Search "village girl with her grandfather eating soup" (2024)

Showing results for village girl with her grandfather eating soup

Patient education: Low-sodium diet (Beyond the Basics)

ClosePatient education: Low-sodium diet (Beyond the Basics)Patient education: Low-sodium diet (Beyond the Basics)Author:Barbara Olendzki, RD, MPH, LDN Section Editors:George L Bakris, MDMark D Aronson, MD Deputy Editor:John P Forman, MD, MScl*terature review current through: Nov 2022. | This topic last updated: Jun 15, 2021.Please read the Disclaimer at the end of this page.LOW-SODIUM DIET OVERVIEW — Sodium is an element that is naturally found in many foods. The body requires a small amount of sodium in the diet to control blood pressure and blood volume. However, most people consume many times the amount of sodium needed. A healthy level of sodium in the diet contains fewer than 2.3 grams (2300 milligrams, or about the amount of sodium in one teaspoon) of sodium each day. People with certain medical conditions such as high blood pressure, kidney disease, and heart problems can benefit from a diet that is lower in sodium.This topic will review how to read food labels, how to choose foods that are lower in sodium, and how to consume foods with less salt.WHY SHOULD I REDUCE SODIUM IN MY DIET? — Reducing sodium intake lowers blood pressure in people with high and borderline high blood pressure. Reducing sodium can also help to prevent the collection of fluid in the lower legs or abdomen. People with chronic kidney disease and heart failure must control sodium intake to prevent volume overload, which increases blood pressure and causes swelling. (See"Patient education: Chronic kidney disease (Beyond the Basics)" and"Patient education: Heart failure (Beyond the Basics)".)Switching from a higher-sodium diet to a lower-sodium diet can modestly reduce blood pressure in people who have normal blood pressure. When the sodium intake is lowered from 4000 to 2000 mg per day, blood pressure falls by 2 to 3 mmHg. This reduction may be as great as 10 mmHg over several years and can substantially lower the risk of heart disease.Benefits — In addition to directly reducing blood pressure, a lower sodium intake may also enhance the effectiveness of high blood pressure medications and other non-drug treatments, such as weight loss. A lower sodium intake has also been associated with other health benefits, including a reduced risk of dying from a stroke, reversal of heart enlargement, and a reduced risk of kidney stones and osteoporosis . (See"Patient education: Kidney stones in adults (Beyond the Basics)" and"Patient education: Osteoporosis prevention and treatment (Beyond the Basics)".)WHERE IS SODIUM FOUND? — The main sources of sodium in the diet are processed foods, restaurant prepared foods, and salt added to food at the table. Processed foods include prepared frozen meals, canned foods, soups, pickled foods, snack foods, lunch meats, cheese, condiments, sauces, dressings, breads, and cereals, just to name a few. Sodium found in processed food accounts for approximately 80 percent of a person's daily sodium intake in a typical Western diet and can quickly add up, even without adding more salt to meals.Terms like "low sodium" and "reduced sodium" can be confusing. The following table provides a guide to what these terms mean (table 1).Guidelines — Several professional organizations have issued evidence-based guidelines for reducing sodium intake. Most clinicians agree that people with high blood pressure should consume less than 2300 milligrams (2.3 grams) of sodium per day. People with other conditions may be advised to consume even less (1500 to 1800 mg per day).The sodium content of packaged, processed, and prepared foods can usually be determined by reading food labels (figure 1) or consulting a reference book. Many websites and mobile applications (“apps”) also provide nutrient data (eg, www.nutrition.gov), and low-sodium cookbooks are available.It is important to remember that the amount of sodium listed is for a particular serving size; eating more or less than the listed serving size changes the amount of sodium consumed. In addition, many people add more salt to foods; just one teaspoon of table salt contains approximately 2300 milligrams of sodium, which is more than many people need for the entire day. Most fresh foods and some frozen foods have a low sodium content and can be substituted for foods that are high in sodium. Reading labels, when provided, can be extremely helpful.HOW DO I CUT DOWN ON SODIUM? — Although it is difficult initially to cut back on the amount of sodium in the diet, most people find that their taste adjusts quickly to reduced sodium. Salt is an acquired taste, and taste can be retrained in 10 to 14 days if people stick with the lower-sodium diet. Fresh herbs, spice blends without sodium, citrus, and flavored vinegar make tasty alternatives to the salt shaker.It may be helpful to keep a detailed food record and add up sodium intake. Within a short period of time (less than a week), the main sources of sodium can be identified and daily intake can be calculated.Suggestions to decrease sodium include the following:●Be aware that you may experience a perceived decrease in food flavor in the beginning, but other pleasurable tastes and flavors will emerge within two weeks.●Consider cutting back further on the sodium in your meals to allow for the sodium in your snacks. Many online food tracking apps can help you achieve this goal.●Put away the salt shaker and reduce or eliminate salt used in cooking. Experiment with adding flavor with herbs, spices, garlic, onions, or lemon instead.●Look for low-sodium products such as spice blends and read labels for serving size and sodium content on canned, bottled, and frozen foods.●Make a list of healthy low-sodium foods to substitute. Many grocery stores now supply this information.●When dining out, request that the food be prepared without salt, ask for dressings or sauces to be put on the side, and avoid bacon bits, cheese, and croutons at the salad bar.●Do not add salt to your food before eating. Teach family members to taste food before adding salt.●Avoid fast food. If this is not possible, choose restaurants that offer fruits or vegetables without sauces or dressings. Ask that no salt be used to prepare food, when possible.●Do not use salt substitutes that are high in potassium unless a health care provider tells you to do this. Herb and spice combinations that are salt-free are widely available and can be used to flavor foods.●Water softeners remove calcium and add sodium to drinking water. Do not drink softened water. When purchasing bottled water, check the label to ensure that it does not contain sodium.●Look at labels for over-the-counter medications. Avoid products that contain sodium carbonate or sodium bicarbonate. (Sodium bicarbonate is another name for baking soda.)●Fresh fruits and vegetables are naturally low in sodium. In addition, a diet rich in fruits and vegetables provides additional benefits in lowering blood pressure. The DASH diet (Dietary Approaches to Stop Hypertension) is a well-known intervention to treat high blood pressure. The DASH diet requires the person to eat four to five servings of fruit, four to five servings of vegetables, and two to three servings of low-fat dairy, and all foods must contain less than 25 percent total fat per serving.Foods to choose — The following are examples of foods that may be lower in sodium. It is essential, however, to check the labels to determine the actual amount of sodium present (figure 1), as amounts can vary widely from one brand to another.●Breads – Whole-grain breads, English muffins, bagels, corn and flour tortillas, biscuits, most muffins ●Cereals – Many cooked low-salt (read the label to determine sodium content) hot cereals (not instant) such as oatmeal, cream of wheat, rice, or farina, puffed wheat, puffed rice, shredded wheat●Crackers and snack foods – All unsalted crackers and snack foods, unsalted peanut butter, unsalted nuts or seeds, unsalted popcorn●Pasta, rice, and potatoes – Any type of pasta (cooked in unsalted water), potatoes, white or brown rice●Dried peas and beans – Any cooked dried beans or peas (without seasoning packet), or low-salt canned beans and peas●Meats and protein – Fresh or frozen beef, poultry, and fish; low-sodium canned tuna and salmon; eggs or egg substitutes●Fruits and vegetables – Any fresh, frozen, or canned fruit, any fresh or frozen vegetables without sauce, canned vegetables without salt, low-salt tomato sauce/paste●Dairy products – Milk, cream, sour cream, non-dairy creamer, yogurt (be sure to read labels for serving size)●Fats and oils – Plant oils (olive, canola, corn, peanut), unsalted butter or margarine●Soups – Salt-free soups and low-sodium bouillon cubes, unsalted broth, homemade soup without added salt●Sweets – Gelatin, sherbet, pudding, ice cream, some baked goods, sugar, honey, jam, jelly, marmalade, syrup●Beverages – Coffee, tea, soft drinks, fruit-flavored drinks, low-salt tomato juice, any fruit juice●Condiments – Fresh and dried herbs; lemon juice; low-salt mustard (not commercially available but can be made at home), vinegar, and "hot" sauce; low- or no-salt ketchup; seasoning blends that do not contain saltFoods to avoid — Many foods, especially those that are processed, have a high sodium content. Items that can be substituted for high-sodium foods are listed in the following table (table 2).●Breads – Biscuits, prepared mixes (pancake, muffin, cornbread), instant hot cereals, many boxed cold cereals, self-rising flour●Crackers and snack foods – Salted crackers and snack items (chips, pretzels, popcorn), regular peanut butter, prepared dips/spreads, salted nuts or seeds●Pasta, rice, and potatoes (processed or from restaurants) – Macaroni and cheese mix; rice, noodle, or spaghetti mixes; canned spaghetti; frozen lasagna; instant potatoes; seasoned potato mixes●Beans and peas – Beans or peas prepared with ham, bacon, salt pork, or bacon grease; most canned beans and peas unless labeled as low-sodium●Meats and proteins – Salted, smoked, canned, spiced, and cured meat, poultry, or fish; many deli meats and poultry, unless stated to be low salt; bacon; ham; sausage; lunch meats; hot dogs; breaded frozen meat, fish, or poultry; frozen dinners and other frozen meals; pizza●Fruits and vegetables – Regular canned vegetables and vegetable juices, regular tomato sauce and tomato paste, olives, pickles, relishes, sauerkraut, frozen vegetables in butter or sauces, crystallized and glazed fruit, maraschino cherries, fruit dried with sodium sulfite●Dairy products – Buttermilk, Dutch-processed chocolate milk, processed cheese slices and spreads, most cottage cheese, aged or natural cheeses●Fats and oils – Prepared salad dressings, bacon, salt pork, fatback, salted butter or margarine●Soups – Regular canned or prepared soups, stews, broths, or bouillon; packaged and frozen soups●Desserts – Packaged baked goods●Beverages – Softened water; carbonated beverages with sodium or salt added; regular tomato or vegetable juice; some alcoholic beverages (variable sodium content)●Sauces, dressings, and condiments –Table salt, lite salt, bouillon cubes, meat extract, taco seasoning, Worcestershire sauce, tartar sauce, ketchup, tomato and chili sauces, cooking sherry and wine, onion salt, mustard, garlic salt, soy sauce, tamari, meat flavoring or tenderizer, steak and barbecue sauces, seasoned salt, monosodium glutamate (MSG), Dutch-processed cocoa, many salad dressingsWHERE TO GET MORE INFORMATION — Your healthcare provider is the best source of information for questions and concerns related to your medical problem.This article will be updated as needed on our web site (www.uptodate.com/patients). Related topics for patients, as well as selected articles written for healthcare professionals, are also available. Some of the most relevant are listed below.Patient level information — UpToDate offers two types of patient education materials.The Basics — The Basics patient education pieces answer the four or five key questions a patient might have about a given condition. These articles are best for patients who want a general overview and who prefer short, easy-to-read materials. Patient education: Low-sodium diet (The Basics) Patient education: Chronic kidney disease (The Basics) Patient education: Swelling (The Basics) Patient education: High blood pressure in children (The Basics) Patient education: Diabetes and diet (The Basics) Patient education: Medicines for heart failure with reduced ejection fraction (The Basics) Patient education: Hemodialysis (The Basics) Patient education: Preparing for hemodialysis (The Basics) Patient education: Peritoneal dialysis (The Basics) Patient education: Dialysis and diet (The Basics) Patient education: High blood pressure emergencies (The Basics) Patient education: Diabetes insipidus (The Basics) Patient education: When your lungs fill with fluid (The Basics) Patient education: Medicines for chronic kidney disease (The Basics)Beyond the Basics — Beyond the Basics patient education pieces are longer, more sophisticated, and more detailed. These articles are best for patients who want in-depth information and are comfortable with some medical jargon. Patient education: Chronic kidney disease (Beyond the Basics) Patient education: Heart failure (Beyond the Basics) Patient education: Kidney stones in adults (Beyond the Basics) Patient education: Osteoporosis prevention and treatment (Beyond the Basics)Professional level information — Professional level articles are designed to keep doctors and other health professionals up-to-date on the latest medical findings. These articles are thorough, long, and complex, and they contain multiple references to the research on which they are based. Professional level articles are best for people who are comfortable with a lot of medical terminology and who want to read the same materials their doctors are reading. Diet in the treatment and prevention of hypertension Salt intake, salt restriction, and primary (essential) hypertensionThe following organizations also provide reliable health information.●Medline Plus(www.nlm.nih.gov/medlineplus/ency/article/002415.htm, available in Spanish)●American Heart Association(www.heart.org/HEARTORG/Conditions/HighBloodPressure/PreventionTreatmentofHighBloodPressure/Shaking-the-Salt-Habit_UCM_303241_Article.jsp)●National Kidney Foundation(https://www.kidney.org/news/kidneyCare/spring10/WithoutSalt)●US Food and Drug Administration (FDA):(https://www.fda.gov/Food/ResourcesForYou/Consumers/ucm315393.htm)●2015 to 2020 Dietary Guidelines for Americans(https://health.gov/dietaryguidelines/2015/guidelines/)ACKNOWLEDGMENT — The editorial staff at UpToDate would like to acknowledge Norman M Kaplan, MD, who contributed to an earlier version of this topic review.This generalized information is a limited summary of diagnosis, treatment, and/or medication information. It is not meant to be comprehensive and should be used as a tool to help the user understand and/or assess potential diagnostic and treatment options. It does NOT include all information about conditions, treatments, medications, side effects, or risks that may apply to a specific patient. It is not intended to be medical advice or a substitute for the medical advice, diagnosis, or treatment of a health care provider based on the health care provider's examination and assessment of a patient's specific and unique circ*mstances. Patients must speak with a health care provider for complete information about their health, medical questions, and treatment options, including any risks or benefits regarding use of medications. This information does not endorse any treatments or medications as safe, effective, or approved for treating a specific patient. UpToDate, Inc. and its affiliates disclaim any warranty or liability relating to this information or the use thereof.The use of this information is governed by the Terms of Use, available at https://www.wolterskluwer.com/en/know/clinical-effectiveness-terms ©2023 UpToDate, Inc. and its affiliates and/or licensors. All rights reserved.Topic 4411 Version 25.0

