Diet plan for sepsis plays an important role in sepsis treatment. First, it could help prevent and treat infections. Second it can help with recovery from illness and prevent complications from developing such as problems with blood flow to vital organs and tissue breakdown
Sepsis is a system-wide response to an infection, triggered by toxins released into the bloodstream by bacteria. It is often fatal due to the body’s extreme response. One issue that individuals with sepsis must deal with is the inability to eat. In this article, we will cover everything there is to know about diet for sepsis and what you need to do.
WHAT DO I NEED TO KNOW ABOUT SEPSIS?
Thanks to Nottingham University medical student Catarina Soares for researching and putting this piece together. Have a read of Catarina’s other pieces discussing The Dietfits Study and the persistent diet-myth about whether fruit is for “bad”.
It isn’t difficult to find countless headlines and scare stories about sepsis – or any illness, for that matter. But what exactly is sepsis, and why should we be worried about it?
What is sepsis?
Sepsis is defined as a life-threatening organ dysfunction caused by an overwhelming response to infection. When we get an infection, our body triggers a defence mechanism, the inflammatory response, to fight off the bug or toxin. This inflammatory response can sometimes be so strong that our immune system causes harm to our own body: collateral damage in the fight against the infection.
It’s important to highlight the difference between a ‘bad infection’, sepsis, and septic shock. Sepsis is when the body’s response to infection (not the bacteria themselves) damages the tissues and organs, making it more serious than an infection alone, and septic shock is a very severe form of sepsis. An infection is caused by a bacteria or other bug that enter the body and cause damage or disease, and although it causes inflammation, it does not always lead to sepsis.
How does sepsis affect the body?
A very strong inflammatory response can do us harm by interfering with the body’s ability to function normally. During the inflammatory response, some of the chemicals released make the blood vessels leakier for the white blood cells (that fight infection) to get to the bacteria. However this process can also make the blood pressure fall. A drop in blood pressure subsequently reduces blood flow to vital organs, which means they don’t get enough oxygen to work properly, which leads to organ dysfunction.
Inflammation also acts a little like a domino effect: once it is triggered, it recruits more and more cells through the release of chemicals. Although there are also some molecules that are anti-inflammatory to help regulate this response, in sepsis the balance is tipped towards inflammation.
Another effect of widespread inflammation is the activating of blood clotting molecules, which causes coagulation of blood. This process can block small blood vessels, also leading to organ damage.
What causes sepsis?
It can be brought on by different kinds of infection, like pneumonia, skin or wound infections, meningitis, or the flu. As it’s associated with infections, those with a more fragile immune system are at a greater risk of developing sepsis – a bigger, more widespread infection is more likely to trigger the immune system into overdrive.
What are the symptoms of sepsis?
A blood test may be needed to know if someone has sepsis, but there are screening tools which give healthcare professionals clues to the diagnosis.
When blood pressure drops, the body has an automatic response to try bring it back up or getting the nutrients and oxygen where they’re needed. To do this, the heart starts pumping faster and the breathing rate increases. This means that people with sepsis will often have a fast heart rate and a fast breathing rate, in addition to low blood pressure. They may also have a fever (above 38ºC), which is part of the body’s reaction to fight infection, or they may have a very low temperature (less than 36ºC).
In cases of severe sepsis, and septic shock, other symptoms can include confusion or disorientation, a significant decrease in urine output, rashes (that don’t disappear when pressed on), or cold and clammy skin.
Blood tests give us more information about how unwell someone is. Two key tests doctors check as part of the sepsis pathway are the white blood cell count (WBC) and lactate. However, other blood tests, microbiology tests, and imaging are ordered too, to paint a complete picture of what is wrong.
How is it treated?
