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Immunity, Infection, Fever Sepsis: basal + 13% for each 1˚C above normal.
Recommendations for healthy young adults Normal temp: 37.8
o Do not become obese. **if you have a fever of 38.8, sepsis= basal +13%
o Be physically active on a daily basis. **if 39.8, basal + 26%
o Enjoy a wide variety of food. **If 41%, basal + 39%
o Consume a variety of fruits, vegetables, and grain products daily. Energy Requirements
o Choose a diet low in saturated fats and cholesterol. Simple trauma: basal + 20%
o Exercise moderation in salt and sugar consumption. Multiple injuries: basal + 40%
o Drink alcoholic beverages in moderation, if at all and don’t smoke. Burns:basal + 50-100%
o Moderate your protein intake. o Depends on degree of burn
o Maintain an adequate intake of calcium. o Rule of 9
o Do not take unnecessary dietary supplements in excessive Growth and anabolism:
amounts. o Basal + 50 to 100%
o 100% for growth in infancy and adolescence.
Implementation Guidelines **Mean age for adolescence:
o Cook at home as frequent as possible. Philippines: 10-12 yrs old
o Shop fresh foods, unprocessed foods, fish, poultry, and dairy USA: 9-10 yrs old
products. o 50% for the years in between. (2-12 years of age)
o Always read the labels.
o Understand the difference between grams of fat and percentage
of calories from fats. Immunity, Infection, and Fever
o Steam, broil or bake foods. DO NOT FRY! Nutritional deficiency Decreased resistance to infection infection
o Slowly wean yourself from adding salt. aggravates existing malnutrition
o Maintain calcium intake. Nutrient needs are increased during infection by the following
o AVOID fads and “magic bullets”. mechanisms:
1. Stress reaction induces a catabolic response, which increase
MUST KNOW!! losses of nitrogen, magnesium, potassium, phosphate, and zinc.
Estimation of Energy Requirement 2. In severe infection or fever, increased metabolic rate raises
MEMORIZE: BMR=[55-(2x age in years) x wt in kg] energy needs.
The smaller the child, the higher the BMR 3. In anorexia there id a decreased in food intake.
Maintenance: basal+ 20% 4. Nutrition losses may be increased due to increased perspiration,
o Includes specific dynamic action and amount of energy needed for vomiting, and diarrhea.
equilibrium in the resting but awake state with minimal muscular 5. Malabsorption in enteric infection interferes with nutrient
movement. utilization.
MEMORIZE: a. Smaller, younger child – more caloric intake
Activity: basal + 0-25% b. Older – lesser caloric intake
o 0% for comatose state.
o 25% for hospitalized child who ambulates 2-3x a day. Nutritional Considerations
o 50% for active non-hospitalized child. 1. Catabolic effect on CHON metabolism
o Net loss of CHON is from 0.6 to 1,2g/kg body weight/day
Medical Nutrition Prelims Page 1
Diets in Fever and Anemia: Dr.Ramolete November 7, 2013
1mg/day is needed to maintain positive iron balance in childhood. Pallor – seen if hemoglobin falls to 7-8g/dl
<10% of dietary iron is absorbed.
Need 8-10 mg of iron is necessary to maintain iron levels. o Normal Hemoglobin in adults: 12-15 g/dl; 12-14g/dl in Pedia
During infancy – approximately 1mg of iron in bovine milk. o Palmar pallor
Breast milk makes it difficult to maintain body iron – due to rapid growth in o Pallor – palmar crease, nailbeds, conjunctivae
infancy. When hemoglobin drops <5g/dl
Breastfed infants absorbed 2-3 more iron than bovine fed infant. o Irritability, anorexia, lethargy
o Systolic flow murmur (Hemic murmur – secondary to increase in
Etiology: systolic flow)
Infancy – high concentration of hemoglobin of newborn falls during the 1 st Decrease hemoglobin – tachycardia, high output cardiac failure
to 3rd month of life.
Iron is reclaimed and stored for blood formation in the 1 st 6-9 months of **MUST KNOW TABLE!!
life in term infants. IDA Alpha and B Anemia of
o For low birth weight – stores are depleted, thus need for dietary thalassemia chronic disease
stores. Hgb Decreased Decreased Decreased
In term infants – anemia is due to dietary intake deficiency, which occurs MCV Decreased Decreased Normal to
at 9-24 months. decreased
Causes: RDW Decreased Normal Normal to
Intake of bovine milk increased
o Low iron content RBC Decreased Normal to Normal to
Blood loss from milk protein colitis increased decreased
Occult bleeding from: Serum Decreased Normal Increased
o Peptic ulcer diseases (More Common) ferritin
H. pylori infection TIBC Increased Normal Decreased
Amoxicillin Transferrin Decreased Normal Decreased
Clarithromycin saturation
Mebendazole FEP Increased Normal Increased
Metronidazole – taken for 14 days Transferrin Increased Normal Increased
o Meckels diverticulum (More Common) receptor
o Polyp (More Common) Reticulocyte Decreased Normal Normal to
o Hemangioma (More Common) Hgb conc decreased
o Inflammatory bowel disease (More Common)
Infection from: MCV: Mean Corpuscular Volume
o Hookworms, Trichuristrichiuria, Plasmodium, Helicobacter pylori RDW: Red Cell Distribution Width
Adolescent TIBC: Total Iron Binding Capacity
o Menstrual loss FEP: Free erythrocyte Protoporphyrin