Patient education: Acute diarrhea in adults (Beyond the Basics)

ClosePatient education: Acute diarrhea in adults (Beyond the Basics)Patient education: Acute diarrhea in adults (Beyond the Basics)Authors:Regina LaRocque, MD, MPHJason B Harris, MD, MPH Section Editor:Stephen B Calderwood, MD Deputy Editor:Elinor L Baron, MD, DTMHLiterature review current through: Nov 2022. | This topic last updated: May 24, 2022.Please read the Disclaimer at the end of this page.DIARRHEA OVERVIEW — Diarrhea is commonly defined as three or more loose or watery stools per day. Nearly everyone will have an episode of diarrhea at some point during their life, with the average adult experiencing it four times per year. Although most cases of diarrhea resolve within a few days without treatment, it's important to know when to seek help.This topic review discusses the causes and treatments of sudden onset (acute) diarrhea in adults in developed countries. A discussion of acute diarrhea in resource-limited countries and returning travelers is not included here. Diarrhea that lasts for more than 14 days (called chronic diarrhea) and acute diarrhea in children are discussed in separate topic reviews. (See"Patient education: Chronic diarrhea in adults (Beyond the Basics)" and"Patient education: Acute diarrhea in children (Beyond the Basics)".) A topic review that discusses antibiotic-associated diarrhea is also available. (See"Patient education: Antibiotic-associated diarrhea caused by Clostridioides difficile (Beyond the Basics)".)DIARRHEA CAUSES — Diarrhea can be caused by infections or a variety of other factors. The cause of diarrhea is not identified in most people, especially those who improve without treatment.Diarrhea caused by infections usually results from eating or drinking contaminated food or water. Signs and symptoms of infection usually begin 12 hours to four days after exposure and resolve within three to seven days. (See"Patient education: Foodborne illness (food poisoning) (Beyond the Basics)".)Diarrhea not related to an infection can occur as a side effect of antibiotics or other drugs, food allergies, gastrointestinal diseases such as inflammatory bowel disease, and other diseases. In addition, there are many less common causes of diarrhea. A summary of the various common causes of diarrhea is available in the table (table 1).DIARRHEA SYMPTOMS — A person with diarrhea may be mildly to severely ill. A person who has mild illness may have a few loose bowel movements but otherwise feels well. By contrast, a person with severe diarrhea may have 20 or more bowel movements per day, happening up to every 20 or 30 minutes. In this situation, a significant amount of water and salts can be lost, seriously increasing the risk of dehydration. Diarrhea may be accompanied by fever (temperature greater than 100.4°F or 38°C), abdominal pain, or cramping.DIARRHEA HOME CAREDrink adequate fluids — If you have mild to moderate diarrhea, you can usually be treated at home by drinking extra fluids. The fluids should contain water, salt, and sugar. Oral rehydration solution (ORS), a specific mixture of glucose and sodium, is the best first-line treatment and is available in over-the-counter commercial preparations. Sports drinks (eg, Gatorade) are not optimal for fluid replacement, although they may be sufficient for a person with diarrhea who is not dehydrated and is otherwise healthy. Diluted fruit juices and flavored soft drinks along with salted crackers and broths or soups may also be acceptable.One way to judge hydration is by looking at the color of your urine and monitoring how frequently you urinate. If you urinate infrequently or have urine that is dark yellow, you should drink more fluids. Normally, urine should be light yellow to nearly colorless. If you are well hydrated, you normally pass urine every three to five hours.If you become dehydrated and are unable to take fluids by mouth, a rehydration solution can be given into a vein (intravenous fluids) in a health care provider's office or in the emergency department.Diet — There is no particular food or group of foods that is best while you have diarrhea. However, adequate nutrition is important during an episode of acute diarrhea. If you do not have an appetite, you can drink only liquids for a short period of time. Boiled starches and cereals (eg, potatoes, noodles, rice, wheat, and oats) with salt are recommended if you have watery diarrhea; crackers, bananas, soup, and boiled vegetables may also be eaten.Antidiarrheal medications — Medications to reduce diarrhea are available, and are safe if there is no fever (temperature greater than 100.4°F or 38°C) and the stools are not bloody. These medications do not cure the cause of the diarrhea, but help to reduce the frequency of bowel movements.●Loperamide (Imodium®) is available without a prescription; the dose is two tablets (4 mg) initially, then 1 tablet (2 mg) after each unformed stool. No more than 16 mg is recommended per day. If you take loperamide, be careful to never exceed the dose on the label unless specifically instructed by your doctor. Taking more than the recommended dose has led to serious heart problems in some people.●Diphenoxylate-atropine (Lomotil®) is a prescription medication used to treat diarrhea; its benefit is similar to loperamide, although it can be associated with more bothersome side effects.●Bismuth subsalicylate (Pepto-Bismol®, Kaopectate®) has also been used for treatment of acute diarrhea, although it is not as effective as loperamide. Bismuth subsalicylate may be recommended in certain situations, such as if you have fever and bloody diarrhea. However, women who are pregnant should not take bismuth subsalicylate. The dose of bismuth subsalicylate is 30 mL or two tablets every 30 minutes for up to eight doses.Antibiotics — Antibiotics are not needed in most cases of acute diarrhea, and they can cause further complications if used inappropriately. Antibiotics may be recommended in certain situations, such as if you have the following signs or symptoms:●More than eight loose stools per day ●Fever●Bloody stool●Dehydration●Symptoms that continue for more than one week●A weakened immune system●You require hospitalizationHowever, the decision to use antibiotics must be made carefully after discussing the potential risks and benefits with a health care provider who is familiar with the situation.Preventing spread — Adults with diarrhea should be cautious to avoid spreading infection to family, friends, and co-workers. You are considered infectious for as long as diarrhea continues. Microorganisms causing diarrhea are spread from hand to mouth; hand washing, care with diapering, and staying out of work or school are a few ways to prevent infecting family and other contacts.Hand washing — Hand washing is an effective way to prevent the spread of infection. Hands should ideally be wet with water and plain or antibacterial soap and rubbed together for 15 to 30 seconds. Pay special attention to the fingernails, between the fingers, and the wrists. Rinse your hands thoroughly and dry with a single use towel.If a sink is not available, alcohol-based hand rubs are a good alternative for disinfecting hands. Spread the hand rub over the entire surface of your hands, fingers, and wrists until dry. Hand rubs may be used several times. Hand rubs are available as a liquid or wipe in small, portable sizes that are easy to carry in a pocket or handbag. When a sink is available and your hands are visibly dirty, it is best to wash them with soap and water.Clean your hands after changing a diaper, before and after preparing food and eating, after going to the bathroom, after handling garbage or dirty laundry, after touching animals or pets, and after blowing your nose or sneezing.DIARRHEA PREVENTIONFood safety — The following precautions have been recommended for all consumers by the Food Safety and Inspection Services (www.fsis.usda.gov) and the Centers for Disease Control and Prevention.●Do not drink raw (unpasteurized) milk or foods that contain unpasteurized milk.●Wash raw fruits and vegetables thoroughly before eating.●Keep the refrigerator temperature at 40°F (4.4°C) or lower; the freezer at 0°F (-17.8°C) or lower.●Eat precooked, perishable, or ready-to-eat food as soon as possible.●Keep raw meat, fish, and poultry separate from other food.●Wash hands, knives, and cutting boards after handling uncooked food, including produce and raw meat, fish, or poultry.●Thoroughly cook raw food from animal sources to a safe internal temperature: ground beef 160°F (71°C); chicken 170°F (77°C); turkey 180°F (82°C); pork 145°F (63°C) with a three minute rest time.●Seafood should be cooked thoroughly to minimize the risk of food poisoning. Eating raw fish (eg, sushi) poses a risk for a variety of parasitic worms (in addition to the risks associated with organisms carried by food handlers). Freezing kills some, although not all, harmful microorganisms. Raw fish that is labeled "sushi-grade" or "sashimi-grade" has been frozen.●Cook chicken eggs thoroughly, until the yolk is firm.●Refrigerate foods promptly. Never leave cooked foods at room temperature for more than two hours (one hour if the room temperature is above 90°F/32°C).Food safety for pregnant women or those with a weakened immune system — The following additional recommendations apply to pregnant women and those who have a weakened immune system:●Do not eat hot dogs, pâtés, luncheon meats, bologna, or other delicatessen meats unless they are reheated until steaming hot; avoid the use of microwave ovens since uneven cooking may occur.●Avoid spilling fluids from raw meat and hot dog packages on other foods, utensils, and food preparation surfaces. In addition, wash your hands after handling hot dogs, luncheon meats, delicatessen meats, and raw meat, chicken, turkey, or seafood or their juices.●Do not eat pre-prepared salads, such as ham salad, chicken salad, egg salad, tuna salad, or seafood salad.●Do not eat soft cheeses such as feta, Brie, and Camembert, blue-veined cheeses, or Mexican-style cheeses such as queso blanco, queso fresco, or Panela, unless they have a label that clearly states that the cheese is made from pasteurized milk.●Do not eat refrigerated pates or meat spreads. Canned or shelf-stable products may be eaten.