If doctors suspect sepsis, they start a treatment plan known as Sepsis Six (1,6):
- Give oxygen
- Do some blood tests
- Give antibiotics
- Give fluids
- Measure urine production
- Blood cultures (to try find any bugs in the blood)
This fights the infection in the best way possible: first doctors start with broad antibiotics that can kill most bugs, and try to find out which bacteria is causing the illness so that at a later stage, antibiotics that are more targeted to that bacteria can be used. Measuring urine production and doing blood tests allows doctors to monitor the patient’s progress, to know how poorly they are, and whether they’re getting better. The fluids and oxygen are supportive measures – they keep the blood pressure up and oxygen levels high to help the body recover until it’s well enough to do that on its own.
Should I be afraid?
It’s not something you need to worry about every time you get an infection but knowing NHS advice is helpful in case you’re ever worried that you or someone you know may have sepsis – particularly those who are at greater risk.
- You should call 999 or go straight to A&E if a child looks mottled, bluish or pale; is very lethargic or difficult to wake; feels abnormally cold to touch; is breathing very fast; has a rash that does not fade when you press it; or has a fit or convulsion. If the child is under 5 and not feeding, is vomiting repeatedly or hasn’t had a wee or wet nappy for 12 hours, and you’re worried they’re getting worse, call 111 or see your GP.
- Women who are pregnant, or have recently given birth, had a miscarriage or a termination of pregnancy are a high risk group for sepsis. The signs and symptoms are similar, but may be less obvious – so it’s important to be aware of them.
- People who have a compromised immune system (such as those undergoing chemotherapy) are another high-risk group. These patients are given advice by their doctors to be in contact if their temperature goes over 38ºC.
If you’ve recently had an infection or injury, and think you may have the early signs of sepsis, follow NHS advice and ring 111 for further guidance.
Although sepsis is dangerous, it is also treatable – especially when picked up early. Doctors and other healthcare professionals undergo a lot of training in order to recognise and treat sepsis. There are also a great deal of public education measures to make sure people are informed about what symptoms to look out for, especially those at a higher risk. I couldn’t put it any better than the UK Sepsis Trust – if you’re worried, just ask: “could it be sepsis?”.
Sepsis Treatment
Your doctor will probably keep you in the hospital’s intensive care unit (ICU). Your medical team will try to stop the infection, keep your organs working, and manage your blood pressure. IV fluids and extra oxygen can help with this.
Broad-spectrum antibiotics may fight infections caused by bacteria early on. Once your doctor knows what’s causing your sepsis, they can give you medicine that targets that specific germ. Often, doctors prescribe vasopressors (which make your blood vessels narrow) to improve blood pressure. You could also get corticosteroids to fight inflammation or insulin to keep control of your blood sugar.
If your case is severe, you might need other types of treatment, like a breathing machine or kidney dialysis. Or you may need surgery to drain or clean out an infection.
Sepsis Complications
As sepsis gets worse, it causes more problems throughout your body. These may include:
- Kidney failure
- Dead tissue (gangrene) on fingers and toes, leading to amputation
- Lung, brain, or heart damage
- A higher risk of infections over time
Sepsis can be deadly in between 25% and 40% of cases.
Sepsis Prevention
Preventing infection is the best way to prevent sepsis. Take these steps:
- Wash your hands often with soap and water for at least 20 seconds each time.
- Keep up with recommended vaccines for things like flu and chickenpox.
- Keep control of any chronic health conditions.
- If you have an injury that’s broken your skin, clean it as soon as possible. Keep it clean and covered as it heals, and watch for signs of infection.
- Treat any infections. Get medical care right away if they don’t get better or if they seem like they’re getting worse.
Neutropenic Diet
What is a Neutropenic Diet?
A neutropenic (nu-tro-PEE-nik) diet is for people with weakened immune systems. This diet helps protect them from bacteria and other harmful organisms found in some food and drinks. If your immune system is not working well, your body may have a hard time protecting itself from these bacteria. Cooking foods (like beef, chicken, fish, and eggs) completely makes sure that all bacteria are destroyed.
Who Needs to Follow a Neutropenic Diet?
Doctors often recommend this diet before and after certain types of chemotherapy and other cancer treatments. A blood test called an absolute neutrophil count (ANC) can help determine the body’s ability to fight off infection. Many cancer patients have this blood test done routinely. When the ANC is less than 500 cells/mm3, the patient is often instructed to follow a neutropenic diet. This diet should be followed until the doctor tells the patient to resume his or her regular diet.
