Salt intake

The ACE inhibitors may cause a significant drop in blood pressure after the first dose This effect can be minimized by discontinuing the diuretic therapy (if the patient is taking a diuretic) or by increasing salt intake for at least 1 week before treatment with the ACE inhibitors is begun or beginning treatment with small doses. After the first dose of an ACE inhibitor, the nurse monitors the blood pressure every 15 to 30 minutes for at least 2 hours and afterward until the blood pressure is stable for 1 hour. 

All patients with ascites require counseling on dietary sodium restriction. Salt intake should be limited to less than 800 mg sodium (2 g sodium chloride) per day. More stringent restriction may cause faster mobilization of ascitic fluid, but adherence to such strict limits is very difficult. Patients usually respond well to sodium restriction accompanied by diuretic therapy.14,22,31,32 The goal of therapy is to achieve urinary sodium excretion of at least 78 mEq (78 mmol) per day.22 While a 24-hour urine collection provides this information, a spot urine sodium/ potassium ratio greater than 1.0 provides the same information and is much less cumbersome to perform. 

Sodium balance is achieved when salt intake is equal to salt output. The intake of salt in the average American diet (10 to 15 g/day) far exceeds what is required physiologically. Only about 0.5 g/day of salt is lost in sweat and feces. The remaining ingested salt must be excreted in the urine. The amount of sodium excreted by the renal system is determined by ... 

Angiotensin I Salt intake and ACE Variation in the efficacy of reduced sodium intake (90) Susceptibility to essential hyperten-... 

Electrolyte imbalance Electrolyte imbalance may occur, especially in patients receiving high doses with restricted salt intake. Perform periodic determinations of serum electrolytes. 

Life-style measures that are widely agreed to lower blood pressure and that should be considered in all patients in whom they may apply are weight reduction, reduction of excessive alcohol consumption, reduction of high salt intake and increase in physical activity. Particular emphasis should be placed on cessation of smoking and on healthy eating patterns that contribute to the treatment of associated risk factors and cardiovascular diseases. 

Improper BP measurement Volume overload and pseudotolerance Volume retention from kidney diseaase Excess salt intake Inadequate diuretic therapy Drug induced or other causes Non-adherence to therapy Doses too low Inappropriate combinations Non-steroidal anti-inflammatory drugs Cocaine and other iflicit drugs Sympathomimetics (decongestants, anorectics)... 

Diuretics, typically spironolactone, form the main therapy, combined with restricted salt intake. Sodium restriction is usually unnecessary where fluid retention is mild, and if marked limitation (less than 40 mmol per day intake) is imposed, may lead to impaired nutrition and is poorly accepted. Diuretic treatment often requires reinforcement with loop diuretics. Treatment can be maintained if urinary sodium excretion is at least 30 mmol per day. Removal of ascites through diuresis requires fluid transfer through the intravascular fluid compartment. If diuresis is too intense the intravascular fluid volume is reduced and hypotension causes hepatorenal failure to follow. The aim should be, through monitoring weight loss, to restrict fluid removal to 0.5 kg per day. In this way the risks of hyponatraemia, renal and hepatic impairment should be reduced. 

Hypokalemia. Used in patients with low serum K+ resulting from diuretic therapy with other agents. Its use should be restricted to patients who are unable to supplement their dietary intake or adequately restrict their salt intake or who cannot tolerate orally available KCl preparations. 

Concern has been expressed that because the consumption of salt is associated with the risk of hypertension, promotion of the health benefits of fluoridated salt will confuse the public. However, populations in countries such as France or Germany are not encouraged to increase their salt intake in order to improve their oral health. Rather they accept fluoridation of salt as a passive means of improving their dental health and do not appear to be consuming more salt in order to enhance any effect [142]. 

Fluoridation of domestic salt for human consumption was initiated in Switzerland in 1955 [133]. Fluoridated salt usually contains 200-250 mg/kg of fluoride, mostly in the form of potassium salt, so 1 g of fluoridated salt provides 0.20-0.25 mg of fluoride [2]. The average daily adult salt intake is estimated to vary from 5 to 10 g [6] so, if all consumed salt were fluoridated, the total daily intake of fluoride would range from 1 to 2.5 mg. Salt fluoridation can reach the entire population, however, addition of fluoride is limited mainly to domestic salt, leaving salt used by bakeries, large kitchens, enterprises and institutions, as well as by the food industry, unfluoridated. Schemes of fluoridation of domestic salt are most developed in France, Germany and Switzerland [134]. Detailed information on the history and experiences of salt fluoridation in Switzerland, France, Germany, Central and Eastern Europe and America were recently reported [133,135-138]. 

