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Haley Robertson KNH 413- Spring Medical Nutrition Therapy Nutrient 1. What is the nutrient? a. Sodium (salt) 2. What is the RDA/DRI for the nutrient? a. The Adequate Intake level for healthy adults is 1,500 mg/day of sodium in the diet. The Upper Limit (UL) of Sodium is 2,300 mg/day of sodium in the diet. This is the highest amount that can be taken without posing a threat to the health of adults. 3. How is the nutrient metabolized? a. Sodium is absorbed in the intestine by… i. It is freely permeable across the interstitial cell ii. The most prominent method is by co-transport with glucose and amino acids. (the absorption of sodium depends on the absorption of glucose and amino acids) b. Once absorbed it leaves the cell through the sodium pumps i. Depending on how much sodium is taken in will depend on how much is pumped out 1. When a lot is absorbed a lot is pumped out, creating high osmolarity in the intercellular spaces c. The sodium is later diffused into the blood in the capillaries d. It is excreted in order to determine sodium balance i. It is then reabsorbed in 3 main regions of the nephron ii. Also in the cortical and medullary collecting ducts e. Excretion is regulated by i. Aldosterone ii. Circulating numbers of ANP iii. Amount of AT-II and PGE2 levels in the kidney iv. Tubular secretion regulated by secretion of K+ H+ 4. What are food sources of the nutrient? Sodium Chloride is the most common form of sodium and is also known as “table salt” Sodium is something that occurs naturally in a lot of foods including o Milk o Beats o Celery o Water (depending on the source) There are also added forms of sodium such as monosodium glutamate, sodium nitrite, sodium saccharin, sodium bicarbonate, and sodium benzoate o These are added in sauces and processed foods such as canned foods Processes meats also contain sodium o Bacon o Sausage o Ham o Salami Fast food 5. What disease states alter the nutrients metabolism? People who are “salt sensitive” have a greater reaction in blood pressure as a result of sodium consumption than the average person. Most people who are “salt sensitive” include the aging population, African Americans, already have high blood pressure, diabetics, or have chronic kidney disease. 6. What are the tests or procedures to assess the nutrient level in the body? a. Venipuncture i. Blood is taken from the vein to test for serum sodium levels ii. Normal range for Sodium is 135-145 mEq/L 7. What is the drug –nutrient interactions? a. These drugs have been associated with the increased risk of low blood concentrations of sodium i. Diuretics ii. Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) iii. Opiate derivatives iv. Phenothiazines v. Serotonin-Reuptake Inbihibitors (SSRIs) vi. Tricyclic Antidepressants 8. How is the nutrient measured? a. The nutrient is typical measured in milligrams, but can sometimes be listed in grams. 9. What is the Upper Tolerable Limits? Upper Tolerable Limits 10.What are the physical signs of deficiency? Patients complain of… o Lack of energy o Fatigue o Drowsiness o Lack of concentration o Pale face o Sharp wrinkles o Deep eyes, sunken in orbits o Absent-minded look o Irregular tongue borders o Low blood pressure o High daytime urination o Salty food cravings o Nauseous o Thirsty o Drinking water and other liquids all the time 11.What are physical signs of toxicity? Toxicity can also lead to excess extracellular fluid volume because water is pulled into the cells to keep normal concentrations of sodium. Excess amounts of sodium can lead to o Nausea o Vomiting o Diarrhea o Abdominal cramps High concentrations of sodium are often a result of excess fluid loss through sweat or physical activity or lack of water intake in general o This can often cause Dizziness or fainting Low blood pressure Diminished urine production Some of the more serious side effects of high concentrations of sodium include o Edema o Rapid heart rate o Difficulty breathing o Convulsions o Coma o Death Resources Americans consume too much sodium (salt) . (2011, February 24). Center for Diseases Control and Prevention . Retrieved , from http://www.cdc.gov/features/dssodium/ Bowen, R. (1995, October 22). Absorption of water and electrolytes. The Small Intestine: Introduction and Index . Retrieved , from http://www.vivo.colostate.edu/hbooks/pathphys/digestion/smallgut/absorb_water.html David, Z. (2014, February 26). Sodium in diet. Medline Plus. Retrieved , from http://www.nlm.nih.gov/medlineplus/ency/article/002415.htm Hertoghe, T. (2014, January 1). Sodium deficiency complaints and signs . Hertoghe Consultation. Retrieved , from http://www.hertoghe.eu/patients/index.php?option=com_content&view=article&id=123:sodiumdeficiency-complaints-and-signs&catid=38&Itemid=162&lang=en Higdon, J., Drake, V., & Obarzanek, E. (2008, November 1). Micronutrient information center: Sodium (chloride) . Oregon State University Linus Pauling Institute . Retrieved , from http://lpi.oregonstate.edu/infocenter/minerals/sodium/ Verma, S. (2013, March 19). Electrolyte balance and sodium metabolism. SlideShare. Retrieved , from http://www.slideshare.net/medicinedoctorinchd/sodium-metabolism