Patients undergoing autologous stem cell transplants typically follow this diet during the pre-transplant chemotherapy and for the first 3 or more months after transplant. Patients undergoing allogeneic stem cell transplants typically follow this diet during the pre-transplant chemotherapy and continue on it until they no longer take immunosuppressive drugs. The transplant team will tell the patient how long to follow this diet.
People who have had an organ transplant or who are being treated for HIV/AIDS also may need to follow this diet. If you are not sure if you should follow this diet, check with your doctor, nurse, or dietitian.
General Tips
The following pages list the foods you should choose when you are on a neutropenic diet. Foods you should avoid are also listed. Please check with your doctor, nurse, or dietitian if you have questions about the diet or safe food preparation. Some general tips include:
- Avoid all fresh fruits and vegetables, including all fresh garnishes. Cooked vegetables, canned fruits, and juices are fine.
- Avoid raw or rare-cooked meat, fish, and eggs. Meat should be cooked to the “well- done” stage. All eggs should be thoroughly cooked (no runny yolks).
- Avoid salad bars, fruit bars, and deli counters. Buy vacuum-packed lunch meats rather than freshly sliced meats.
- Avoid raw nuts. You may eat baked products with these ingredients.
- Make sure all of the dairy products you eat are pasteurized.
- Avoid yogurt and yogurt products with live and active cultures.
- Be safe in the way you handle foods. Wash your hands before handling food. Wash all surfaces, cutting boards and cutting utensils thoroughly. Keep hot food hot and cold food cold. (See the UPMC patient education sheet Food Safety: Preventing Foodborne Illness for more information.)
- At home, you may use tap water. If you choose to use bottled water, be sure it is labeled as follows:
- Reverse osmosis or
- Distillation or
- Filtered through an absolute1 micron or smaller filter
- Well water is OK if it is boiled for at least 1 minute.
Neutropenic Diet
Beverages
| Foods to Choose | Foods to Avoid |
|---|---|
| Instant and brewed decaf or regular coffee and tea | Any others, such as cold brewed tea or sun tea |
| Individual cans or bottles of carbonated beverages | |
| Tap, bottled and distilled waterIce made with tap water | |
| Brewed herbal teas | |
| All canned, bottled and powdered beverages and sports drinks |
Starches (including breads, crackers, cereal, and potatoes)
| Foods to Choose | Foods to Avoid |
|---|---|
| All types of bread, rolls, English muffins, fruit muffins, bagels, sweet rolls, donuts | Breads and rolls with raw nuts |
| Waffles | Cereals containing raw nuts |
| French toast, pancakes | Raw oats |
| Potato chips, corn chips, tortilla chips, pretzels, popcorn, crackers, melba toast | Uncooked pasta, pasta salad, or potato salad with raw vegetables or eggs |
| All types of cooked and ready-to-eat cereals | |
| Cooked grains, rice, and pasta, such as noodles, macaroni, and spaghetti | |
| Cooked white or sweet potatoes and yams, French fries, tater tots, hash browns, etc. |
Dairy products
| Foods to Choose | Foods to Avoid |
|---|---|
| Pasteurized milk; fat-free milk, 2% milk, whole milk, buttermilk, or chocolate milk | Unpasteurized milk or yogurt |
| Sour cream | Milkshakes made with non-commercial ice cream or made in a blender |
| Milkshakes using individual cartons of ice cream and milk, or homemade milkshakes | Yogurt or soft ice cream from a machine |
| Commercial eggnog | Eggnog made with raw eggs |
| Commercial supplements such as instant breakfast drinksliquid and powdered drinks | Yogurt and yogurt products made with live and active cultures |
| Commercial frozen milkshakes | |
| Refrigerated and frozen pasteurized whipped topping |
Cheese
| Foods to Choose | Foods to Avoid |
|---|---|
