The Sodium-Controlled Diet limits sodium intake. Foods and condiments high in sodium are eliminated or restricted at suggested levels to optimally manage blood pressure and underlying medical conditions associated with hypertension or chronic organ damage. The average dietary sodium intake is approximately 4,100 mg/day for American men and 2,775 mg/day for American women. The consumption of processed foods accounts for 75% of the daily sodium intake. The minimum daily sodium requirement for healthy adults is 500 mg
The Sodium-Controlled Diet is used in the treatment of conditions characterized by edema (water retention), including the following: · Cirrhosis of the liver with ascites ·
Heart failure ·
Under normal physiologic conditions, the body responds to an increase in sodium consumption with an increase in sodium excretion, generally eliminating the excess sodium within 24 hours.
However, certain diseases or conditions impair the body’s ability to maintain a normal sodium and water balance, necessitating a reduction in sodium intake
Cirrhosis of the liver with ascites
Ascites, an accumulation of nutrient-rich fluid in the peritoneal cavity, often occurs as a result of hepatic cirrhosis. A small percentage of patients with this condition lose weight and reduce their fluid volume by adhering to a sodium-controlled diet. Almost 90% of patients respond to combination therapy consisting of a sodium-controlled diet and diuretics, whereas the other 10% of patients are resistant to combination therapy and require further medical intervention.
In patients with heart failure, the kidneys respond to a decrease in systemic blood flow by increasing the absorption of sodium and fluids, leading to edema and worsening heart failure. To promote diuresis, a sodium-controlled diet accompanied by diuretic use is the preferred method of treatment. In heart failure, sodium intake should be less than 2,000 mg (2 g) per day.
Sodium restriction will improve clinical symptoms and quality of life. According to the Comprehensive Heart Failure Practice Guidelines, dietary sodium restriction of 2- to 3- g daily is recommended for patients with the clinical syndrome of heart failure and a preserved or depressed left ventricular ejection fraction (LVEF). Further restriction (< 2 g daily) may be considered in moderate to severe heart failure
Sodium-sensitive individuals have an impaired ability to excrete large concentrations of sodium, leading to increased serum sodium levels, hypervolemia, and hypertension. Between 20% and 50% of individuals with hypertension, particularly the elderly and African Americans, respond to an increase in sodium consumption with an increase in blood pressure.
Other lifestyle modifications that can help prevent hypertension include losing excess body weight, following the Dietary Approaches to Stop Hypertension (DASH) eating plan, increasing physical activity, and avoiding excess alcohol intake.
Under normal conditions, the dietary restriction of sodium intake should not cause sodium depletion. However, a sodium-controlled diet is contraindicated in the presence of the following:
Conditions that promote sodium depletion (profuse perspiration, vomiting, and diarrhea) ·
Impaired mechanisms of sodium conservation (colectomy and ileostomy in the postoperative period)
Conditions that conserve sodium as a normal physiologic adjustment (pregnancy)
Lithium carbonate therapy (The kidney does not always discriminate between sodium and lithium. Therefore, with a low sodium intake, the kidney may conserve both sodium and lithium, causing an increased serum lithium level and the potential for lithium toxicity
How to Order the Diet
Order the diet in terms of sodium, not salt.
Order the amount of sodium that should not be exceeded in the diet. Different levels of sodium-controlled diets limit the daily sodium intake to 1,500mg (65 mEq), 2,000 mg (87 mEq), 3,000 mg (130 mEq) or 4,000 mg (174 mEq).
The dietitian may allow certain higher sodium foods to be added to the patient’s diet if the patient’s sodium intake falls below the prescribed range due to low energy intake.
Note that diets containing less than 2,000 mg/day of sodium are difficult to sustain outside of the hospital environment for reasons of palatability and convenience.