The pharmacokinetics of a drug can also determine the frequency of monitoring. Many believe that TDM requires frequent blood drawings, primarily based on the experience with lithium. However, this drug is relatively unique in that its levels are determined by multiple independent factors. Thus, the plasma level of lithium is not solely a function of the dose and of renal status, but also of fluid and salt intake and output, which can vary independent of dose. 

The dose of MAOl can sometimes be reduced, but this adverse effect often occurs at the minimal therapeutic dose. A good fluid intake plus increased salt intake, support stockings, and a mineralocorticoid (e.g., fluorohydrocortisone at doses of 0.3 to 0.8 mg) can alleviate the problem. 

Approximately two thirds of kidney stones contain Ca2+ phosphate or Ca2+ oxalate. Many patients with such stones exhibit a defect in proximal tubular Ca2+ reabsorption that causes hypercalciuria. This can be treated with thiazide diuretics, which enhance Ca2+ reabsorption in the distal convoluted tubule and thus reduce the urinary Ca2+ concentration. Salt intake must be reduced in this setting, since excess dietary NaCI will overwhelm the hypocalciuric effect of thiazides. Calcium stones may also be caused by increased intestinal absorption of Ca2+, or they may be idiopathic. In these situations, thiazides are also effective, but should be used as adjunctive therapy with other measures. 

There is an additional layer of complexity associated with the effects of renal prostaglandins. In contrast to the medullary enzyme, cortical COX-2 expression is increased by low salt intake, leading to increased renin release. This elevates glomerular filtration rate and contributes to enhanced sodium reabsorption and a rise in blood pressure. PGE2 is thought to stimulate renin release through activation of EP4 or EP2. PGI2 can also stimulate renin release and this may be relevant to maintenance of blood pressure in... 

A link between heavier alcohol consumption (more than three drinks per day) and hypertension has been firmly established in epidemiologic studies. Alcohol is estimated to be responsible for approximately 5% of cases of hypertension, making it one of the most common causes of reversible hypertension. This association is independent of obesity, salt intake, coffee drinking, and cigarette smoking. A reduction in alcohol intake appears to be effective in lowering blood pressure in hypertensives who are also heavy drinkers the hypertension seen in this population is also responsive to standard blood pressure medications. 

Aldosterone is secreted at the rate of 100-200 mcg/d in normal individuals with a moderate dietary salt intake. The plasma level in men (resting supine) is about 0.007 mcg/dL. The half-life of aldosterone injected in tracer quantities is 15-20 minutes, and it does not appear to... 

Blood pressure, especially systolic pressure, increases with age in Western countries and in most cultures in which salt intake is high. In women, the increase is more marked after age 50. Although treated conservatively in the past, most clinicians now believe that hypertension should be treated vigorously in the elderly. 

The most common use of salt is as part of daily diets. Although it is added directly to food, 75% of the salt consumed in the United States is a result of eating processed foods The National Academy of Sciences has determined that a minimum daily requirement of 500 mg of sodium is safe, which equates to 1,300 mg of salt. The Academy and the federal government recommend that sodium consumption be no more than 2,400 mg per day, which equals 6,100 mg of salt. Most Americans consume levels higher than this, and many health organizations recommend decreasing salt intake. Excess salt can lead to health problems such as elevated blood pressure, although recent research seems to indicate that normal or moderately... 

Of the seven macro mineral elements required by dairy cattle, five can be considered fertilizer elements (potassium, calcium, phosphorus, magnesium, and sulfur), but sodium and chloride are both toxic lo plants at high concentrations and present practical problems in areas with saline soils. High salt intakes have also been shown lo increase udder edema in heifers. Because of the importance of chloride in nutrition and mclabolisni. research is needed to define the chloride requirements of lactating cows and clarify mineral relationships, especially between chloride and potassium plus sodium-... 

If you re like most people, you probably feel a little guilty about reaching for the saltshaker at mealtime. The notion that high salt intake and high blood pressure go hand in hand is surely among the most highly publicized pieces of nutritional lore to appear in recent decades. 

Let s get back now to the dinner table. What about the link between dietary salt intake and high blood pressure There s no doubt that most people in industrialized nations have a relatively high salt intake, and there s no doubt that high blood pressure among industrialized populations is on the rise. What s not so clear is how the two observations are related. 

---