| Commercially packaged cheese (for example, American, Swiss, Parmesan, mozzarella, cheddar) | Unpasteurized and raw milk cheese |
| Pasteurized cottage cheese, ricotta cheese | Cheeses with molds (for example, blue, Gorgonzola, Roquefort, and Stilton cheeses) |
| Processed cheese (for example, Velveeta) | Soft cheeses (for example, Brie, Camembert, feta, farmer cheese) |
| Cheeses containing uncooked vegetables | |
| Mexican-style cheeses, such as queso fresco and queso blanco |
Desserts (and other sweets)
| Foods to Choose | Foods to Avoid |
|---|---|
| Cakes, pies, and cookies | Cakes with raw nutsRaw, un -baked cookie dough |
| Baked custard, pudding, and gelatin | Soft ice cream or yogurt from a machine |
| Commercial ice cream, sherbet, fruit ice, and Popsicles | Non-commercial or homemade ice cream or sherbet |
| Refrigerated cream-filled pastries and desserts | Cream filled pastries that are not refrigerated |
| Candy, including chocolate | Candy with raw nuts |
| Pasteurized honey and syrup | |
| Chewing gum |
Fats
| Foods to Choose | Foods to Avoid |
|---|---|
| Butter or margarine | Avocado dressing |
| Cream cheese, sour cream, salad dressings, or mayonnaise | Fresh salad dressing containing aged cheese, raw eggs, or fresh herbs |
| Oil- all types | |
| Shortening used in cooking | |
| Non-dairy creamers |
Fruits and fruit juices
(These foods may be restricted during severe neutropenia and during your hospital stay.)
| Foods to Choose | Foods to Avoid |
|---|---|
| Canned fruits and juices | All fresh fruits except those listed in the “Foods to Choose” column |
| Pasteurized frozen juices | Unwashed raw fruit |
| Pasteurized cider and apple juice | Unpasteurized fruit juices |
| Thick-skinned fruits such as raw bananas, grapefruit, and oranges that are washed in cold water, and peeled by a nurse or family member | |
| Frozen fruits | |
| Dried fruits |
Meat (includes fish, poultry, dried beans, eggs, meat substitutes, and soups)
| Foods to Choose | Foods to Avoid |
|---|---|
| Well-cooked meats, beef, lamb, pork and pork products, poultry, game, fish, shellfish, hot dogs, sausage, bacon | Rare or medium rare cooked meat, fish, or poultry |
| Canned tuna or chicken (with no raw vegetables) | Stir-fried foods |
| Cooked baked beans and all other cooked legumes, dried beans, casseroles, stews, and entrées | Cold cuts from delicatessens |
| Frozen entrees | Cold meat or poultry |
| Pasteurized or cooked tofu | Fast food |
| Eggs, well-done | Raw eggs |
| Pasteurized egg substitutes (for example, Egg Beaters) and powdered eggs | Eggs not well-cooked, such as sunny-side-up (runny yolk) |
| Canned and homemade soup (heated well) | Old soups and gazpacho, all miso products such as paste and soup |
| Sushi | |
| Sashimi |
Vegetables
| Foods to Choose | Foods to Avoid |
|---|---|
| All well-cooked canned, frozen or fresh vegetables | All raw vegetables |
| Canned vegetable juices | Stir-fried vegetables |
| Fresh salads | |
| Fresh sauerkraut |
Miscellaneous
| Foods to Choose | Foods to Avoid |
|---|---|
| Individual packages of salt, sugar, and pepper used after cooking | Spices, herbs, or seasonings added to foods after cooking (except for allowed items) |
| All other herbs or seasonings added during cooking | Uncanned or home-canned pickles and kosher pickles |
| Low-sodium seasoning added during cooking | Freshly-made peanut butter |
| Gravy and cream sauce | Hollandaise sauce |
| Commercial peanut butterJam and jelly | Raw nuts |
| Commercial pickles processed in jars or cans | Roasted nuts in shell |
| Lactaid drops | |
| Canned or bottled roasted nuts | |
| Nuts in baked goods | |
| Shelled, roasted nuts |
Dietary supplements
| Foods to Choose | Foods to Avoid |
|---|---|
| Commercial high-calorie/high-protein drinks, puddings, and snack bars if approved by a doctor or nurse | Supplements and vitamins (unless approved by a doctor or nurse) |
Sample diet
Breakfast
1- large egg scrambled
Medium biscuit with 1tsp butter and 1 tsp Jelly
