Evaluation of salt supplementation in CF infants

Background: CF infants may be at increased risk of sodium depletion which may lead to impaired growth. The objective of this study was to evaluate their sodium supplementation requirements. Methods: Ten CF infants had serial measurements of weight and plasma/urine sodium and creatinine. Sodium supplementation was adjusted with the aim of maintaining fractional excretion (FENa) between 0.5% and 1.5% and urinary sodium > 10 mmol/L. Results: Urine sodium:creatinine (UNa:Cr) ratio strongly correlated with FENa [UNa:Cr (mmol/mmol)=35.0 x FENa (r=0.99)]. The FENa target range corresponded to UNa:Cr 17-52 mmol/mmol. All infants required sodium supplementation to achieve UNa:Cr > 17 mmol/mmol. Sodium Supplement requirements (mean +/- SD) at ages 0-3, 3-6, 6-9 and 9-12 months were 1.9 +/- 0.5, 1.8 +/- 0.8, 1.9 +/- 0.9 and 0.8 +/- 0.4 mmol/kg/d. No infant required caloric supplementation to achieve expected weight gain. Conclusions: Using current UK guidelines, many cases of sodium depletion may be overlooked. Some infants require more than the recommended 1-2 mmol/kg/d. UNa:Cr ratio is a useful non-invasive measure to monitor sodium supplementation. (C) 2009 European Cystic Fibrosis Society. Published by Elsevier B.V. All rights reserved.