I9I2] Lafayette B. Mendel i45 



Final words : Warning against schematic employment of dietary 

 precepts. An effort must be made, on the one band, to hold fast to 

 the basic rules of nutrition-therapy, but, on the other, to duly take 

 into account the individuality of the patient. 



Diet and metabolism in fever 



WARREN COLEMAN 



Empiricism has been a signal failure as a basis for the fever diet. 

 Through studies of metabolism the Solution of this problem appears 

 to be at band. With diets containing large amounts of carbohy- 

 drate it is possible to bring typhoid fever patients into nitrogen 

 equilibrium, or nearly so. The apparently excessive quantities of 

 food required for the purpose are almost completely absorbed. 



The heat-production in typhoid fever, as determined by indirect 

 calorimetry, averages about 35 calories per kilogram at absolute 

 rest. Diets furnishing only sufficient energy to cover the heat-pro- 

 duction do not Protect the body against nitrogen or weight loss. 

 The explanation of this discrepancy has not yet been found. 



Respiratory quotients in typhoid fever below 0.65 to 0.70 appear 

 to be due to errors of technique. The lowest quotient we obtained 

 in the fasting state, during the febrile period, was 0.70. During 

 the same period, patients on a füll diet gave quotients varying from 

 0.75 to 0.95 at short intervals after food. The quotient rises dur- 

 ing the later stages of the fever and reaches i.o to 1.15 early in con- 

 valescence. During a relapse, a quotient of 1.04 was obtained while 

 the patient had a temperature of 102° F. (37.7° C). 



The oxygen consumption during the febrile stage varies between 

 4 and 6 c.c. per kilogram a minute. Compared with the amount 

 used in the fasting stage, the oxygen consumption is not greatly 

 increased by the quantity of food administered. 



The body burns carbohydrate by preference during fever as long 

 as it is available. As indicated by a falling quotient, from 100 to 

 120 grams of lactose is, for the most part, consumed, or deposited in 

 the glycogen depöts, after 4 to 5 hours. The optimum amount of 

 carbohydrate in the fever must be determined for each patient in- 

 dividually, but is always large. The optimum amounts of fat and 

 protein have not yet been determined. 



