Dietary Reference Intakes for Water, Potassium, Sodium, Chloride, and Sulfate

Potassium Amount Ingested	Adverse Effect	Medications
Ad lib use of salt substitute	Serum potassium = 7.4 mmol/L	Spironolactone, a potassium-sparing diuretic
Ad lib use of a “lite” salt substitute	Edema, shortness of breath, right-sided and left-sided congestive heart failure	None reported
Estimate of 2.7 g (70 mmol)/d of potassium as “LoSalt” for previous week; diet high in fruits and vegetables	Serum potassium = 7.6 mmol/L; loss of consciousness, dizziness, intermittent vomiting	Atenolol, furosemide, aspirin, and lisinopril (an angiotensin converting enzyme inhibitor)
Estimate of 5.2 g (133 mmol)/d of potassium as “Lo Salt” previously; diet estimated to also provide 2.7 g (70 mmol)/d	Serum potassium = 7 mmol/L	Enalapril (an angiotensin converting enzyme inhibitor)

tation. Therefore, a UL is not set for healthy women during this period.

Special Considerations

Problem Pregnancy. It is suggested that high potassium levels be consumed with care in women with problem pregnancies, such as preeclampsia. High concentrations of the antikaliuretic hormone progesterone (which circulate during gestation) may make women with undetected renal dysfunction or with a sudden decrease in glomerular filtration rate (as occurs with preeclampsia) more likely to develop hyperkalemia when potassium intake is high.

Other Situations. Clinical settings in which high intakes of potassium could pose a serious risk include type 1 diabetes, chronic renal insufficiency (e.g., GFR < 40 mL/minute), end-stage renal disease, severe heart failure, and adrenal insufficiency (see Box 5-1). In these

Table of Contents

Front Matter R1-R20

Summary 1-20

1 Introduction to Dietary Reference Intakes 21-36

2 Overview and Methods 37-49

3 A Model for the Development of Tolerable Upper Intake Levels 50-72

4 Water 73-185

5 Potassium 186-268

6 Sodium and Chloride 269-423

7 Sulfate 424-448

8 Applications of Dietary Reference Intakes for Electrolytes and Water 449-464

9 A Research Agenda 465-470

Appendix A: Glossary and Acronyms 471-476

Appendix B: Origin and Framework of the Development of Dietary Reference Intakes 477-484

Appendix C: Predictions of Daily Water and Sodium Requirements 485-493

Appendix D: U.S. Dietary Intake Data from the Third National Health and Nutrition Examination Survey, 1988–1994 494-517

Appendix E: U.S. Dietary Intake Data for Water and Weaning Foods from the Continuing Survey of Food Intakes by Individuals, 1994–1996, 1998 518-526

Appendix F: Canadian Dietary Intake Data for Adults from Ten Provinces, 1990–1997 527-533

Appendix G: U.S. Water Intake and Serum Osmolality Data from the Third National Health and Nutrition Examination Survey, 1988–1994 534-536

Appendix H: U.S. Total Water Intake Data by Frequency of Leisure Time Activity from the Third National Health and Nutrition Examination Survey, 1988–1994 537-545

Appendix I: Dose-Response Effects of Sodium Intake on Blood Pressure 546-557

Appendix J: Serum Electrolyte Concentrations NHANES III, 1988-94 558-563

Appendix K: Options for Dealing with Uncertainties 564-568

Appendix L: Acknowledgments 569-571

Appendix M: Biographical Sketches of Panel Members 572-576

Index 577-618

Special Considerations