●Do not eat refrigerated smoked seafood unless it has been cooked. Refrigerated smoked seafood, such as salmon, trout, whitefish, cod, tuna or mackerel, is most often labeled as "nova-style," "lox," "kippered," "smoked," or "jerky." The fish is found in the refrigerator section or sold at deli counters of grocery stores and delicatessens. Canned or shelf-stable smoked seafood may be eaten.Travelers' diarrhea prevention — Recommendations to prevent travelers' diarrhea are available separately. (See"Patient education: General travel advice (Beyond the Basics)".)WHEN TO SEEK HELP FOR DIARRHEA — If your diarrhea is not severe, you do not always need to be seen by a doctor, especially if the diarrhea begins to improve within 48 hours. Self-care measures for this situation are discussed above (see 'Diarrhea home care' above).However, if you have one or more of the following signs or symptoms, you should be evaluated by a health care provider:●Profuse watery diarrhea with signs of dehydration. Early features of dehydration include sluggishness, becoming tired easily, dry mouth and tongue, thirst, muscle cramps, dark-colored urine, urinating infrequently, and dizziness or lightheadedness after standing or sitting up. More severe features include abdominal pain, chest pain, confusion, or difficulty remaining alert.●Many small stools containing blood and mucus●Bloody or black diarrhea●Temperature ≥38.5°C (101.3°F)●Passage of ≥6 unformed stools per 24 hours or illness that lasts more than 48 hours●Severe abdominal pain/painful passage of stoolIn addition, if you have persistent diarrhea following antibiotics, are older than 65 years, have other medical illness or a weakened immune system, you should also consult your health care provider.SUMMARY●Acute diarrhea is defined as three or more loose or watery stools per day.●Diarrhea can be caused by infections or other factors. Sometimes, the cause of diarrhea is not known. Diarrhea caused by an infection usually begins 12 hours to four days after exposure and resolves within three to seven days.●A person may have mild to severe diarrhea. Some people with diarrhea also have fever (temperature greater than 100.4°F or 38°C), abdominal pain, or cramping.●People with mild diarrhea do not usually need to go to the doctor, especially if the diarrhea begins to improve within 48 hours. If you develop any of the following, you should call your doctor or nurse immediately:•Profuse watery diarrhea with sluggishness, becoming tired easily, dry mouth and tongue, thirst, muscle cramps, dark-colored urine, urinating infrequently, and dizziness or lightheadedness after standing or sitting up. More severe features include abdominal pain, chest pain, confusion, or difficulty remaining alert.•Passage of many small stools containing blood and mucus•Bloody or black diarrhea•Temperature ≥38.5°C (101.3°F)•Passing 6 or more watery stools per 24 hours or illness that lasts more than 48 hours•Severe abdominal pain●In addition, if you have persistent diarrhea after finishing antibiotics, are older than 69, or have other medical illness or a weakened immune system, you should also consult your doctor or nurse.●The most important treatment for diarrhea is to drink fluids that contain water, salt, and sugar, such as oral rehydration solution (ORS). Sports drinks (eg, Gatorade) may be acceptable if you are not dehydrated and are otherwise healthy. Diluted fruit juices and flavored soft drinks along with saltine crackers and broths or soups may also be acceptable.●If you have dark yellow colored urine or do not pass urine frequently, you should drink more fluids. The urine should normally be light yellow to clear colored.●Medications to reduce diarrhea are available without a prescription, and are safe if there is no fever (temperature greater than 100.4°F or 38°C) and the stools are not bloody. These medications do not cure the cause of the diarrhea, but help to reduce the frequency of bowel movements. Common medications include loperamide (Imodium®), diphenoxylate-atropine (Lomotil®), and bismuth subsalicylate (Pepto-Bismol® or Kaopectate®).●If you do not have an appetite, you can drink only liquids for a short period of time. Boiled starches and cereals (eg, potatoes, noodles, rice, wheat, and oat) with salt are recommended if you have watery diarrhea; crackers, bananas, soup, and boiled vegetables may also be eaten.●Antibiotics are not needed for most people with diarrhea.●If you have diarrhea, be careful to avoid spreading the infection to family, friends, and co-workers. You are contagious for as long as diarrhea continues. Infections are usually spread from hand to mouth; hand washing, care with diapering, and staying out of work or school are a few ways to prevent infecting family and other contacts.WHERE TO GET MORE INFORMATION — Your health care provider is the best source of information for questions and concerns related to your medical problem.This article will be updated as needed on our web site (www.uptodate.com/patients). Related topics for patients, as well as selected articles written for health care professionals, are also available. Some of the most relevant are listed below.Patient level information — UpToDate offers two types of patient education materials.The Basics — The Basics patient education pieces answer the four or five key questions a patient might have about a given condition. These articles are best for patients who want a general overview and who prefer short, easy-to-read materials. Patient education: Diarrhea in adolescents and adults (The Basics) Patient education: Diarrhea in children (The Basics) Patient education: Food poisoning (The Basics) Patient education: Lactose intolerance (The Basics) Patient education: C. difficile infection (The Basics) Patient education: Managing loss of appetite and weight loss with cancer (The Basics) Patient education: Dehydration in children (The Basics) Patient education: Ischemic bowel disease (The Basics) Patient education: Cryptosporidiosis (The Basics) Patient education: Salmonella infection (The Basics) Patient education: Travelers' diarrhea (The Basics) Patient education: E. coli diarrhea (The Basics) Patient education: Listeria (The Basics) Patient education: Campylobacter infection (The Basics)Beyond the Basics — Beyond the Basics patient education pieces are longer, more sophisticated, and more detailed. These articles are best for patients who want in-depth information and are comfortable with some medical jargon. Patient education: Chronic diarrhea in adults (Beyond the Basics) Patient education: Acute diarrhea in children (Beyond the Basics) Patient education: Antibiotic-associated diarrhea caused by Clostridioides difficile (Beyond the Basics) Patient education: Foodborne illness (food poisoning) (Beyond the Basics) Patient education: General travel advice (Beyond the Basics)Professional level information — Professional level articles are designed to keep doctors and other health professionals up-to-date on the latest medical findings. These articles are thorough, long, and complex, and they contain multiple references to the research on which they are based. Professional level articles are best for people who are comfortable with a lot of medical terminology and who want to read the same materials their doctors are reading. Approach to the adult with acute diarrhea in resource-rich settings Clinical manifestations, diagnosis, and treatment of Campylobacter infection Clostridioides difficile infection in adults: Clinical manifestations and diagnosis Shigella infection: Clinical manifestations and diagnosis Shiga toxin-producing Escherichia coli: Clinical manifestations, diagnosis, and treatment Clinical manifestations and diagnosis of rotavirus infection Cryptosporidiosis: Epidemiology, clinical manifestations, and diagnosis Pathogenic Escherichia coli associated with diarrhea Causes of acute infectious diarrhea and other foodborne illnesses in resource-rich settings Norovirus Cholera: Clinical features, diagnosis, treatment, and prevention Acute viral gastroenteritis in adultsThe following organizations also provide reliable health information.●National Library of Medicine(www.nlm.nih.gov/medlineplus/healthtopics.html)●National Institute of Digestive and Diabetes and Kidney Diseases(www.niddk.nih.gov/health-information/digestive-diseases/diarrhea)●Center for Disease Control and Prevention(www.cdc.gov)●American College of Gastroenterology(www.acg.gi.org/patients/gihealth/diarrheal.asp)[1-3]Shane AL, Mody RK, Crump JA, et al. 2017 Infectious Diseases Society of America Clinical Practice Guidelines for the Diagnosis and Management of Infectious Diarrhea. Clin Infect Dis 2017; 65:e45.Riddle MS, DuPont HL, Connor BA. ACG Clinical Guideline: Diagnosis, Treatment, and Prevention of Acute Diarrheal Infections in Adults. Am J Gastroenterol 2016; 111:602.DuPont HL. Acute infectious diarrhea in immunocompetent adults. N Engl J Med 2014; 370:1532.This generalized information is a limited summary of diagnosis, treatment, and/or medication information. It is not meant to be comprehensive and should be used as a tool to help the user understand and/or assess potential diagnostic and treatment options. It does NOT include all information about conditions, treatments, medications, side effects, or risks that may apply to a specific patient. It is not intended to be medical advice or a substitute for the medical advice, diagnosis, or treatment of a health care provider based on the health care provider's examination and assessment of a patient's specific and unique circ*mstances. Patients must speak with a health care provider for complete information about their health, medical questions, and treatment options, including any risks or benefits regarding use of medications. This information does not endorse any treatments or medications as safe, effective, or approved for treating a specific patient. UpToDate, Inc. and its affiliates disclaim any warranty or liability relating to this information or the use thereof.The use of this information is governed by the Terms of Use, available at https://www.wolterskluwer.com/en/know/clinical-effectiveness-terms ©2023 UpToDate, Inc. and its affiliates and/or licensors. All rights reserved.Topic 4021 Version 32.0References1 : 2017 Infectious Diseases Society of America Clinical Practice Guidelines for the Diagnosis and Management of Infectious Diarrhea.2 : ACG Clinical Guideline: Diagnosis, Treatment, and Prevention of Acute Diarrheal Infections in Adults.3 : Acute infectious diarrhea in immunocompetent adults.

