Clear Liquid Diet

Description
The clear liquid diet has traditionally been composed of foods that are transparent and liquid at body temperature. Foods allowed in this diet include juice, gelatin, ice water, popsicles, ice chips, sweetened tea or coffee, and soda pop. These foods are primarily sugar and water. Meat or vegetable broths, primarily composed of water and salt, are also allowed on the clear liquid diet. Some institutions serve hard candy as part of the clear liquid diet because it dissolves to sugar and water at body temperature.

Indications
The clear liquid diet, once widely used in hospitals, has been used to maintain hydration while minimizing colonic residue during the following situations: In gastrointestinal illness, including abdominal distention, nausea, vomiting, and diarrhea In preparing the bowel for surgery or a gastrointestinal procedure To reintroduce foods following a period with no oral intake when poor tolerance, aspiration, or anastomotic leak is anticipated However, the clear liquid diet is nutritionally inadequate for patients of all ages, and long-term use of clear liquids is thought to contribute to hospital malnutrition. At present, use of the clear liquid diet has declined for several reasons, including the following: To avoid underfeeding and to maintain an adequate nutrient intake, the clear liquid diet is used only when absolutely necessary. Calorie and protein supplements may be ordered for patients on clear liquids for more than 3 or 4 days, but these are not widely accepted by patients. The widespread use of polyethylene glycol and sodium phosphate to prepare the bowel for surgical or gastrointestinal procedures has decreased the time required for bowel preparation to 1 or 2 days. Bowel preparation is typically completed within 48 hours and patients consume clear liquids for less than half of this time (Belsey; DeLegge; Maltby). Understanding of time required for gastric emptying has increased. Thus, recommendations for oral intake before surgery have been revised and often only one clear liquid meal is needed preoperatively (American Society of Anesthesiologists). Postoperatively, the amount of time before a general diet can be consumed has declined because of improved anesthesia, the new knowledge that return of bowel sounds is not a prerequisite for feeding, reduced use of postoperative nasogastric suction, and a push toward early feeding to facilitate early discharge (Lewis; Pearl; Pruthi; Seven; Vermeulen). The clear liquid diet and clear liquid supplement beverages are unpalatable, prompting patient complaints and reducing patient satisfaction scores (Scott, American Society of Anesthesiologists).

Copyright 2007 American Dietetic Association. All rights reserved. 1

Guidelines for Preoperative Fasting

The American Society of Anesthesiologists Task Force on Preoperative Fasting recommends fasting from clear liquids for 2 or more hours before procedures requiring general anesthesia. This group also suggests that it is appropriate to fast from intake of any light meal or nonhuman milk at least 6 hours before elective surgery requiring general anesthesia (American Society of Anesthesiologists).

Guidelines for Patients with Diabetes

Because the clear liquid diet is primarily composed of water, sugar, and salt, dietitians receive occasional requests for diabetic or sugar-free clear liquids. However, in recent guidelines, the American Diabetes Association states that sugar-free liquid diets are not appropriate for patients with diabetes. The guidelines further state that patients with diabetes given clear liquid diets should receive approximately 200 g carbohydrate spread equally throughout the day (Clement).

Sample 1-Day Menu

Breakfast Cranberry juice Chicken broth Lime gelatin Soda Water, ice, or popsicle Coffee Midmorning Apple juice Lunch Grape juice Beef broth Orange gelatin Soda Water, ice, or popsicle Tea Midafternoon Cranberry juice Dinner Apple juice Chicken broth Cherry gelatin Soda Water, ice, or popsicle Tea Bedtime Grape juice

Nutrient Composition
Energy Carbohydrate Protein Fat Sodium (mg) Potassium (kcal) (g) (g) (g) (mg) Total 1167 274 14 0 2709 519

Copyright 2007 American Dietetic Association. All rights reserved. 2

References
American Society of Anesthesiologists Task Force on Preoperative Fasting. Practice guidelines for preoperative fasting and the use of pharmacologic agents to reduce the risk of pulmonary aspiration: application to healthy patients undergoing elective procedures. Anesthesiology. 1999;90:896-905. Belsey J, Epstein O, Heresbach D. Systematic review: oral bowel preparation for colonoscopy. Aliment Pharmacol Ther. 2007;25:373-384. Clement S, Braithwaite SS, Magee MF, Ahmann A, Smith EP, Schafer RG, Hirsch IB. Management of diabetes and hyperglycemia in hospitals. Diabetes Care. 2004;27:553-591. Delegge M, Kaplan R. Efficacy of bowel preparation with the use of a prepackaged, low fibre diet with a low sodium, magnesium citrate cathartic vs a clear liquid diet with a standard sodium phosphate cathartic. Aliment Pharmacol Ther. 2005;21:1491-1495. Lewis AJ, Eggar M, Sylvester PA, Thomas T. Early enteral feeding versus nil by mouth after gastrointestinal surgery: a systematic review and meta-analysis of controlled trials. BMJ. 2001;323:1-5. Maltby JR, Pytka S, Watson NC, Cowan RA, Fick GH. Drinking 300 mL of clear fluid two hours before surgery has no effect on gastric fluid volume and pH in fasting and non-fasting obese patients. Can J Anaesth. 2004;51:111-115. Pearl ML, Frandina M, Mahler L, Valea FA, DiSilvestro PA, Chalas E. A randomized controlled trial of a regular diet as the first meal in gynecologic oncology patients undergoing intraabdominal surgery. Obstet Gynecol. 2000;100:230-234. Pruthi RS, Chun J, Richman M. Reducing time to oral diet and hospital discharge in patients undergoing radical cystectomy using a perioperative care plan. Urology. 2003;62:661-665. Scott SR, Raymond PL, Thompson WO, Galt DJ. Efficacy and tolerance of sodium phosphates oral solution after diet liberalization. Gastroenterol Nurs. 2005;28:133139. Seven H, Calis AB, Turgut S. A randomized controlled trial of early oral feeding in laryngectomized patients. Laryngoscope. 2003;113:1076-1079. Vermeulen H, Storm-Versloot MN, Busch ORC, Ubbink DT. Nasogastric intubation after abdominal surgery. Arch Surg. 2006;141:307-314.

Copyright 2007 American Dietetic Association. All rights reserved. 3