sodium has decreased by less than 0. Eq/L/h, then the sodium content of the rehydration fluid is decreased. This allows for a slow controlled correction of the hypernatremic state. Hyperglycemia and hypocalcemia are sometimes associated with hypernatremic dehydration. Serum glucose and calcium levels should be closely monitored. Pharmacologic management. Note the following: Antidiarrheal agents are not recommended because of a high incidence of side effects including lethargy, respiratory depression, and coma.
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