Serum sodium and potassium levels with dietary evaluation

Title

Creator

Bulatao-Jayme, Josefina

Camara-Besa, Solita

Marco, Pacifico

Language

English

Source

Volume XV (3) January-March 1959

Year

1958

Subject

Pregnancy -- Nutritional aspects

Medicine -- Periodicals

Rights

In Copyright - Educational Use Permitted

Fulltext

SERUM SODIUM AND POTASSIUM LEVELS WITH DIETARY EVALUATION OF NON-TOXEMIC AND TOXEMIC FILIPINO PREGNANT WOMEN* JOSEFINA BULATAO-JAYME, M.D., M.P.H., SOLlTA CAMARA-BESA. M.D., M.S. (Biochemistry) and PACIFICO MARCOS, M.D. Food & Nutrition Research Center & U.P.-P.G.H. Medical Centet· The study of serum sodium and potassium levels in Fi1ipinos was started by one of us in 1951 ·(l). In "normal" adult students, serum sodium varied from 137.4-156.5 m Eq/L, with a mean of 147, and serum potassium ranged from 3.9-5.5 m Eq/L with a mean of 4. 7. The present study was undertaken mainly for the purpose of determining sodium and potassium levels in Filipino pregnant women of both non-toxemic and toxemic groups. Simultaneously, complete dietar~' histories of the subjects were taken, particularly with regards to the use of salt and salty food seasonings, in an attempt to correlate these findings with the serum sodium level and to elicit any possible distinct differences in dietar~' pattern between the two groups. Although numerous extensive and intensive studies have been made in recent years in an effort to establish the definite role of nutrition in the development of toxemias of pregnancy, not much headway has so far been accomplished. Most of the investigators, however, are agreed that malnutrition plays an important part in susceptibility to toxemia among pregnant women, but no direct relationship between a particular nutrient or nutrients and toxemia has as yet been agreed upon. As a matter of fact, the mass of evidence from animal and human studies on the relationship of maternal nutrition and reproductive performance has so far be'en at best contradictory. It is hoped that, eventually, with more studies on this· controversial • Thl.o otudy W"'I IUPJH>rlfll in P•rt by l1 1rnnt from tho Unh-ou!ty of the Phl)lppin"" N1lur•l Sl'leno• ltcounh C .. nter. 157 158 AC1A MEDICA PBILIPPINA subje4 there will evolve a pattern which will serve to pinpoint the key to the puzzle. The relation of dietary salt to certain diseases was noted even as far back as at the end of the 15th century when John of Gaddesden (2) commented on the value of salt restriction in the treatment of heart disease. Although medical literature abounded in the past century with reports commending this procedure for patients with heart disease, it was only in the present century that its value in pregnant women threatened with eclampsia was suggested. J.O. Arnold (3) recommended salt restriction in these patients in 1934, while K. de Shoo (4) reported in 1937 that he was almost able to e1iminate eclampsia from his patients in Utrecht, Holland, by placing them on a low salt regime in the second half of pregnancy. He implicated sodium as the cause of eclampsia. Numerous similar reports on the favorable influence of the limitation of sodium on the course of pregnancy and labor have since appeared. One a11;icle in 1958 that caught our interest was the radically opposing report of Robinson ( 5) concerning her study of 2077 pregnant women wherein there was a lower incidence of toxemia, edema, antepartum hemorrhage and perinatal death in the group advised to increase their salt intake as against the group advised to decrease it. The women with early toxemia who were treated with extra salt improved, their recovery being quicker and more complete when larger doses of sall were given. Recurrence occurred when salt intake was lowered. Though we wanted to repeat this study among Filipino pregnant women, we fe1t that there was first a need for the estabHshment of baselines-hence the present sturly. METHODS Pregnant patients admitted to the obstetrical service of the Philippine General Hospital for delivery or as toxemic cases were taken as subjects. A toxemic patient was so..ca11ed \vhen she had one or more of the fo11owing signs: ( 1) Hypertension: diagnosed when there was a sudden increase of at least 15 mm. in the systolic or 10 mm. SERUM SODIUM AND POTASSIUM LEVELS 169 in diastolic blood pressure over that of a previous normal reading; if there was no previous reading avai1able, a blood pressure of 130 mm. systolic or ove1· and 90 nun. diastolic or over, when found after the 24th week of gestation was classified as toxemia. (2) Albuminuria of ( +) or more. (3) Edema which must involve the upper extremities or the face. (4) Convulsions and/or coma. A total of 200 patients were covered but only 99 nontoxemic and 97 toxemic cases are being reported since the rest were either discharged before histories could be taken or the blood samples obtained were insufficient for examination. A blood sample was