It is very difficult to dissociate the dietetic treatment of haemoptysis from the general treatment of this complication. The dietetic treatment of haemoptysis varies very considerably with the cause and severity of the bleeding and the condition of the patient.
It must be remembered that haemoptysis may be anything between slight discolortaion of the sputum to a loss of blood amounting to several pints. Slight discoloration of the sputum is by no means uncommon among consumptives and is probably the result of some local congestion. Such cases rapidly clear up if kept at rest for a day or two and usually require no special dietetic treatment. If, however, the discoloration continues or if the bleeding is from the commencement rather more marked it is desirable to restrict the diet somewhat particularly in the amount of fluid taken, in order to reduce blood pressure to some extent. This is easily accomplished by cutting off all tea, coffee, etc., reducing the amount of milk taken to 1 pint a day, and for a day or two reducing the amount of solid food taken to a slight extent.
In the case of severe haemoptysis, due probably to the erosion of a blood vessel or the rupture of a pulmonary aneurism, the indication is to reduce blood pressure as quickly as possible and to maintain it at a low level for some days after all bleeding has ceased. For this purpose the diet should be small in bulk and should contain but very little fluid. For the first 24 hours after a severe haemorrhage little or no food should be given, milk in small amount, 1 or 2 teaspoonfuls at a time, being allowed to allay thirst more than for any other purpose. Milk should be iced and the mouth should be washed out at intervals with iced water, or small lumps of ice may be given to suck. Such patients suffer a great deal from thirst, especially if they are treated by free purgation with salts; ice relieves the thirst better than anything else, but care must be taken that the patient does not swallow a considerable quantity of fluid in this way.
During the next few days the diet should be small in amount, unstimulating, and should not contain an excessive amount of fluid; 1 1/2 pints of milk, and 3 or 4 oz. of toast and butter, and an egg or shredded meat sandwiches will be ample and should be taken cold and in small quantities at a time.
The diet should be increased on the third or fourth day after the attack and the original diet may in most cases be resumed in ten days' time. The following diet which was taken by a patient with haemoptysis on the fourth day after the attack is a good example of the kind of diet we prescribe.
8 a.m......One egg beaten up with milk, 1 oz.
Toast, 1 oz., buttered.
10 a.m......Raw meat sandwich, bread, 1 oz.; meat, 1 oz.; butter.
12 noon.....Custard pudding, 3 oz.
2 p.m......Benger's food, 3 oz.
4 p.m......Pounded chicken or fish, 3 oz.
Bread or potatoes, 1 oz.
6 p.m......Milk and casumen, 2 oz.
Toast, 1 oz., buttered.
8 p.m......Poached egg on toast.
10 p.m......Junket, custard, 3 oz.
2 a.m......Benger's food, 3 oz.
4 a.m......Milk and casumen, 4 oz.
Such a dietary is easily taken, has a very fair nutritive value, and is small in bulk. If the patient's condition is satisfactory it is advisable to continue the use of a diet of this kind, but gradually increasing the amount and the intervals for giving food, until the sputum is clear, at which date an ordinary diet can usually be safely resumed. Throughout the week or ten days following the haemoptysis, and prior to the clearing up of the sputum, a careful watch should be kept upon the blood pressure, which can be controlled to a very considerable extent by careful dieting and the exhibition of saline purgatives. With a satisfactory low blood pressure the diet can often be gradually approximated to the normal diet before the sputum has completely cleared. Where there is much exhaustion or high fever a few days after the haemoptysis, it is wiser to increase the diet more rapidly, controlling the blood pressure as much as possible in other ways. In patients who have a succession of haemorrhages, the dietetic indications are very similar, viz., the strength of the patient must be maintained at all costs, but at the same time the pulse rate and the blood pressure should be controlled as far as possible. It is impossible to lay down more precise instructions in the dietetic treatment for such cases.