Salt

It's actually a bit of a question the reason why I write this. I know that there are doctors and similar who read this blog and I'm kind of hoping that they can answer the question that I have.

First a little background. Our patient is a 93 year old female who lives in a nursing home; she'd been discharged from hospital earlier this week following a chest infection. Over the past day she had gone off her food and was refusing to drink. The nursing home's GP was called and he prescribed something that scared the hell out of us ambulance folk.

One TSP of table salt, stirred into lemon juice to be taken three times a day.

I'm hoping that 'TSP' is teaspoon and not tablespoon.

Is it any wonder that she is refusing to drink when the next thing past her lips could be incredibly salty. I would also imagine that this would upset her stomach.

I know that if someone has a low amount of salt in their blood it is a problem – but I've never seen it treated in this fashion before. I would actually consider this 'treatment' abuse.

We contacted the LAS HEMS doctor (note their new website, they are even having a go at a blog, although they should get rid of the helicopter sound). He was also shocked by this 'treatment'.

So – before I put in a formal complaint about what I consider an inappropriate and possibly dangerous treatment, I just want to be sure that I haven't missed some brilliant new research that shows giving salty drinks to little old ladies is preferable to the way we normally treat a low salt content in the blood.

28 thoughts on “Salt”

  1. I'm not a doctor, but I assume it's something to do with dehydration. But a whole tsp in one glass of water sounds like too much, and why wouldn't they use proper electrolyte solutions?

  2. The home made rehydration recipe is; 1 LEVEL teaspoon of salt 8 level teaspoons sugar in a litre of boiled water.

  3. Sounds like a home-made (and cheap) rehydration recipe got garbled in translation. It was probably meant to be a teaspoon of salt and a dash of lemon juice (to make it taste nice) in a litre of water and the shonky nursing staff forgot the point of rehydration is the water…

  4. Hi Tom, hope you don't mind a quick irrelevant comment to point you to this http://troubled-diva.com/labels/rednoseday.html and ask you to submit a post from your archive – it's been set up by UK bloggers in aid of Comic Relief, which is next Friday so there's not much time, and despite the difficult nature of your work you do write lots of funny posts y'know (see Mr Grumpy below if you don't believe me) so maybe you could lob one in? Thanks – am off back to my customary lurking position now!

  5. The case of the boy who died by having too much salt fed to him raises a question? Do you think – no we won't go there?

  6. In response to Vic, if we are thinking of the same case the couple were cleared of feeding the boy too much salt and it was decided that the boy had a disease which prevented the salt being passed out of his body. Maybe best not to suggest otherwise.

  7. I think it's safe to say that giving someone that “Oral Rehydration Solution” is abuse and should be reported immediately.

  8. It sounds totally foul! Why not make sure the poor woman gets regular cups of tea and suitable food, that her water glass is full and changed regularly so it is fresh, it is placed within reach and she has a straw or beaker to help her drink it – even if it means a staff member standing beside her for 10 minutes while she does?

  9. Recommended adult daily sodium intake = 500mg.1 tsf salt = 2358mg [7074mg during each 24 hr period].

    If this lady was recently in hospital the GP may have a discharge summary confirming hyponatraemia.

    The GPs knowledge of this patient may have led him/her to believe that she may be more ameanable to an old-fashioned remedy ?

    If I have a problem with an aspect of somebodies practice I generally prefer to discuss it with them first [if this is possible] before deciding to make a formal report.

    Have you considered contacting the GP ? it might put your mind at rest.

  10. Surely a normal IV saline infusion would be a more suitable route and probably more controlable in that it is simple to see how much has been administered and over how long a period. Also the fact that the patient wouldn't have to put it past their lips would be better as well.Again though, I suppose you have to be there and get the “full picture” before we get on our high horses!!

  11. Are we sure it's meant to be swallowed and not gargled or something? Cos that's the only capacity in which I've ever been advised to use salt concoctions. And from those experiences I learned that even accidentally swallowing a bit leads to vomiting.

  12. The boy you're probably thinking of did indeed have a medical condition meaning his body couldn't process salt properly, and the couple have now been acquitted. However, there have been a number of salt poisoning cases in the press of late, including that of the mother who fed salt into her son's drip.Makes me sick to think anyone could do that to their own child.

  13. I tend to have low sodium levels myself and was just advised to add salt to my food if I feel the effects. In summer I've been known to add a small pinch of salt to my tea – doesn't take much. Funny thing is, if you need it you can't taste it which is an easy way to test and why giving salt orally isn't so strange. I think I'd balk at a teaspoon full in lemon juice though. Euwww!

  14. Ever had a pizza in Dublin ?I did – I'm fairly certain it satisfied my sodium requirements for at least several weeks.