Diet during therapeutic use of monoamine oxidase inhibitors

CloseDiet during therapeutic use of monoamine oxidase inhibitorsDiet during therapeutic use of monoamine oxidase inhibitors Food Allowed (not allowed if spoiled or improperly stored)* Minimize intake¶ Not allowed Beverages Decaffeinated beverages (eg, coffee, tea, soda); milkCaffeine-containing drinks Clear alcoholic spirits (eg, gin, vodka, rum) Red or white wine (no more than two 4-ounce servings per day) Bottled/canned beer, including nonalcoholic (no more than two 12-ounce servings per day) Soy milk Tap (draft) beer, Korean beer, vermouth Breads, cereals, crackers Commercial yeast breads, hot and cold cereals, most crackers (ie, containing no aged cheese) None Sourdough bread; crackers and breads that contain aged cheese Dairy, eggs, cheeses Butter, cottage cheese, eggs, farmers or pot cheese, cream cheese, ricotta cheese, pasteurized milk, pasteurized cream, ice cream, pudding, yogurt American processed cheese, mozzarella, parmesan, Romano, sour cream (limit these to one serving of ½ cup) All aged cheeses are absolutely not allowedΔ, including: Blue/bleu, camembert, cheddar, gorgonzola, gouda, gruyere, provolone, Roquefort, Stilton, Swiss Meat, fish, and poultry All fresh packaged, fresh frozen, or fresh processed (not aged or smoked) meats, fish, and poultry; fresh breakfast sausage Pepperoni, hot dogs, bologna All aged, smoked, pickled, or cured meats/fish/poultry are absolutely not allowed, including: Aged, smoked, pickled or dried meats (eg, bacon, aged or dried sausage, all types of salami, Genoa, mortadella, corned beef, pastrami); aged chicken and beef liver; dried, pickled or smoked fish (eg, pickled herring, lox, smoked salmon, smoked trout, shrimp paste); liverwurst; meat extracts; meat alternatives that contain soy product (eg, meatless hot dogs made from tofu) Starches – potatoes/rice Potatoes, rice, noodles, pasta, and most stuffings None Soy products (eg, tofu, tempeh) Vegetables and beans Most fresh, frozen, canned, or dried vegetables, leafy salad greens, lentils, and beans (except fava and soy beans); most veggie burgers (ie, containing no soy product) Chili peppers Fava or broad beans (Italian green beans) and their pods, Kim chee (Kimchi), sauerkraut, snow peas, soy beans, bean pastes, edamame beans Fruit and fruit juices Most fresh, frozen, or canned fruits and fruit juices Avocado (not over-ripened), canned figs, raspberries Avocado (over-ripened), banana (over-ripened), banana peel, dried fruit, any kind of fruit that is over-ripened Soups, gravies, casseroles, pizza Home prepared (not prepackaged) soups, gravies, casseroles that contain no aged cheese, bouillons, flavoring cubes, or meat extracts Occasional consumption of one to two slices of pizza from large chain commercial outlets appears safe (ie, generally made with low tyramine cheese); avoid: larger quantities, extra cheese, or pizzas containing aged cheese Soups, gravies, casseroles, pizzas that contain aged cheese; soups or casseroles with flavoring meat extracts (eg, flavor cubes, bouillon), miso, broad or fava beans and their pods, tofu, tempeh, soy products (eg, soy sauce, teriyaki sauce) or yeast extracts Fats and oils Butter, cream cheese, margarine, mayonnaise, olive oil, vegetable oils Moderate amount (eg, 2 to 4 ounces) of peanut butter is considered safe Fats and oils included in fermented, aged, cured, smoked, pickled, or other foods that are not allowed Snacks Potato chips, popcorn, most nuts, most crackers (ie, containing no aged cheese) Moderate consumption of peanuts is considered safe Snack foods containing aged cheeses Sweets Sugar, hard candy, honey, molasses, syrups One serving of chocolate (eg, 2 ounces) is considered safe None Desserts Cakes, cookies, gelatin, pastries, pies, sherbets, sorbets One serving of chocolate-containing dessert (eg 4 ounces) is considered safe None Condiments and miscellaneous Ketchup, mustard, mayonnaise, non-cheese salad dressings, salt, spices, herbs, Worcestershire sauce None All aged or fermented soy and yeast products (eg, soy sauce, teriyaki sauce, soy paste, Thai or Vietnamese fish sauce, marmite/vegemite and other concentrated yeast extracts), sauerkrautFoods and beverages listed as "not allowed" often contain significant amounts of tyramine that can interact with nonselective MAOIs, or potentially with selective MAOI-b inhibitors at high doses, and may result in elevated blood pressure or hypertensive crisis.The ingredients of all foods and beverages (including those listed in this table as "allowed") should be reviewed prior to consumption to confirm they do not also include ingredients that are not allowed.Tyramine avoidance should be continued for two weeks following discontinuation of an MAOI.MAOI: monoamine oxidase inhibitor.* No leftover, improperly stored, handled, or spoiled foods of any type should be consumed. It is important to purchase and consume only fresh meats, poultry, and fish that are properly wrapped and stored under refrigeration and eaten the same day or frozen right away. Fresh produce should be consumed within 48 hours of purchase and not eaten if overripe. Use canned or frozen foods immediately upon opening or thawing.¶ Eat these foods occasionally; no more than one serving (eg, ½ cup) of one to three of these foods or beverages each day.Δ The majority of cases of food-related hypertensive crisis during treatment with MAOIs are associated with consumption of aged cheeses.Data from: Hirsch M, Birnbaum RJ. An Approach to psychopharmacological treatment. In: The Ten-Minute guide to psychiatric diagnosis and treatment, Stern TA (Ed). New York: Professional Publishing Group, Ltd, 2005. p.355. Copyright © 2005 Castle Connolly Graduate Medical Publishing, Ltd.McCabe-Sellers BJ, Staggs CG, and Bogle ML. Tyramine in foods and monoamine oxidase inhibitor drugs: A crossroad where medicine, nutrition, pharmacy and food industry converge; J Food Comp Anal. 2006; 19:S58.Lexicomp Online. Copyright © 1978-2023 Lexicomp, Inc. All Rights Reserved.Graphic 80345 Version 15.0

Patient education: E. coli diarrhea (The Basics)

