What are the optimal dietary recommendations for patients with acute illness?

From the Guidelines

When you're sick, the best approach is to prioritize oral diet over enteral or parenteral nutrition if possible, as recommended by the ESPEN guideline 1. This approach is supported by the most recent and highest quality study, which emphasizes the importance of tailoring nutrition therapy to the individual patient's needs and preferences.

Key Principles

• Hydration is key: Focus on clear broths, soups, and herbal teas to provide essential nutrients and hydration.
• Easy-to-digest foods: Opt for foods like bananas, rice, applesauce, and toast (the BRAT diet) to minimize digestive discomfort.
• Nutrient-dense foods: Include foods rich in vitamin C, such as citrus fruits or berries, to support immune function.
• Probiotics: Consider yogurt with live cultures to help restore gut health, especially after antibiotic use.
• Avoid irritants: Limit or avoid dairy (except yogurt), greasy foods, caffeine, and alcohol, which can exacerbate symptoms or dehydration.

Nutrition Therapy

• Energy and protein targets: Aim for gradual introduction of nutrition therapy, with energy and protein targets tailored to the individual patient's needs, as outlined in the Critical Care review 1.
• Macronutrient composition: Consider the optimal composition of carbohydrates, lipids, and proteins, taking into account the patient's specific requirements and tolerance, as discussed in the Clinical Nutrition guideline 1.

Practical Recommendations

• Small, frequent meals: Divide meals into smaller, more frequent portions to improve tolerance and reduce discomfort.
• Monitor and adjust: Regularly assess the patient's nutritional needs and adjust the nutrition plan accordingly, taking into account their individual response and preferences. By following these principles and recommendations, patients can receive personalized nutrition therapy that supports their recovery and overall well-being, while minimizing the risk of adverse effects or complications 1.

From the Research

Food and Fluid Intake When Sick

When individuals are sick, it is essential to consume the right foods and fluids to help manage symptoms and support recovery. The following are some key points to consider:

• Fluid and electrolyte replacement is crucial, especially for patients experiencing nausea and vomiting 2, 3
• Small, frequent meals can help alleviate symptoms of nausea and vomiting 2
• Avoiding trigger foods is also recommended 2
• In cases of electrolyte imbalances, such as hyponatremia or hypernatremia, specific treatments like infusion of isotonic sodium chloride solution or restriction of fluid intake may be necessary 3

Electrolyte Imbalances and Treatment

Electrolyte imbalances can occur when individuals are sick, and it is vital to address these imbalances promptly. Some key points to consider include:

• The most common form of electrolyte disorder in the emergency room is hyponatremia, which can cause symptoms like nausea, dizziness, and falls 3
• Hyperkalemia can lead to neurological, gastrointestinal, and cardiac symptoms, and treatment may involve calcium injection, glucose with insulin, and high-dose inhalative administration of betamimetics 3
• Maintaining the balance of fluid and electrolytes is crucial, and practitioners must be aware of key monitoring and assessment parameters 4

Management of Nausea and Vomiting

Nausea and vomiting are common symptoms that can be challenging to manage, especially in cases of chronic unexplained nausea and vomiting. Some key points to consider include:

• Nonpharmacologic management options like fluid and electrolyte replacement, small frequent meals, and avoidance of trigger foods can be effective 2
• Antiemetic drugs can reduce symptoms of acute nausea and vomiting, but chronic symptoms may require more targeted treatments 2, 5
• New and improved interventions, such as bioelectrical neuromodulation and complementary medicine, are becoming available for the management of nausea and vomiting 5