1. Salt: How much, how often, and why? Julie Matel, MS, RD, CDE CF Center Dietitian

2. Salt Salt = NaCl Sodium + Chloride  Essential minerals  Must be supplied in the diet

3. Why is salt important for people who have CF?  Na CL lost in the sweat (2-5 x normal amounts)  Skin tastes salty  Sweat chloride test used to diagnose CF Normal = less than 40 mmol/L NaCl CF = at least 60 mmol/L and usually more than 100 mmol/L NaCl

4. Functions of Salt in the Body Salt helps to…  maintain the body’s fluid balance  maintain muscle contractions  Salt is a vital component of blood, plasma, and digestive secretions

5. Consequences of Increased Salt Loss in CF  More rapid onset of heat prostration (heat stroke)  Reduced appetite  Abdominal pain  Weakness  Nausea  Headache  Poor growth

6. Who is at risk for having low sodium levels?  Breast fed infants with CF  Anyone with CF experiencing vomiting and diarrhea  Anyone with CF living in a hot environment or exercising vigorously

7. Acid Base and Electrolyte Disturbances in Infants with CF  103 infants diagnosed with CF prior to 1 year (1990-2000)  Evaluated for acid base and electrolyte disturbances Fustik et al. Ped Inter (2002) 44, 289-292.

8. Macedonia

10. Results  16% of the infant CF population had electrolyte and acid base disturbances  Age 2 to 6 months  No seasonal occurrence was found  All infants breast fed  Most not previously diagnosed with CF  All infants had history of some loose stools and failure to thrive prior to admission  94% of infants presented with vomiting  All infants were pancreatic insufficient  Only 60% showed mild to moderate signs of dehydration Fustik et al. Ped Inter (2002) 44, 289-292.

11. The Bottom Line….  Early infant age  Breast-feeding  Delayed diagnosis  Heat exhaustion  The presence of CFTR mutations associated with severe disease… are predisposed factors for development of electrolyte and acid base abnormalities in CF patients

12. Exercise Study Objective: To determine how much salt is required to increase voluntary fluid intake

13. Exercise study  11 subjects with CF (6 girls, 5 boys)  Ages 11-20 years  Attended 3 sessions of intermittent moderate exercise (4, 20 min bouts of cycling)  95 degrees F (50% humidity)

14. Exercise Study One of the following beverages was assigned in each session…  Water  Flavored water  Flavored water with 690 mg/L of Na and 6% carbohydrate  Additional session in 6 subjects with flavored drink with 1150 mg/L of Na and 6% carbohydrate Gatorade = 452 mg/L of Na

17. Bottom Line…  Children and adolescents with CF underestimated their fluid intake and became dehydrated when exercising in the heat  When given a higher sodium beverage (1150 mg/L), fluid intake increased sufficiently to prevent dehydration  Add 1/8 tsp to every 12 oz of Gatorade

18. How much salt do I need? No one is sure! For people without CF…  120 mg for infants less than 6months  1500 mg for adults People with CF need more

19. Sodium Recommendations for CF  Eat salty foods  Use salt shaker freely at meals and snacks  Add 1/8 tsp of salt to 1 ½ cups (12 oz) of sports drink during outdoor exercise (especially on hot days)  Add 1/8 tsp daily to breast milk or formula for infants

20. What are the best sources of salt?  Table salt  Salted nuts  Bacon  Pickles  Canned soup  Salted crackers/chips  Canned vegetables  Frozen dinners

21. Food Labels FoodSodium (mg) Ramen, Noodles1430 Salt ¼ tsp580 Dill Pickle570 Canned Soup (1 cup)480 Hard pretzels (1 oz)385 Pedialyte (1 cup)245 Cheerios (1 cup)204 Bacon 1 slice185 Gatorade 1 cup200

22. Can I get too much salt?  Very unusual for someone with CF to get too much  At risk for too little!