ClosePatient education: E. coli diarrhea (The Basics)Patient education: E. coli diarrhea (The Basics) Please read the Disclaimer at the end of this page.What is E. coli? — E. coli are bacteria that live in the digestive systems of animals and people (figure 1). Everyone has them, and they do not usually cause problems. But there are different types of E. coli. Some types cause disease. Eating or drinking something with one of these types in it can cause diarrhea and other symptoms.When E. coli causes disease, it usually happens in the digestive system. But E. coli can sometimes cause illness if it gets into areas of the body where it does not normally live. For example, E. coli can cause a urinary tract infection if it gets into the urinary tract (figure 2).What are the symptoms of E. coli infection? — The symptoms of E. coli infection of the digestive system include:●Diarrhea – This can be watery or bloody, and mild or severe.●Belly pain●Vomiting – This is more common in children infected with one specific type of E. coli.E. coli that causes bloody diarrhea sometimes also causes problems with the kidneys or blood. This is not common, but can be serious if it does happen.Should I see a doctor or nurse? — See your doctor or nurse if:●You have more than 6 runny bowel movements in 24 hours.●You have bloody diarrhea.●You have a fever higher than 101.3ºF (38.5ºC) that does not go away after a day●You have severe belly pain.●You have diarrhea or fever and are age 70 or older.You should also see a doctor or nurse if your body has lost too much water from diarrhea. This is called "dehydration." Signs of dehydration include:●Having lots of diarrhea that is very watery●Feeling very tired●Thirst●Dry mouth or tongue●Muscle cramps●Dizziness, especially when you stand up●Confusion●Urine that is very yellow, or not needing to urinate for more than 5 hoursWill I need tests? — Most people do not need tests for E. coli. But the doctor or nurse might want to do: ●Tests on a sample of your bowel movements●Blood testsThe types of E. coli that cause bloody diarrhea can sometimes also cause problems with the kidneys or blood. If you get sick with E. coli, doctors might do tests to check for these problems.How is E. coli infection treated? — Many people do not need any specific treatment. Diarrhea from E. coli is not usually treated with antibiotic medicines. With some types of E. coli that cause diarrhea, antibiotics might actually make the illness worse. But if E. coli causes symptoms in other parts of the body, you might need antibiotics.People who get dehydrated might need fluids through a thin tube called an "IV." The tube goes into a vein. This treatment is usually given in the hospital.Is there anything I can do on my own to feel better? — Yes. If you have diarrhea, you can:●Drink a lot of liquids that have water, salt, and sugar. Good choices are soup broth and water mixed with juice. If you are drinking enough fluids, your urine will be light yellow or almost clear.●Eat a little food if you feel hungry. Good choices are potatoes, noodles, rice, oatmeal, crackers, bananas, soup, and boiled vegetables. Salty foods help the most.Ask your doctor or nurse before you take any over-the-counter medicines for diarrhea. If you have E. coli infection, some of these medicines can be harmful.Can E. coli infection be prevented? — To reduce your chances of getting and spreading E. coli, be sure to:●Wash your hands after changing diapers, cooking, eating, going to the bathroom, taking out the trash, or touching animals●Stay home from work or school until you feel better, if you get diarrhea●Pay attention to food safety. Here are some tips:•Do not drink unpasteurized milk or foods made with it.•Wash fruits and vegetables well before eating them.•Keep the refrigerator colder than 40ºF and the freezer below 0ºF.•Cook meat and seafood until well done.•Cook eggs until the yolk is firm.•Wash hands, knives, and cutting boards after they touch raw food.For more tips on food safety, see the table (table 1).More on this topic Patient education: Diarrhea in adolescents and adults (The Basics) Patient education: Diarrhea in children (The Basics) Patient education: Dehydration in children (The Basics) Patient education: Travelers' diarrhea (The Basics) Patient education: Acute diarrhea in adults (Beyond the Basics) Patient education: Acute diarrhea in children (Beyond the Basics) Patient education: General travel advice (Beyond the Basics)This topic retrieved from UpToDate on: Jan 02, 2023.This generalized information is a limited summary of diagnosis, treatment, and/or medication information. It is not meant to be comprehensive and should be used as a tool to help the user understand and/or assess potential diagnostic and treatment options. It does NOT include all information about conditions, treatments, medications, side effects, or risks that may apply to a specific patient. It is not intended to be medical advice or a substitute for the medical advice, diagnosis, or treatment of a health care provider based on the health care provider's examination and assessment of a patient's specific and unique circ*mstances. Patients must speak with a health care provider for complete information about their health, medical questions, and treatment options, including any risks or benefits regarding use of medications. This information does not endorse any treatments or medications as safe, effective, or approved for treating a specific patient. UpToDate, Inc. and its affiliates disclaim any warranty or liability relating to this information or the use thereof.The use of this information is governed by the Terms of Use, available at https://www.wolterskluwer.com/en/know/clinical-effectiveness-terms ©2023 UpToDate, Inc. and its affiliates and/or licensors. All rights reserved.Topic 86006 Version 9.0

Patient education: Diarrhea in adolescents and adults (The Basics)

See Also

Search "rice and kebab black vector"

In most cases, poor weight gain in preschool and school-age children is the consequence of inadequate dietary nutrient intake relative to typical needs for metabolism and growth. In other cases, poor weight gain is related to increased metabolic requirements secondary to an underlying disease state,

Management and sequelae of sexual abuse in children and adolescents

Sexual abuse occurs when a child engages in sexual activity for which they cannot give consent, is unprepared for developmentally, and cannot comprehend. This includes fondling and all forms of oral-genital, genital, or anal contact with the child (whether the victim is clothed or unclothed), as wel

Foods with high levels of potassium

CloseFoods with high levels of potassiumFoods with high levels of potassium Grains Whole-grain breads, wheat bran, granola and granola bars Beverages Sports drinks (Gatorade, etc), instant breakfast mix, soy milk, coffee/tea (limit to 16 fluid ounces) Snack foods/sweets Fig cookies, chocolate (1.5 to 2 ounces), molasses (1 tablespoon) Fruits Apricots, avocado (¼ whole), bananas (½ whole), coconut, melon (cantaloupe and honeydew), kiwi, mango, nectarines, oranges, orange juice, papaya, pears (fresh), plantains, pomegranate (and juice), dried fruits (apricots [5 halves], dates [5], figs, prunes, raisins), prune juice, yams Vegetables Bamboo shoots, baked or refried beans, beets, broccoli (cooked), Brussels sprouts, cabbage (raw), carrots (raw), chard, greens (except kale), kohlrabi, olives, mushrooms (canned), potatoes (white and sweet), parsnips, pickles, pumpkin, rutabaga, sauerkraut, spinach (cooked), squash (acorn, butternut, hubbard), tomato, tomato sauce, tomato juice, and vegetable juice co*cktail Dairy products Milk and milk products, buttermilk, yogurt Proteins (3-ounce serving) Clams, sardines, scallops, lobster, whitefish, salmon (and most other fish), ground beef, sirloin steak (and most other beef products), pinto beans, kidney beans, black beans, navy beans (and most other peas and beans, serving size is ½ cup) Soups Read label for potassium as many low-sodium soups and bouillon cubes or broth may have added potassium Condiments Imitation bacon bits, salt substitutes, or lite salt made with potassium Nuts, seeds, and legumes Tofu, lentils, adzuki beans, most legumes, peanut butter, most nuts, and most seeds (including sunflower seeds)Unless noted, one serving is ½ cup (4 ounces). These foods have more than 200 mg of potassium per serving, and should be avoided or eaten in very small portions if you are limiting potassium.Graphic 67156 Version 5.0

Patient education: Salmonella infection (The Basics)