1/2 cup apple juice
1/2 cup 2% milk
Coffee or tea
Morning snack
1cup dry cereal
1 cup 2% milk
2 Tbsp dried fruit
Lunch
Baked Meat loaf/ gravy
1/2 cooked corn
1/2 cup canned peaches
Slice wheat bread
Butter or margarine
Coffee or tea
1 cup 2% milk
Afternoon snack
1 cup of milkshake or high protein drink
Dinner
3 ounces Baked or Roasted Chicken
1/2 cup oven fried potatoes
1/2 cup glazed carrots
Dinner roll with butter or margarine
1/2 cup fruit cocktail
Coffee or tea
Evening Snack
Slice pound cake with whip topping
Managing Sepsis
Surviving Sepsis After Discharge
Recovery varies for everyone individually. While most patients with sepsis recover fully, those patients who go on to develop severe complications such as septic shock may need additional support and possibly rehabilitation on their road to recovery. Managing sepsis at home, after discharge from the hospital includes addressing several factors.
Initial sepsis recovery generally includes:
- Physical therapy and rehabilitation starting in the hospital: move around and get back to being able to perform daily activities like bathing, sitting up/ standing, walking, going up/downstairs, etc.
- Always start slowly and once strength is built up, increase activity as tolerated
What to Expect When at Home
Getting back to normal may feel challenging and your mind and body will need time to heal. Pay close attention to your body’s clues and seek additional help if you require help with:
Physical challenges:
- Weakness, fatigue, general aches, and pains
- Sleep irregularities
- Feeling short of breath
- Loss of appetite / Bad taste in your mouth / Stomach upset
- Weight loss
- Skin changes – dry/itchy/flaky skin
- Hair loss
- Unsteady movements
Mental health concerns:
- Insomnia
- Depression, not taking care of yourself
- Avoiding social contacts and being unmotivated
- Feeling anxious, angry, and frustrated
- Inability to concentrate
- Easily getting confused
- Having nightmares/flashbacks and bad memories
- Post-sepsis syndrome (see below)
What Should Be Done to Recover Well at Home From Sepsis
- Get plenty of rest and build up strength gradually
- Set small, achievable goals for each week – taking a bath, dressing yourself, walking up stairs
- Slowly increase activity and exercise as tolerated
- Maintain a healthy sleeping routine
- To prevent dehydration, drink plenty of fluids. Choose water and other caffeine-free clear liquids until you feel better. If you have kidney, heart, or liver disease and must limit fluids, talk with your doctor before you increase the amount of fluids you drink.
- Eat a healthy diet. Include fruits, vegetables, and whole grains in your diet every day.
- Do not smoke or use other tobacco products. When you quit smoking, you are less likely to get a cold, the flu, bronchitis, and pneumonia. If you need help quitting, please reach out to our smoking cessation team at 833-795-QUIT (833-795-7848).
You will be discharged with a list of your medicines when you leave the hospital.
- Know your medicines. Know what they look like, how much you should take each time, how often you should take them, and why you take each one.
- Take your medicines exactly as your provider tells you to. Even when you are feeling better, it is important to finish the full antibiotic treatment to make sure all bacteria have been killed.
- Carry a list of your medicines in your wallet or purse. Include any nonprescription medicines and supplements on the list.
Write down all your questions and follow up with your clinician for your scheduled check-up.
- Keep a journal
- Record your thoughts, dreams, successes, and struggles
- Record your temperature at least once daily (see log)
- Assess your health daily and seek help if you are not feeling well (see log)
- Engage in a conversation with friends and family about your experiences
- Learn about your condition and how you can prevent it from returning