Posts Tagged With: sodium

Clinical Nutrition: Edema

So today was the first day of my 2-week clinical rotation at Mon General Hospital. I followed a Registered Dietitian around today, which included going on rounds and speaking to patients referred by a physician or nurse.  One simple clinical term I came across today was edema.  Edema is an abnormal accumulation of fluid in the intercellular tissue spaces or body cavities.  The edema I saw today was present in the feet and ankles, but edema can also be found on other places in the body, such as periorbitally, or around the eyes.  (I didn’t include a photo in this blog, but if you feel like googling “pitting edema,” go right ahead!)

Edema can happen when fluid intake exceeds fluid loss, and can lead to a rapid weight gain. Just a weight gain of 2.2 pounds can mean 1 liter of fluid retention. So if a patient has gained 25 pounds in the last week, it could mean that the patient has retained 11 liters of water in their intercellular tissue spaces or body cavities.

The disease states associated with edema include cardiac failure, hypoalbuminemia (albumin osmotic force- lower albumin releases water into tissue spaces), malnutrition, liver failure, or kidney failure.  These conditions can cause a patient’s body to hold onto excess sodium and water.  In heart failure, renal blood flow is decreased.  This leads to renal retention of sodium and water in order to increase blood flow.  In addition, edema can also be caused by rapid administration of fluids, especially intravenous (IV) fluids.  Edema is treated with diuretics, which can rid the body of excess water. Low-sodium diets can also given to the patients, at 2g or less per day.

Pitting edema is measured on a 4-point scale, with 1+ being the least severe edema and 4+ being the most severe. A physician can press a finger onto the patient’s site of edema and a “pit” will form which will remain indented for anywhere from a brief second to over 30 seconds.  Examples of the 4-point scale are included below:

Pitting Edema – measurement

1+
Barely detectable impression when finger is pressed into skin.   
2+
Slight indentation.15  seconds to rebound
3+
Deeper indentation. 30  seconds to rebound.
4+
> 30  seconds to rebound.

O’Sullivan, S.B. and Schmitz T.J. (Eds.). (2007). Physical rehabilitation: assessment and treatment (5th ed.). Philadelphia: F. A. Davis Company. p.659


1+
2mm depression, barely detectable.Immediate rebound.
2+
4mm deep pit.A few seconds to rebound.
3+
6mm deep pit.10-12 seconds to rebound.
4+
8mm: very deep pit.>20 seconds to rebound.

Hogan, M (2007) Medical-Surgical Nursing (2nd ed.). Salt Lake City: Prentice Hall

Categories: Clinical Nutrition | Tags: , , , , , , , , , , , | Leave a comment

Sea Salt vs. Table Salt

Back in the fall I volunteered at the “Go Red for Women” event at the West Virginia Heart Institute.  Other first and second year WVU dietetic interns and I got to meet 1-on-1 with the women who attended the event and give them nutritional counseling based on their lab values (fasting glucose, cholesterol, blood pressure, weight, BMI) they had recorded and received earlier in the event.  In the beginning, I was very nervous to be giving nutritional advice and answering nutrition questions from strangers, but as the day went on, it was actually a very enjoyable and educational experience.

After talking with each of the women about how they can improve their lab values through changes in their diet, I’d ask if they had any nutrition questions they wanted answered.  The question that came up the most frequently was concerning sea salt.  Some women had been hearing about how sea salt is healthier than table salt, and they wanted to know if there was any truth in that.

Short answer: No, sea salt isn’t any better or healthier than table salt.

Long answer: Sea salt is made from evaporating sea water from the ocean.  So, besides the sodium chloride (NaCl), there are also trace amounts of minerals such as iron, sulfur, and magnesium left behind in these course granules.  The extra minerals can affect the taste or color of sea salt, but are so trace in amount that they really don’t provide any extra nutritional benefit.  Table salt, on the other hand, is made from mining salt deposits from the earth, and is comprised strictly of sodium chloride (NaCl). Most table salts have also been “iodized” which means they have been fortified with the mineral iodine, to prevent iodine deficiencies which can lead to hypothyroidism and goiters.

Americans are already consuming high levels of sodium in the diet, much of which comes from the processed, pre-packaged foods we buy.  The average American consumes 2500-5000mg of sodium per day, which is higher than the current recommendation of 2300-2400mg a day, or the equivalent of 1 teaspoon of salt per day.

The choice between sea salt and table salt really comes down to your personal preference.  Do you like the course-grained texture of sea salt or do you prefer the fine-grained texture of iodized table salt?  Either way, both contain the same amount of sodium per teaspoon, so both should be limited in the typical American diet.

If you’re looking for a way to reduce the sodium in your diet, but you don’t want to put down the salt shaker, you might want to try a salt substitute– many are made from potassium chloride (KCl) and are lower in sodium or sodium-free.  Mrs. Dash has a variety of spice and herb blends that will still add flavor to any dish, but without the sodium level of table salt.  You could also choose lower-sodium varieties of the foods you already buy.  Just be aware that not all claims are created equal:

  • “salt free” or “sodium free” = Less than 5mg of sodium per serving
  • “low sodium” = Less than 140mg of sodium per serving
  • “reduced sodium” or “less sodium” = At least 25% less sodium than what is normally in the reference food
  • “light sodium” = At least 50% less sodium than what is normally in the reference food
  • “unsalted” or “no salt added” = No salt was added during processing, but it can still contain naturally-occuring sodium.
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