ClosePatient education: Salmonella infection (The Basics)Patient education: Salmonella infection (The Basics) Please read the Disclaimer at the end of this page.What is Salmonella infection? — Salmonella infection is an illness that can cause nausea, vomiting, and diarrhea. "Salmonella" is a kind of bacteria. People most often get the infection from eating or touching foods that contain the bacteria. This is often chicken or eggs, or dairy products. You can also get the infection from touching certain animals, such as chickens, ducks, and turtles, then putting your hands to your mouth.What are the symptoms of Salmonella infection? — Symptoms usually come on within a few days of eating food (or touching an animal) that has the bacteria. The symptoms include:●Nausea or vomiting●Fever – This usually lasts 2 or 3 days.●Diarrhea that can be watery or bloody – This usually lasts 4 to 10 days. ●Belly pain or crampingSalmonella infection is usually not serious, and most people get better within a few days to a week. But in some cases, the bacteria get into the bloodstream. If this happens, people with certain conditions could get very sick. These include people whose immune system is weaker than normal, or who have cancer or another serious disease.Should I see a doctor or nurse? — See your doctor or nurse if you:●Have severe belly pain●Cannot eat or drink●Vomit blood or have blood in your bowel movements●Have a fever higher than 100.4°F (38°C) for more than 2 or 3 days Is there a test for Salmonella infection? — Yes, but not everyone needs to be tested. If your symptoms are not severe, you probably won't need a test. But if you have a high risk of getting very sick from Salmonella infection, your doctor might do a test even if you do not have severe symptoms. People at high risk include those with a weak immune system, babies under 1 year old, and adults older than 50.If your doctor decides to do a test, this involves taking a sample of your bowel movement to check for Salmonella bacteria. But it can take 2 or 3 days to get the test results. If you have a high risk of getting very sick from Salmonella infection, your doctor or nurse might not wait for your test results before starting treatment.How is Salmonella infection treated? — It usually goes away on its own, so most people do not need treatment. But if you get very sick, you might be treated in the hospital. Doctors can give antibiotics through a thin tube that goes into a vein, called an "IV."If you have a high risk of getting very sick from Salmonella infection, your doctor might prescribe antibiotic pills.If your immune system is normal, you probably only need to take antibiotics for a few days. But, if you have a weak immune system or a have complications from the infection, you might need them for longer. The antibiotics help get rid of the infection and keep it from coming back. Is there anything I can do on my own to feel better? — Yes. You can:●Drink plenty of liquids that have water, salt, and sugar – If your symptoms are mild, you can try water mixed with juice, flavored soda, or soup broth. This helps replace the fluids your body loses when you throw up or have diarrhea.●Eat what you can, starting with small amounts. Foods with a lot of fat in them might make you feel worse.●Rest if you feel tired.Can Salmonella infection be prevented? — Yes. You can lower the chances of getting or spreading the infection by:●Washing your hands frequently. This is especially important before and after preparing food and after changing diapers, going to the bathroom, blowing your nose, touching animals, or taking out the trash.●Staying home from work or school if you are sick.●Paying attention to food safety. Tips include:•Don't drink unpasteurized milk or eat foods made with it•Wash fruits and vegetables well before eating them•Keep the refrigerator colder than 40°F (4.4°C) and the freezer below 0°F (-18°C)•Cook meat and seafood until well done•Cook eggs until the yolk is firm•Wash hands, knives, and cutting boards after they touch raw foodFor more tips to on handling food safely, see the table (table 1).What if I am pregnant? — If you think you might have Salmonella infection, talk to your doctor, nurse, or midwife. Most pregnant people do not need treatment. But you might need it if you get very sick and are near your due date.More on this topic Patient education: Diarrhea in adolescents and adults (The Basics) Patient education: Food poisoning (The Basics) Patient education: Acute diarrhea in adults (Beyond the Basics) Patient education: Acute diarrhea in children (Beyond the Basics) Patient education: Foodborne illness (food poisoning) (Beyond the Basics)This topic retrieved from UpToDate on: Jan 02, 2023.This generalized information is a limited summary of diagnosis, treatment, and/or medication information. It is not meant to be comprehensive and should be used as a tool to help the user understand and/or assess potential diagnostic and treatment options. It does NOT include all information about conditions, treatments, medications, side effects, or risks that may apply to a specific patient. It is not intended to be medical advice or a substitute for the medical advice, diagnosis, or treatment of a health care provider based on the health care provider's examination and assessment of a patient's specific and unique circ*mstances. Patients must speak with a health care provider for complete information about their health, medical questions, and treatment options, including any risks or benefits regarding use of medications. This information does not endorse any treatments or medications as safe, effective, or approved for treating a specific patient. UpToDate, Inc. and its affiliates disclaim any warranty or liability relating to this information or the use thereof.The use of this information is governed by the Terms of Use, available at https://www.wolterskluwer.com/en/know/clinical-effectiveness-terms ©2023 UpToDate, Inc. and its affiliates and/or licensors. All rights reserved.Topic 83760 Version 10.0

Patient education: Nausea and vomiting with cancer treatment (The Basics)

ClosePatient education: Nausea and vomiting with cancer treatment (The Basics)Patient education: Nausea and vomiting with cancer treatment (The Basics) Please read the Disclaimer at the end of this page.Why might I have nausea and vomiting with cancer treatment? — Nausea is the feeling you get when you think you might throw up. Vomiting is when you actually throw up. Nausea and vomiting are common side effects of a cancer treatment called chemotherapy. Chemotherapy is the term doctors use to describe a group of medicines that kill cancer cells.Not everyone who gets chemotherapy will have nausea and vomiting. Your doctor will tell you how likely it is that you will have these symptoms and how severe they might be.When people have nausea and vomiting after chemotherapy, they usually feel better within 1 to 2 days. But some people have symptoms up to 3 to 4 days after their chemotherapy. This will depend on the type of chemotherapy medicines, the dose, and the treatment schedule.Another type of cancer treatment, called radiation therapy, can also cause nausea and vomiting. Not everyone who gets radiation therapy will have nausea and vomiting. It will depend on the part of the body that is being treated, the dose of radiation, and whether the person gets chemotherapy at the same time.Can nausea and vomiting be prevented? — Yes. If your chemotherapy is the type that is likely to cause nausea and vomiting, your doctor will give you medicines just before your treatment. These medicines can prevent nausea and vomiting. There are different medicines your doctor can use, and they come in different forms. They can come as a pill, skin patch, or a tablet that melts under the tongue. Or they can go into your vein. You might get 1 or more medicines.If you are likely to have nausea and vomiting for a few days after chemotherapy, you might also take some of these medicines at home for 2 to 4 days after treatment.If your radiation therapy can cause nausea and vomiting, your doctor will prescribe medicine for you to take before each day's treatment.What can I do to manage my nausea and vomiting? — To manage your symptoms, you can:●Take the medicines your doctor prescribes to prevent nausea and vomiting, even if you feel fine. The best way to manage nausea and vomiting is to prevent it from happening.●Make sure to drink enough fluids so that you don't get dehydrated. Dehydration is when the body loses too much water. It can cause your urine to be dark yellow and make you feel thirsty, tired, dizzy, or confused.●Eat 5 or 6 small meals during the day after chemotherapy instead of 3 big ones, especially if you have nausea.●Learn how much to eat or drink before your cancer treatment. Some people feel better when they eat or drink a small amount before treatment. Other people feel better if they don't have any food or drink before treatment.●If you have nausea, avoid foods that are spicy, greasy, or "heavy." Instead, eat foods that are bland, such as crackers, rice, and toast. Other good food choices are soup broths, clear soda, tea, bananas, chicken (broiled or baked, not fried), oatmeal, yogurt (plain or vanilla), plain pasta, and ice pops.●Wait at least 1 hour after your treatment before you eat or drink.●Eat and drink slowly.●Ask someone else to cook your food, if the smell of food bothers you.●Try drinking ginger ale or taking over-the-counter ginger supplements to settle your stomach. Experts don't all agree on whether this works, but some people find it helpful.●Ask your doctor about an alternative treatment called acupuncture, which might be helpful for some people.●Some people wonder about trying marijuana (or other forms of cannabis, like CBD oil) to help with nausea or vomiting. But studies have not compared it with newer prescription medicines that are used to prevent nausea and vomiting caused by cancer therapy. For this reason, doctors do not recommend it. The active ingredient in marijuana, dronabinol, is available in pill form for certain situations. Your doctor might suggest this if other treatments have not worked for you.When should I call my doctor or nurse? — Call your doctor or nurse if you:●Are unable to keep any food or drink in your stomach●Vomit up the medicines your doctor gives you to prevent nausea and vomitingMore on this topic Patient education: Nausea and vomiting in adults (The Basics) Patient education: Managing loss of appetite and weight loss with cancer (The Basics) Patient education: Radiation therapy (The Basics) Patient education: When your cancer treatment makes you tired (The Basics) Patient education: Managing pain when you have cancer (The Basics) Patient education: Coping with high drug prices (The Basics) Patient education: Coping with high prescription drug prices in the United States (Beyond the Basics)This topic retrieved from UpToDate on: Jan 01, 2023.This generalized information is a limited summary of diagnosis, treatment, and/or medication information. It is not meant to be comprehensive and should be used as a tool to help the user understand and/or assess potential diagnostic and treatment options. It does NOT include all information about conditions, treatments, medications, side effects, or risks that may apply to a specific patient. It is not intended to be medical advice or a substitute for the medical advice, diagnosis, or treatment of a health care provider based on the health care provider's examination and assessment of a patient's specific and unique circ*mstances. Patients must speak with a health care provider for complete information about their health, medical questions, and treatment options, including any risks or benefits regarding use of medications. This information does not endorse any treatments or medications as safe, effective, or approved for treating a specific patient. UpToDate, Inc. and its affiliates disclaim any warranty or liability relating to this information or the use thereof.The use of this information is governed by the Terms of Use, available at https://www.wolterskluwer.com/en/know/clinical-effectiveness-terms ©2023 UpToDate, Inc. and its affiliates and/or licensors. All rights reserved.Topic 16303 Version 8.0

Patient education: Managing loss of appetite and weight loss with cancer (The Basics)