obtained by finger-prick, usua11y within 6 hours after admission before treatment was administered, except in some toxemic cases where magnesium sulfate had been given intramuscularly or, in a few, intravenously upon admission. The blood sample was analyzed for sodium and potassium using a modification (6) of the ultramicro methods pubJished by Nate1son and Sobel. Since it was impossible to estimate actual intakes of sodium using the recall method of dietary history, a method was devised covering eating habits of the patient with special emphasis on the use of salt and salty seasonings such as toyo. pa.tis, vetsin and bagoong. The diet recorded was the usual dietary pattern of the patient and not any special diet recently initiated during pregnancy. Thus, for instance, salt restriction undertaken just before admission because of an already rising blood pressure was not recorded. A sodium score (Sel' Appendix) was devised based on giving the numerical values of 0, 1, 2, and 3 to gradations of intake from "never" W "always" or from "very little"' to "plenty" of these various materials. The total sodium score of a patient \Vas the sum of the figures covering each material. During the rlietary interview, the amount and kind of foods usually taken at each meal and as snacks were recorded. From the record, th<• avera~e daily intake of calories, carbohydrates, proteins, anct fats was then calculated for each Jll'OUP of patients. 160• ACl'A MBDICA PmLIPPINA RESULTS The subjects in the non-toxemic group ranged in age from 16 to 41 years and averaged 27 years, while those in the toxemic group ranged from 18 to 46 years and averaged 29 years. The mean serum sodium and potassium levels in both groups are shown in Table I. Although the difference in the serum sodium level between the non-toxemic group and the toxemic group appears slight, the rise in the toxemic group waa found to be statistically significant, it being-5.6 which is significant even at 0.1 per cent level. However, the difference in serum potassium levels between the two groups was not found to be statistically significant at the 5 per cent level of significance. TABLE I - MEAN SERUM AND POTASSIUM in mEq. I Mean Serum Sodium ~on- toxemic 14.0.70 .:!:. 4..27 (S.D.) Toxem.ic 144..86 ~ 6.6 (S.D.) I Mean Serum Potauium 4.2 _: 0.64 (S.D.) 3.92 .:!:. 0.60 (S.D.) Sodiuni scores that were obtained ranged from 3 to '33. The minimum possible sodium score that an individual· may obtain was 0 (indicating extremely low intake of salt) while the maximum possible was 42. The average sodium scores for each of the two groups studied showed no significant difference (See Table II) although the score of the non-toxemic group ( 11.0) was slightly higher than that of the toxemic group (10.5). There was no correlation between the sodium score of the non-toxemic group and the serum sodium of the group, while the corresponding values for the toxemic group showed a poor correlation, the coefficient of correlation being 0.2342 with 0.102 standard error of the coefficient. Incidental1y, mention may be made of the average intake of 263 randomly selected households surveyed within the Metropolitan Manila region ·(Manila, Quezon City, Pasay and five suburban Rizal municipalities). These households averaged a <laily per capita intake of 3.01 gm. sodium as estimated from their three-day record of intake of salt, toyo, patis, bagoong and 1•etsin (7). The record covered all seasonings used for cooking and at table. SERUM sonn:::FM ·AND POTASSIUM LEVELS 161 In another study by one of us, sample daily diets (excluding seasoning added at table) were anaJyzed. The day's meals; ready to be served, were found to have a sodium content of 1.25 to 5.83 gm. with a daily mean of 3.43 + 1.115 S.D. (8). The other dietary findings are shown in Table II. Comparing these findings of both groups with the recommendations for FiJipino pregnant women as given in "Table II Recommended DaiJy Food Allowance by Sex, Group Activity and Age Group" of the former Institute of Nutrition (now the Food & Nutrition Research Center), we find that the total calories recommended fell about midway between the caloric intake of the non-toxemic (which was lower) and that of the toxemic (which was higher). The carbohydrate intakes of both groups exceeded the recommended allowance, while their protein (especial1y the animal protein) and thei1· fat intakes were much lower than recommended. None of the caloric or nutrient findings showed any significant difference behveen the non-toxemic and the toxemic groups nor any apparent correlation with the serum sodium levels. Exception to this was the total protein intake of the non-toxemic group which showed a correlation \Vith the serum sodium of the group, the coefficient of correlation being + 0.972 with 0.101 standard error of the coefficient. TABLE II-DAILY RECOMMENDED ALLOWANCES AND MEAN DIETARY FINDINGS AMONG PREGNANT FILIPINO WOMEN Recommended Mean Dietary Findings Allowances ~Toxemic Toxemic ~~~~~~11~~~~ ='odium score 11.04 ~ 4.67 (S.D.) 10.51 _:. 