  15. Klondyke is right and I reckon Caz's guess that it was misinterpreted / passed on wrongly, is correct. The 'homely measures' rehydration mix does exactly the same job as the hugely overpriced rehydration mixtures from pharmacies. Maybe the GP was trying to save the old lady money, but the missing 'litre of boiled water' is crucial!

  16. Hi I'm a nurse and I've never heard of using something like this before without it being put into a litre of water. I've heard of a patient using it (the salt and sugar remedy) at home (to good effect incidently but it was not prescribed by a doctor).If it was definitely meant to be prescrbed in the way that Tom describes, it makes no sense. The taste would be foul which would make the lady in question refuse fluids if she's being given something that tastes rotten. Also as a previous poster said the recommended level of salt is far less than what is in a teaspoon.

    I'd be quite interested in the outcome of this Tom.

  17. I actually treated myself with the oral rehydration solution while I was having a fit of diarrhea in Madagascar one month ago. The recipe has already been mentionned above, but I would like to add that no matter how much other taste (blueberry, orange or other) you add, one teaspoon of salt in one litre of water does taste salty. While in some cases we advocate the parenteral route (IV) for rehydration, in many cases it is better to use the oral route. This especially applies in contries with few resources – and in small children, where you don't want to put in an IV until they really need it.Gargling salty water is sometimes given as an advice to help get rid of slime in the throat, and some say you should sniff it up your nose when you have sinusitis, but drinking the amount you mention seems a bit off.

    – unless it is really hot and you also replenish with a lot of water. When you sweat a lot, you lose a lot of salt too. But old ladies rarely sweat a lot.

  18. I'm not sure it is important to be boiled water – at least, not in this country, where most tap water is potable. I'd reckon it is more important to get fluid into the patient than wait for water to cool down enough to drink. Plus boiled water tastes yuk (notice the difference between a cup of coffee made with fresh water, and with re-boiled water).I would suggest the only purpose of the hot water is to help the salt and sugar dissolve. Therefore take a *small* amount of hot water to do this, and top up with cold.

  19. HiI thought that losing salt through sweating had been disproved, once upon a time we were given salt tablets when working in hot environment or in the tropics, but not anymore. Can someone confirm this??

  20. i'm a nurse with many years experience in emergency admissions, elderly care and currently cardiac intensive care. that GP should be shot, many medications (especially antihypertensives and diuretics) can cause a patient to shed sodium, but there are easy and cheap drug therapies or a change in initial drug regieme, that will correct this small problem. true if a patients sodium becomes very low (or high) it can be come a problem, but in an extremely elderly lady there is little that can be done about that. the GP's “prescription” is barbaric and i would be supprised to see a PRHO write that one up. You are right it is abuse, it is abuse of the doctor patient relationship, because now this elderly lady dosent want to drink or eat anything in case it tastes as horrible as her medication. Tom, please report this, you are probably dealing with a very old fashioned or very unwesternised doctor, who needs retraining or taking up to the top field and put out of his misery.

  21. Having spoken to my doctor hubbie, I would suggest that someone got their lemon juice and lemonade mixed up.*shudder*

    I wouldn't be drinking the juice version I can tell you!

  22. Well, perhaps. I couldn't find an article about it in my quick search, I only found one that said heat stroke due to sodium depletion most often occurs in unacclimatised persons who didn't compensate for salt loss in their sweat. But it's four years old. What I've learnt before, is that you lose more salt the first few days when being exposed to heat. But I'm open for corrections.

  23. In general, Salt dehydrates people very quickly. If an elderly lady who is not replenishing herself regulary i.e drinking plenty of fluids to flush out her renal system, then the salt that builds up will cause renal failure.I agree that this does seem like abuse.I work in a care home and i see doctors coming in and out everyday. I have regretably found that doctors seem to have no time or patience with the elderly and feel that they are wasting time and resources when attending to them.This is a sad case that shockingly seems to be happening everywhere and it should be stopped!! I feel that doctors who show little time and respect for the elderly is abuse in itself.

  24. Salty lemon juice isn't so bad compared to the daily applications of the scarificator to release her accumulated foul humours.

  25. Slightly off subject, but still relevant to osmotic gradients, ion concentrations, etc, I came across this dreadful account (l.salkeld@dailymail.co.uk) of the death of a perfectly healthy young woman. She was swept away by a swollen stream during a practice hike for the Ten Tors, but was still very much alive when she was found.She was airlifted to the Derriford hospital in Plymouth where she survived until the next day.

    Obviously, I do not know the details of this terrible incident, and only a preliminary inquest has been conducted; however, it looks very much as though Charlotte died through secondary drowning a process which I believed had been eliminated almost completely nowadays by the application of careful and intensive nursing. I may, on the other hand, be talking complete nonsense. I wonder whether anyone would care to comment on this tragedy, and could someone explain how to prevent secondary drowning?.

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