ClosePatient education: Managing loss of appetite and weight loss with cancer (The Basics)Patient education: Managing loss of appetite and weight loss with cancer (The Basics) Please read the Disclaimer at the end of this page.What can cause me to lose weight or have no appetite? — You can lose weight or have no appetite because of your:●Cancer – Even if you eat a lot, your cancer might keep your body from taking in all the nutrients it needs.●Treatments – Treatments such as chemotherapy and radiation have side effects that can make it hard to eat. For example, these treatments can cause nausea, vomiting, mouth sores, tiredness, dry mouth, or changes in taste and smell.●Pain – Having pain from either the cancer or treatment (especially surgery) can cause you to lose your appetite.●Mood – Feeling sad or worried can make people lose their appetite.Why is it important to eat enough? — It's important to eat enough so you stay as healthy and strong as possible, especially during your cancer treatment. Eating enough and getting enough fluids will also give you more energy and help you feel better in general.What foods can help keep my weight up? — Eating foods with a lot of calories and protein in them can help keep your weight up. Some examples of these foods are:●Thick soups●Milk, milkshakes, cheese, pudding, and smoothies●Nutritional supplement drinks, such as Ensure, Boost, or Carnation Instant Breakfast●Eggs, chicken, lean red meat, and fish●Yogurt, frozen yogurt, and ice cream●Peanut butter, nuts, dried fruit, and granola barsWhat can I do on my own to eat enough? — To eat enough and make sure that your body gets the nutrients it needs, you can:●Eat 5 to 6 small meals a day, instead of 3 large meals●Eat healthy snacks in between meals whenever you feel hungry●Add butter, oil, nuts, gravy, powdered milk, protein powder, or cream to your foods to give them extra calories and protein●Drink fluids between meals instead of with your meals, so you don't fill up on fluids●Eat foods that smell good, or add spices or condiments to your food●Eat with family or friends●Buy pre-cooked foods or cook food ahead of time and freeze it●Ask someone to cook or shop for you, if you are unable to cook or shop●Take a short walk about an hour before you eat to help you work up an appetite●Ask your doctor if you should take vitamins or work with a nutrition expert●If you have side effects from your treatments that are keeping you from eating, these tips might help:•If you have a dry mouth, drink lots of fluids and avoid foods that are hard or dry (such as toast or crackers). You can eat moist foods, or suck on ice chips or sugar-free hard candy.•If you have mouth sores, eat soft foods that you can chew and swallow easily. You can also cut up your food into small pieces or mash it in a blender. Try to avoid spicy or salty foods.•If you have nausea, eat foods that are bland and dry, such as crackers, rice, and toast. Avoid foods that are spicy and greasy.•If you have trouble having a bowel movement, try to drink more fluids. You can also eat foods with a lot of fiber, such as vegetables, fruits, beans, nuts, oatmeal, and some breads and cereals (figure 1).•If you have diarrhea, try to drink a lot of fluids so your body doesn't lose too much water. Try to avoid milk, greasy foods, and foods with a lot of fiber.When should I call my doctor or nurse? — Call your doctor or nurse if you:●Are not able to keep any food or drink in your stomach●Have severe belly pain●Are dizzy or weak●Have a feverAre there medicines that can increase my appetite? — Yes. Doctors can prescribe different medicines to help increase a person's appetite. Medicines that doctors commonly use include:●Hormone medicines●Steroids – Doctors usually recommend that people not take these medicines for more than a few weeks. Even though these medicines can help, they can also cause problems of their own.Some people wonder about trying marijuana (or other forms of cannabis, like CBD oil) to help increase appetite. But studies have not shown that this works in people with advanced cancer, so doctors do not recommend it.Are there other treatments that can help if I have no appetite or lose weight? — Yes. Sometimes, doctors use other treatments if people are unable to eat or if their body doesn't take in nutrients from the food they do eat.People who can't eat on their own but whose bodies can digest food might get "tube feedings." People who get tube feedings get their food and nutrients through a tube that goes into the stomach or small intestine (figure 2).People whose bodies are unable to digest food might get their nutrition through a thin tube that goes into the vein. But doctors don't usually need to use this type of treatment for patients who have cancer.More on this topic Patient education: Managing pain when you have cancer (The Basics) Patient education: When your cancer treatment makes you tired (The Basics) Patient education: Nausea and vomiting in adults (The Basics) Patient education: Diarrhea in adolescents and adults (The Basics) Patient education: High-fiber diet (The Basics) Patient education: What are clinical trials? (The Basics) Patient education: Acute diarrhea in adults (Beyond the Basics) Patient education: High-fiber diet (Beyond the Basics)This topic retrieved from UpToDate on: Jan 01, 2023.This generalized information is a limited summary of diagnosis, treatment, and/or medication information. It is not meant to be comprehensive and should be used as a tool to help the user understand and/or assess potential diagnostic and treatment options. It does NOT include all information about conditions, treatments, medications, side effects, or risks that may apply to a specific patient. It is not intended to be medical advice or a substitute for the medical advice, diagnosis, or treatment of a health care provider based on the health care provider's examination and assessment of a patient's specific and unique circ*mstances. Patients must speak with a health care provider for complete information about their health, medical questions, and treatment options, including any risks or benefits regarding use of medications. This information does not endorse any treatments or medications as safe, effective, or approved for treating a specific patient. UpToDate, Inc. and its affiliates disclaim any warranty or liability relating to this information or the use thereof.The use of this information is governed by the Terms of Use, available at https://www.wolterskluwer.com/en/know/clinical-effectiveness-terms ©2023 UpToDate, Inc. and its affiliates and/or licensors. All rights reserved.Topic 16248 Version 7.0

Cannabis withdrawal

Cannabis (also called marijuana) is the third most commonly used psychoactive substance worldwide, after alcohol and tobacco (nicotine) [1]. Its euphorigenic, sedative, and analgesic properties are primarily due to one cannabinoid: delta-9-tetrahydrocannabinol (THC). THC concentration is commonly us

Summary of response interventions in the 2015 Nepal earthquake

CloseSummary of response interventions in the 2015 Nepal earthquakeSummary of response interventions in the 2015 Nepal earthquake Distribution of individual clean delivery kits Description Clean delivery kits including chlorhexidine for prevention of umbilical cord infection among newbornsBeneficiaries 1100 visibly pregnant women in all 31 earthquake-affected districts, except in Kathmandu ValleySetting up of WHO MCKs and medical tents Description 40 MCKs provided by WHO with all necessary equipment for establishing a birthing center and a functional outpatient departmentMore than 350 medical tents provided by UNFPA, UNICEF, and German Development CooperationMCKs were installed in damaged hospitals, primary health centers, and health posts to serve as emergency shelters for the provision of health servicesOther medical tents served as shelters for RH servicesOutcomes More than 100 birthing centers resumed their services under these tentsDeployment of nursing and medical teams with skilled birth-attendance competencies Description 25 nurses qualified as skilled birth attendants (in 24 birthing centers) were deployed as well as 8 senior nurses (to cover 40 birthing centers)This program was supported by UNICEF and implemented through the MIDSONThe nurses volunteered from government hospitals and nursing collegesThey provided extra support and onsite coaching to the regular maternity staff, helped staff cope with the surge of activities, and facilitated institutional deliveries and timely management of complicated pregnancies/deliveries; some nurses also volunteered to join NGOs' emergency programsOne roving obstetrician was deployed to the affected hospitals to initiate/continue C-sections and other medical reproductive health proceduresOutcomes By June 2015: Antenatal care was re-established in all services sites; majority of birthing centers were able to provide delivery services and C-section services were available in 13 of 14 district hospitalsOrganization of outreach reproductive health camps Description The RH camps were mobile in nature, remaining in one site for about 2 to 4 days before moving to the next community; the number of mobile camps ranged from 8 to 14 per district considering its population coverage and needs; it also included on-site local capacity building, enabling referrals to health facilities and a mobile unit for awareness-raising sessions; it was implemented together with DPHOs; information on the scheduled dates for mobile RH camps was disseminated through FCHVs youth groups prior to the camps132 RH camps were conducted in 128 villages, with support from UNFPARH camps were carried out by national health professionalsProvided SRH services free of charge for earthquake-affected people in remote communities in all 14 affected districts[1]Provided life-saving health care support to women and their families, ranging from antenatal and postnatal check-ups, safe delivery, family planning, lab testing facilities (including for HIV), management of STI, psychosocial support, health response to genderbased violence, and referrals; key health messages and information were delivered to women and girlsFree-of-charge transportation of severe cases identified through the camps was ensuredBeneficiaries 104,740 women and adolescent girls reached; UNFPA has estimated that the needs of 1.4 million affected people were coveredDistribution of ERH kits Description 1331 ERH kits provided to tertiary level hospitals, district hospitals, and smaller health facilities in all the 14 most affected districts, through a total of 37 partners; the kits were also used in the outreach RH camps and in the WHO Medical Camp Kits; the additional kits were supplied/replenished depending on the request from MoH, DPHOs, and/or implementing partnersProvided at community, primary health care, and referral hospital levels, ranging from 1 to up to 35 boxes of equipmentKits included contraceptives, drugs, and supplies for STI treatment and clinical delivery assistance, instruments, equipment, and supplies for the management of obstetric complications, including assisted deliveries and C-sections, medical abortion, and postrape treatment kitsMisoprostol was added to the kits where a program aiming to prevent postpartum hemorrhage during home deliveries was already ongoingOutcomes 213 health facilities benefited from the ERH kitsUNFPA has calculated that the needs of an estimated 1.4 million affected population were coveredProvision of psychosocial counseling Description Provision to maternity hospital health workers who needed support, on voluntary basis, for six weeks after the disaster to help them cope with the stress induced by the earthquake and repeated aftershocks and the unprecedented surge in caseload they were handlingSocial mobilizers and health services providers trained on psychosocial counseling were identified and hired in close collaboration with DPHOBeneficiaries Approximately 100 staff (25 percent) of the central referral maternity hospital in Kathmandu WHO: World Health Organization; MCKs: medical camp kits; UNFPA: United Nations Population Fund (formerly United Nations Fund for Population Activities); UNICEF: United Nations Children's Fund (formerly United Nations International Children's Emergency Fund); RH: reproductive health; MIDSON: Midwifery Society of Nepal; NGO: nongovernment organization; DPHOs: district public health offices; FCHVs: female community health volunteers; SRH: sexual and reproductive heath; STI: sexually transmitted infection; ERH: emergency reproductive health; MoH: Ministry of Health.Reference:United Nations Population Fund. Dignity first: UNFPA Nepal 12 month earthquake report April 2016.Reproduced from: Chaudhary P, Vallese G, Thapa M, et al. Humanitarian response to reproductive and sexual health needs in a disaster: the Nepal Earthquake 2015 case study. Reprod Health Matters 2017; 51:25. Available at: https://www.tandfonline.com/doi/full/10.1080/09688080.2017.1405664 (Accessed on February 27, 2018). Reproduced under the terms of the Creative Commons Attribution License.Graphic 116906 Version 1.0

Patient education: Low-sodium diet (The Basics)

