DIET AND SALT RESTRICTION

The patient with chronic venous congestion of stomach and gut and with an enlarged congested liver is intolerant to a rich or bulky diet. At the same time, however, he requires a sufficiency of calories to meet his daily requirements, and as soon as his condition permits he must be given enough protein to meet his metabolic needs. In the early stages of treatment the diet must be light, small in bulk and mainly carbohydrate. Meals should be small and frequent rather than few and large; food should be taken dry and fluids given between meals. Since retention of salt is an essential cause of oedema, some restriction of sodium ' is usually necessary. Some of the popular proprietary glucose and fruit drinks contain a considerable quantity of sodium citrate, and as such are not permissible to the patient in cardiac failure. There is no purpose in reducing the sodium intake in the food to the point of unpalatability and allowing the patient large ; quantities of the offending ion in a medicated fruit drink. As recovery takes place, the diet may be made more liberal and a gradual return to a light diet permitted. A specimen light diet, poor in salt content, will be found below. The main ion retained by the body in cardiac failure is sodium; to some extent chloride is also retained, but passively. Restriction of the sodium content of the diet is useful, but to be effective must be strict. A truly salt-free diet is not , only difficult to attain, but those containing as little as 0-2 g. of sodium daily ' are unpalatable, badly tolerated by the patient, and may lead to deterioration in renal function. Generally speaking, a salt-poor diet will suffice—one in which sodium intake is restricted to approximately i g. daily. This can be achieved by avoiding salty foods, by using salt sparingly in cooking, by adding no salt to food at table and by taking no beverages rich in sodium such as are mentioned above. Until recent years the long-term prescription of salt-poor diets of this type was an important feature of the management of cardiac failure. With the advent of the newer diuretics, such drastic restriction of salt has become less imperative, though in some chronic resistant cases diets of this type are still useful. SALT-POOR DIET Approx. 1-25 g. Na. 1,700 Cal, Nad 4 g. Breakfast: 1 egg or small piece of white fish. 2 slices of bread. Jelly marmalade if desired. Butter from allowance. Tea with sugar, and milk from allowance. Mid-morning Glass of fruit juice. Average helping of meat, fish, chicken, rabbit or tripe. Avoid ketchups and sauces. Small helping of vegetable. Small helping of potato. Fruit, stewed or fresh. Small helping of milk pudding made with milk from ration, or lemon sago or caramel custard, using milk and egg from allowance Tea— Small helping of meat or chicken or fish, or an egg. Tomato or other vegetable if desired. 2 slices of bread. Butter from allowance. Jam or jelly if desired. Tea with sugar, and milk from allowance. Supper— 2 slices of bread or 2 tea biscuits. Tea with sugar, and milk from allowance. Helping of fruit, fresh or stewed. Bedtime— Glass of fruit juice. While restriction of sodium intake is desirable, the reverse is true of potassium. Depletion of body potassium is common in untreated cardiac failure and further reduction of the body stores is liable to occur under treatment with diuretics. Potassium deficiency may potentiate the action of digitalis and lead to dangerous toxic effects. Potassium supplements, most acceptably given as effervescent potassium tablets (B.P.C.) each containing 6-5 mEq. K+ as bicarbonate and acid tartrate, are valuable to obviate such complications; four to six tablets daily are required. As an adjuvant, fresh fruit juice a rich dietary source of potassium is allowed. Such juices, as opposed to the quasi synthetic proprietary beverages, have a low content of sodium and are well tolerated. Salt substitutes are available for patients intolerant of the tasteless food implicit in a salt poor diet. When one of these is chosen as a substitute, the physician should ensure that he is in fact prescribing a preparation containing potassium chloride and not a citrate or other salt of sodium which, of course, defeats the purpose of salt restriction.