NEURALLY MEDIATED HYPOTENSION AND ITS TREATMENT
Neurally Mediated Hypotension Working Group
Johns Hopkins Hospital
Revised January 1997
An adult requires between 2000 and 3000 milligrams (mg) of sodium to maintain health. Although health advice in the last two decades has suggested that a low salt intake helps prevent heart disease and stroke, many individuals with neurally mediated hypotension, including those who begin with a low normal blood pressure, cannot tolerate this low salt diet. We believe that individuals with neurally mediated hypotension need to take in much higher amounts of salt.
The exact amount needed is different for each individual, and is often affected by your taste for salty foods, but it is difficult to take too much, provided that you have access to lots of fluids if you become thirsty. A few have been unable to tolerate an increase in sodium intake without developing increased agitation, but this is uncommon.
Table salt is also an excellent source of sodium, as it has 2300 mg of sodium per teaspoon. Salt tablets are a way of geting adequate amounts of salt without dramatically changing the taste of your foods. If you elect to increase your sodium intake with salt tablets, a good place to start is with one 450 mg tablet three times a day, working up to two tablets (900 mg) three times a day. Some of our patients report better tolerance of a buffered salt tablet (Thermotabs, which contain 450 mg sodium chloride and 30 mg potassium chloride; available from Menley and James, 1-800-321-1834). Salt tablets are available without a prescription.
As for fluid intake, be sure to drink at least 2 liters of fluid a day. Some people find sports drinks (which have the advantage of a higher sodium content) to be a good source of fluids. CeraLyte-70 is a special rehydration fluid designed to provide optimal absorption of salt and fluid from the gut, and it contains 2.2 grams of sodium chloride per liter of fluid. It can be obtained at many pharmacies, or by calling toll-free 1-888-237-2598 (1-888-CERALYTE).
The following are high salt foods to help with your needs:
Breads and cereals -- mg of sodium:Noodles, potatoes, rice from instant mixes -- 500Dairy Products:
Wheaties (1 cup) -- 400
Waffles (one) -- 355
All Bran (1/2 cup) -- 285
Cheerios (1 cup) -- 260
Rice Krispies (1 cup) -- 260
Saltine crackers (6) -- 200Parmesan cheese (1 oz.) -- 450Fruits and Vegetables:
Processed cheese and cheese spreads (1 oz.) -- 320
Cottage cheese (1/2 cup) -- 230Dill pickle (1) -- 1430Meat, poultry, fish:
Tomato juice (8 oz.) -- 800
Sweet pickle (1) -- 570
Frozen vegetables with special sauces (1/2 cup) -- 375
Canned tomato sauce and puree (1/4 cup) -- 370
Canned vegetables (1/2 cup) -- 245Enchilada (the whole...) -- 1300Snacks, condiments:
TV dinner (1) -- 1200
Sweet-n-sour pork (1 serving) -- 1100
Lasagna (1 serving) -- 1000
Soup, canned (1 cup) -- 895
Fish-n-chips (1 serving) -- 750
Hamburger (1) -- 690
Hot dog (1) -- 550
Tuna, canned (1/2 cup) -- 535
Corn beef (1 oz.) -- 530
Fried chicken (1 serving) -- 530
Pizza, cheese (1 slice) -- 500
Pork-n-beans, chili (1 cup) -- 460
Luncheon meat (1 slice) -- 300
Bacon (4 slices) -- 280Pretzel Stix (at Giant), 1 tray (28 g) -- 1460
Soysauce (1 tbsp) -- 870
Olives, green (4) -- 600
Salted nuts (1/2 cup) -- 420
Olives, ripe (4) -- 400
Fruit pit (1/8 pie serving) -- 355
An adult requires between 1,600 to 2,000 mg of potassium per day to maintain health. However, those who are taking Florinef will have a higher need because the drug depletes potassium. Unlike sodium, manufacturers are not required to list the amount of potassium on food labels. For this reason, it is important that you become familiar with the food items listed below. Generally, good sources of potassium include milk, meats, and fruits, and vegetables. Below is a more complete list of potassium content of various foods.
Beans/Peas -- mg of Potassium:Pork and Beans (1/2 cup) -- 335Cereals:
Lima Beans (1/2 cup) -- 480
Blackeye Peas, Kidney Beans, Lentils (1/2 cup) -- 350Bran buds, All Bran (1/2 cup) -- 380Dairy Products:
Fiber One, Grape Nuts (1/2 cup) -- 240
Raisin Bran (1/2 cup) -- 175
Pancakes, Aunt Jemima, whole wheat (3 cakes) -- 380Milk (1 cup) -- 400Miscellaneous:
Yogurt (1 cup) -- 400-500
Instant Breakfasts -- Carnation, Delmark,
Slimfast, made with milk (1 cup) -- 600-800
Hot Cocoa made with milk (1 cup) -- 600-800
Instant Chocolate Pudding (1/2 cup) -- 200-300
Simple Pleasures frozen desert (1/2 cup) -- 200-300
Ice Cream/Ice Milk (1 cup) -- 200-400Molasses, Blackstrap (1 Tbsp) -- 585Fruits:
Spaghetti Sauce (1/2 cup) -- 475
Cream soups made with milk (1 cup) -- 300-450
Tomato, Minestrone, Vegetable soups (1 cup) -- 200-300
Split Pea Soup (1 cup) -- 400Apple juice/Applecider (1 cup) -- 300Meats:
Apricot Nectar (1 cup) -- 286
Avocado (1/2) -- 550-750
Banana (1 Banana) -- 451
Honeydew melon/Cantelope (1 cup) -- 460-500
Kiwi (1 Kiwi) -- 250
Nectarine (1 Nectarine) -- 288
Orange or Grapefruit juice (1/2 cup) -- 200
Orange (1 Orange) -- 240
Pineapple (1 cup) -- 270
Plum (1 medium) -- 110
Prunes, cooked (1/2 cup) -- 370
Raisins (1 oz. box) -- 220
Strawberries (1 cup) -- 250
Beef, Chicken, Pork, Lamb, Fish, and Shellfish
(except imitation crab, 3 1/2 oz. cooked,
about the size of a deck of cards) -- 200-400
Chili with beans, 1 cup -- 500
Enchiladas (chicken, 8.25 oz. entree) -- 624
Hamburger helper, 1 serving -- 440
Lasagna, Stouffers, 8 oz. entree -- 363
Pizza, Lean Cuisine, 5.1 oz. entree -- 300
Vegetables:
Asparagus (1/2 cup cooked) -- 280
Broccoli, Carrots or Mixed Vegetables,
frozen, cooked (1 cup) -- 300-350
Brussel Sprouts, Zucchini, Collards, Kale,
Parsnips, frozen, cooked (1 cup) -- 450-600
Carrot, 1 whole, raw -- 233
Cauliflower, Corn, Peas, and Carrots,
frozen, cooked (1 cup) -- 200-300
Cucumber, 1 whole -- 430
Tomato, 1 medium, raw -- 270
Potato, 1 large, baked -- 600
Sweet Potato, 1 large, baked -- 400
V-8 Tomato juice cocktail (1 cup) -- 570
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