ClosePatient education: Low-sodium diet (The Basics)Patient education: Low-sodium diet (The Basics) Please read the Disclaimer at the end of this page.What is sodium? — Sodium is the main ingredient in table salt. It is also found in lots of foods. The body needs a very small amount of sodium to work normally, but most people eat much more sodium than their body needs.Who should eat less sodium? — Nearly everyone eats too much sodium. The average American takes in 3400 milligrams of sodium each day. Experts say that most people should have no more than 2300 milligrams a day.Some people with certain health conditions should follow a low-sodium diet. Ask your doctor how much sodium you should have.Why should I eat less sodium? — Reducing the amount of sodium you eat can have lots of health benefits:●It can lower your blood pressure. This means it can help lower your risk of stroke, heart attack, kidney damage, and lots of other health problems.●It can reduce the amount of fluid in your body, which means that your heart doesn't have to work as hard●It can keep the kidneys from having to work too hard. This is especially important in people who have kidney disease.●It can reduce swelling in the ankles and belly, which can be uncomfortable and make it hard to move●It can lower the chances of forming kidney stones●It can help keep your bones strongWhich foods have the most sodium? — Processed foods have the most sodium. These foods usually come in cans, boxes, jars, and bags. They tend to have a lot of sodium even if they don't taste salty. In fact, many sweet foods have a lot of sodium in them. The only way to know for sure how much sodium you are eating is to check the label (figure 1).Here are some examples of foods that often have too much sodium:●Canned soups●Rice and noodle mixes●Sauces, dressings, and condiments (such as ketchup and mustard)●Pre-made frozen meals (also called "TV dinners")●Deli meats, hot dogs, and cheeses●Smoked, cured, or pickled foods●Salted snack foods and nuts●Restaurant mealsWhat should I do to reduce the amount of sodium in my diet? — Many people think eating a low-sodium diet just means not adding salt to their food. But this is not true. Not adding salt at the table or when cooking will help a little. But almost all of the sodium you eat is already in the food you buy at the grocery store or at restaurants (figure 2).Here are some tips to help you eat less sodium:●Avoid processed foods when possible. This is the most important thing you can do to eat less sodium. Processed foods include most foods that are sold in cans, boxes, jars, and bags.●Instead of buying pre-made, processed foods, buy fresh or fresh-frozen fruits and vegetables. ("Fresh-frozen" means the food is frozen without anything added to it.)●Buy meats, fish, chicken, and turkey that are fresh instead of canned or sold at the deli counter. (Meats sold at the deli counter are high in sodium.)●Try to eat at restaurants less often●When possible, try to make meals from scratch at home using fresh ingredients●If you do need to buy canned or packaged foods, choose ones that are labeled "sodium-free" or "very low sodium" (table 1). Or choose foods that have less than 400 milligrams of sodium in each serving. The amount of sodium in each serving appears on the nutrition label that is printed on canned or packaged foods (figure 1).The table has some examples of foods to avoid and foods to choose instead (table 2).Whatever changes you make, make them slowly. Choose 1 thing to do differently, and do that for a while. If you can keep doing that change easily, add another change. For instance, if you usually eat green beans from a can, try buying fresh or fresh-frozen green beans and cooking them at home without adding salt. If that works for you, keep doing it. Then choose another thing to change.If you try making a change and it doesn't work right away, don't give up. See if you can reduce sodium in other ways. The important thing is to take small steps and to keep doing the changes that work for you.Can I still eat out at restaurants sometimes? — One of best ways to limit your sodium is to only eat out at restaurants every once in a while. When you do eat out, try to choose places that offer healthier choices and fresh ingredients.No matter where you eat, when choosing what to order:●Ask your server if your meal can be made without salt●Avoid foods that come with sauces or dips●Choose plain grilled meats or fish and steamed vegetables●Ask for oil and vinegar for your salad, rather than dressing●If a meal you really want has more sodium than you should have, consider saving half of it to eat another dayWhat if food just does not taste as good without sodium? — Starting a low-sodium diet can be hard. The good news is your taste buds can get used to having less sodium. But you have to give them some time to adjust.It can also help to try other ways to add flavor to your foods. Try things like herbs, spices, lemon juice, and vinegar.What about salt substitutes? — Flavoring your food with a salt substitute is a good way to reduce how much salt you eat. But check with your doctor or nurse before trying this. Some salt substitutes can be dangerous if you have certain health problems or take certain medicines.Do medicines have sodium? — Yes, some medicines have sodium. If you are buying medicines you can get without a prescription, look to see how much sodium they have. Avoid products that have "sodium carbonate" or "sodium bicarbonate" unless your doctor prescribes them. (Sodium bicarbonate is baking soda.)More on this topic Patient education: High blood pressure in adults (The Basics) Patient education: Controlling your blood pressure through lifestyle (The Basics) Patient education: Heart failure (The Basics) Patient education: Stroke (The Basics) Patient education: Low-sodium diet (Beyond the Basics)This topic retrieved from UpToDate on: Jan 02, 2023.This generalized information is a limited summary of diagnosis, treatment, and/or medication information. It is not meant to be comprehensive and should be used as a tool to help the user understand and/or assess potential diagnostic and treatment options. It does NOT include all information about conditions, treatments, medications, side effects, or risks that may apply to a specific patient. It is not intended to be medical advice or a substitute for the medical advice, diagnosis, or treatment of a health care provider based on the health care provider's examination and assessment of a patient's specific and unique circ*mstances. Patients must speak with a health care provider for complete information about their health, medical questions, and treatment options, including any risks or benefits regarding use of medications. This information does not endorse any treatments or medications as safe, effective, or approved for treating a specific patient. UpToDate, Inc. and its affiliates disclaim any warranty or liability relating to this information or the use thereof.The use of this information is governed by the Terms of Use, available at https://www.wolterskluwer.com/en/know/clinical-effectiveness-terms ©2023 UpToDate, Inc. and its affiliates and/or licensors. All rights reserved.Topic 16108 Version 10.0

Interactive diabetes case 3: Hypoglycemia in a patient with type 1 diabetes

CloseInteractive diabetes case 3: Hypoglycemia in a patient with type 1 diabetesInteractive diabetes case 3: Hypoglycemia in a patient with type 1 diabetesAuthor:Lloyd Axelrod, MD Section Editor:David M Nathan, MD Deputy Editor:Katya Rubinow, MDLiterature review current through: Dec 2022. | This topic last updated: Mar 30, 2022.CASE — A 27-year-old male graduate student is referred by his university health service clinician for management of type 1 diabetes.At age 12 years, the patient was hospitalized for inability to walk, found to be in diabetic ketoacidosis (DKA), and started on insulin. He has had no other episodes of DKA. He checks his capillary blood glucose level approximately five times a day, but he does not keep a diary. He takes glargine insulin 26 units at 11 PM daily and doses of lispro insulin four times daily. He describes his blood glucose values and lispro insulin doses as shown in the table (table 1).He reports headaches and weakness with low blood glucose readings almost daily but denies sweating, tremulousness, palpitations, or syncope. These symptoms and low blood glucose values can occur at any time of day depending on food intake and insulin dose. He does not eat breakfast. His first meal of the day, at noon, is typically two sandwiches and a glass of fruit juice. Dinner at 6 PM is typically 3 ounces of meat, a vegetable, soup, and two red bliss potatoes. He snacks frequently and variably in the evenings.The glycated hemoglobin (A1C) was 5.80 percent six weeks ago and 5.90 percent three months ago. He weighs 160 pounds (72.7 kilograms) with a body mass index (BMI) of 23 kg/m2. What is your assessment and plan?●The patient is in excellent control based on his A1C levels, at which some hypoglycemia is to be expected. Since the symptoms are minimal, you advise him to eat breakfast and caution him about the danger of taking lispro insulin at 7 AM without eating. (See"Interactive diabetes case 3: Hypoglycemia in a patient with type 1 diabetes – A1".)●The patient may be having frequent episodes of hypoglycemia with hypoglycemia unawareness. He needs to eat breakfast, keep a written diary, and learn to count carbohydrates. You reduce the dose of glargine insulin to 20 units at bedtime and reduce the dose of lispro insulin before lunch to 10 units and the dose of lispro before dinner to 12 units. (See"Interactive diabetes case 3: Hypoglycemia in a patient with type 1 diabetes – A2".)●His primary issue at age 27 years is cardiovascular disease prevention. He needs a statin, a beta-adrenergic blocking agent, an angiotensin-converting enzyme (ACE) inhibitor, and aspirin. (See"Interactive diabetes case 3: Hypoglycemia in a patient with type 1 diabetes – A3".)INFORMATION FOR PATIENTS — UpToDate offers two types of patient education materials, "The Basics" and "Beyond the Basics." The Basics patient education pieces are written in plain language, at the 5th to 6th grade reading level, and they answer the four or five key questions a patient might have about a given condition. These articles are best for patients who want a general overview and who prefer short, easy-to-read materials. Beyond the Basics patient education pieces are longer, more sophisticated, and more detailed. These articles are written at the 10th to 12th grade reading level and are best for patients who want in-depth information and are comfortable with some medical jargon.Here are the patient education articles that are relevant to this topic. We encourage you to print or e-mail these topics to your patients. (You can also locate patient education articles on a variety of subjects by searching on "patient info" and the keyword(s) of interest.)●Basics topics (see"Patient education: Type 1 diabetes (The Basics)" and"Patient education: Using insulin (The Basics)")●Beyond the Basics topics (see"Patient education: Type 1 diabetes: Overview (Beyond the Basics)" and"Patient education: Blood glucose monitoring in diabetes (Beyond the Basics)" and"Patient education: Type 1 diabetes: Insulin treatment (Beyond the Basics)")Topic 4136 Version 12.0

Cases illustrating intensive insulin therapy in special situations

Adults with diabetes who are motivated and well educated can often keep their blood glucose concentrations in the target or near-target range on routine days. They may, however, need advice for more unusual events. Although it is not possible to cover all eventualities, some management guidelines ca