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Managing Nutrition in an Emergency

nephroplus | April 23, 2016

By Mrinal Pandit, Chief Dietician, NephroPlus
Natural disaster – a flood, hurricane, earthquake – often come with little or no warning. One has to understand that the routine will not be the same. There will also be times you will not have access to dialysis. There will be limited stores of food and reaching markets places could be difficult. Choosing wisely and planning for crises is important to avoid accumulation of toxins such as potassium, sodium, phosphorous and fluid overload and eventually avoid clinical emergencies.

In an emergency we need to focus more on the basic requirement than flavors and preferences. It is necessary to follow strict diet regime during a crisis at least till you get dialysis. If proper care is not taken; it can lead to a life threatening event.

Even though it is unlikely that an emergency will cut off food supply for more than two weeks, consider maintaining supply that will last for that long.

Consider the following tips before putting together your grocery list:
1. Foods with longer shelf life are preferred.
2. Remember special dietary needs.
3. Avoid Food that will make you thirsty.
4. Foods that require no refrigeration, water, special preparation or cooking are the best.

Storage Tips:
1. Keep food in covered containers.
2. Keep food in a dry, cool spot—a dark area if possible away from sunlight.
3. Discard any food that has an unusual odor, color or texture.
4. Discard foods from cans that are swollen, dented or corroded, even though the product may look safe to eat.
5. Inspect all food for signs of spoilage before use.

Food Safety and Sanitization:
1. If it is a flood prone area stack the food on shelves.
2. Discard any food that has come into contact with contaminated floodwater.
3. In the case of a power outage make sure the freezer temperature is 0 °C or below and refrigerator temperature at 4 °C or below to avoid bacterial growth.
4. Never taste a food item to determine its safety.
5. Limit the number of times you open the freezer, this will allow food to be safe.

Other important points to ponder in an emergency.
1. Supply of vitamins and supplements for at least 2 weeks.
2. In case you are diabetic, maintain insulin stores, if using a glucometer, keep batteries and strips handy.
3. Maintain a grocery list.
4. Keep Candles and matchsticks handy.
5. Keep a Torch and extra batteries.
6. Make sure you have Purified Drinking Water available.
7. Keep a List of contacts needed in emergency: Hospital, Doctor, Dialysis Unit, Relatives.
8. Keep a Power bank.

Sample Meal Plan
Emergency Meal plan will be a strict diet unlike the diet at the time on dialysis. This meal plan will be formulated so as to avoid accumulation of waste product in the body. The meal will provide 35-40 g proteins, 800-1000 mg phosphorus, 1500 mg sodium, 1000-1500 mg potassium and fluid restriction up to 500 ml.

Day 1

Meal Menu House Hold Measures
7:00 am Early morning Weak Tea ½ tea cup
9:00 am Breakfast Cereals
Milk : Water dilution 1:1
1 soup bowl
1 cup
11:00 am Mid-Morning Apple 1 small portion
1:30 pm Lunch Curd rice
Cucumber
1 soup bowl
1 bowl
4:00 pm Tea Time Bread
Unsalted Butter
2 slice
1-2 tsp.
7:30 pm Dinner Rice
Ghee
Dal powder (gun Powder/ Metkut)
2 bowl
1-2 tsp.
1 tsp.
Bed time 10:00 pm Milk 60 m ½ tea cup

Fluid from the meal: 120 ml.
Water intake allowed: 380 ml (3 Tea cups).
Salt: ¼ tsp. (Use measuring spoon).

Day 2

Meal Menu House Hold Measures
7:00 am Early morning Weak Tea ½ tea cup
9:00 am Breakfast Semolina Cooked in water (Sweet)
Ghee
1 bowl
1 tsp.
11:00 am Mid-Morning Orange 1 small portion
1:30 pm Lunch Daliya cooked with beans
Boiled Leached Beetroot
1 soup bowl.
1 bowl
4:00 pm Tea Time Boiled leached potato sautéed in un salted butter and pepper 1 medium potato.
7:30 pm Dinner Oats cooked capsicum
curd
1 soup bowl
1 small bowl
Bed time 10:00 pm Unsalted biscuits 2-3 in no.

Fluid from the meal: 60 ml
Water intake allowed: 440 ml (3 ½ Tea cups)
Salt: ¼ tsp. (Use measuring spoon)

Day 3

Meal Menu House Hold Measures
7:00 am Early morning Weak Tea ½ tea cup
9:00 am Breakfast Puffed rice with jaggery
ghee
1 bowl
1-2 tsp.
11:00 am Mid-Morning Guava 1 medium size
1:30 pm Lunch Lemon rice(No added groundnut/Dal)
Radish Sliced
1 soup bowl.
1 bowl
4:00 pm Tea Time Boiled sautéed vegetable with pepper
Mayonnaise
1 soup bowl
1 tsp.
7:30 pm Dinner Tempered rice
curd
1 soup bowl
1 small bowl
Bed time 10:00 pm Puffed rice plain, unsalted. 2-3 in no.

Fluid from the meal: 60 ml
Water intake allowed: 440 ml (3 ½ Tea cups)
Salt: ¼ tsp. (Use measuring spoon)

If there is ample warning before an emergency, we still have time to run to the market and get fresh produce. These foods will last at least a week after they have been purchased and will give you a fresh alternative to all that packaged food.

Few things that can be purchased just before an emergency:
Raw tomatoes, Fruit vegetables (All gourd family), Capsicum, Wheat Flour, Unsalted biscuits, Rice Flakes, Puffed rice, Potatoes, Packed low fat milk carton, Guavas, Apples, Pineapple, Pear, Loaf of bread, unsalted butter. Small single use yogurt pouches to avoid spoilage and contamination.
If the food options are available, rice can be replaced with Chapattis/ Rotis. Low potassium vegetables can be included.

Typically exchanges of food groups that are allowed can be distributed as follows:

Food Groups Household measures Calories (Kcal) Proteins (gm) Sodium (mg) Potassium (mg)
Cereals Wheat, Chapatti, Upma, Poha, Puffed Rice, Oats, Daliya, Jowar, Rice 5 Serving 500 15 22 280
Pulses Green Gram Dal, Lentil, Red gram Dal, Horse Gram Dal Fresh Green Peas. ½ Serving 50 5 10 85
Vegetables Bottle gourd, Pumpkin, Ridge gourd, Tinda, Knol – Khol, Parmal, Snake gourd, Radish, Cucumber, Onions, Leached potatoes. 3-4 Serving 350 4 86 250
Milk Double toned Milk 2 Tea cups 160 8 46 220
Curd Low fat curd 100g 60 3.1 32 115
Fats Ghee, Vegetable oil 4-5 tsp. /day 180 0 0 0
Sugar Table Sugar 4-5 tsp 100 0 0 0
Fruits Apple, Pineapple ,Orange 100g 100 0 22 50
Salt Table Salt ¼ tsp. 0 0 1250 0
Total 1500 35 1500 1000

Note:The amount of nutrient may vary depending on the portion size taken and cooking method.
# 1 serving = 30 g raw foods = 1 bowl cooked food
#1 Tea spoon= 5 g
#1 Tea cup = 120 ml
#1 veg bowl = 100 g

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