3.98 (S.D.) Calories 2345 2250.0 + 719 (S.D.) 2430 + 894 (S.D.) C"a1"bohydrates (gm.) 312 383.0 + 133 (S.D.) 418 + 170 (S.D.) Total Proteins (g.m.) 87 65.0 + 26 (S.D:) 67 + " (S.D.) - . .\.nimal Proteins (gm.) 52.1 30.0 _:.17.5 (S.D.) 29 - 18 (S.D.) \'eiretabl<' Prot<'im1 (gm.) :~5 35.0 ~ 13.1 (S.D.) 38 - 17 (S.D.) Fat;t; (gm.) 81 51.0 c: 27 (S.D.) 63 + 30 (S.D.) 162 ACTA MEDICA PBILIPPINA The relatively large standard deviations obtained in the dietary findings are to be expected and are comparable with other similar studie& Two studies (9, 10), one on a group of obese pregnant women using the dietary history as a tool for determining food intake, gave practically the same standard deviations in their dietary data. Despite these findings, Trulson (11) in her assessment of methods for obtaining data for clinical work observed that "the Jong-range interview of usual food practices which will reveal previous as well as present eating patterns is the method of choice for clinical studies." SUMMARY The serum sodium and serum potassium of 99 non-toxemic and 97 toxemic Filipino pregnant women were determined and correlated with their food habit. regarding the use of salt and salty seasonings and with their intakes of calories, carbohydrates, proteins, and fats, data on which was taken by the reca11 method. There was a statistica1ly significant higher mean serum sodium in the toxemic group. Serum potassium levels and dietary findings showed no significant differences between the two groups, nor any correlation between the serum sodium levels and the dietary findings, except with the total protein intake of the non-toxem.ic group which gave a positive correlation with the serum sodium of the group. Dietary findings are compared with recommended aJiowances for Filipino pregnant women. ACKNOWLEDGMENTS The authors are indebted to Dr. Alfredo Baens, former Head of the Department of Obstetrics, U.P.-P.G.H. Medical Center, for allowing the use of patients in Wards 17 and 14-A for the study; to Dr. Rodolfo Florentino and Miss Felicitas Piedad of the Food & Nutrition Research Center who assisted in the dietary study and to Miss Minerva Bataclan, research assistant employed under grant from the U.P. Natural Science Fund, for the serum sodium and potassium analyses. SERUM SODIUM AND POTASSIUiU J,EVELS 163 UEJ•'ERENCES 1. CAMAUA·BESA, S. F.: The Serum Sodium and Potassium Value,; in Normal Filipino Studenti;. Acta Med. PhjJ. 8:151-166, (Jan.March), 1952. 2. PAYNE, A. S. aud CALLAHAN, D.: The Low Sodiuni Cook Book. Little Drown a11d Company, 1953. 3. ARNOLD, J. 0.: Treatment of Eclampsia. The )fedieal Clinics of No11h America. 18:297-306 (July), 1934. 4. SHOO, K. DE.: The Prevention of Eclampsiu. Am .. J. of Obstetril's and Gynecology. 34:911-939, {December), 1937. 5. ROBINSON, M.: Salt in P1-egnancy. The Lancet, I: 178, (Jan.) 1958. 6. CAMARA-BESA, S. F. and M. BATACLAN.: A Comparison of th{' Macro and the Uitramic1·0 Methods of Serum and Potassium Analysis by Flame Photometl'y. Acta Med. Phil. 12: 76-89 {Oet.Dec.), 1955. 7. FOOD AND NUTRITION UESEARCH CENTER, :\fanila-Unpuhliahed data. 8. CAMARA-BESA, S. F. and M. BATACLAN.: The Sodium and Potassium Content of Philippine Foods. II Sample Daily Dieti;. Acta Med. Phil. 9:270-273, (Apr.-June), 1953. 9. BERG, ANNA S. VAN DEN and J, MAYER.: Com11arison of OneDay Food Record and Research Dietary History on a Group of Obese Pregnant Women. J. Am. Dietet. A. 30:1239-1244, 1954. LO. PEEL, RUTH and MARY DODDS.: Nutritive Intake of Women Fa<'tocy Employees. J. Am. Dietet. A. 33:1150-llS:J, 1957. 11. TRULSON, MARTHA F.: Assessment of Dietnry Sturly Method". J. Am. Dietet. A. 30:991-995, 1954. APPBNDIX A Dietary History of Sodium Intake Uaual Food Rabil• Score Usual Food Habits Score 1. Amount of salt used in cooking. Very little Jut enough On the salty aide Plenty 2 , Frequency of uae of aeaaoninge in cooking. Toyo Never or rarely Sometimes Often Always Patia Never or 1·arely Sometimes Often Always Bagoong Never or ral'ely Sometimes Otb!n Alwaye Vetsin (Monosodiwn glutamate) Never or rarely Sometimes Often Always Soda Never 01· rarely Sometlme11 Often Always :J. Frequency of adding seasoning, st table. Salt Never or rarely Sometimes Often Always Toyo Never or t'arely Sometimes Often Always Patis Never or rarely Sometimes Often Always Bagoong Never or rarely Sometimes Often Always .& • IC she eata food she does not cook, does she find ;t Salty to her tute Salted just right Necessary to add salt, patis, toyo to tt after tasting tt. Necenary to add aalt, patis, toyo to it even without tasting it. 5. Frequency of takint the following medicine: 164 Sodium bicarbonate Never or rarely Sometime!! Often Always Sodium 11alicylate Never or rarely Sometimes Often Always Sodium sucaryl Never or rarely Sometimes Often . .\lwayi; Tota..I Score

pages

157-164

Media