The client passes a urinary stone, and lab analysis of the stone indicates that it is composed of calcium oxalate. Based on this analysis, which of the following would the nurse specifically include in the dietary instructions?
A. Increase intake of meat, fish, plums, and cranberries.
B. Avoid citrus fruits and citrus juices.
C. Avoid green, leafy vegetables such as spinach.
D. Increase intake of dairy products.
Correct Answer: C. Avoid green, leafy vegetables such as spinach.
Oxalate is found in dark green foods such as spinach. Other foods that raise urinary oxalate are rhubarb, strawberries, chocolate, wheat bran, nuts, beets, and tea. The more oxalate that is absorbed from the digestive tract, the more oxalate in the urine. Often a combination of calcium from foods or beverages with meals and fewer high-oxalate foods is required.
Option A: Eating large amounts of protein may increase the risk of kidney stone formation. The daily protein needs can usually be met with 2-3 servings a day, or 4 to 6 ounces. Eating more than this if you are at risk of kidney stones is unnecessary.
Option B: Oxalate is produced as an end product of Vitamin C (ascorbic acid) metabolism. Large doses of Vitamin C may increase the amount of oxalate in the urine, increasing the risk of kidney stone formation. If taking a supplement, do not take more than 500 mg of Vitamin C daily.
Option D: A diet rich in calcium helps reduce the amount of oxalate being absorbed by the body, so stones are less likely to form. Eat calcium-rich foods and beverages every day (2 to 3 servings) from dairy foods or other calcium-rich foods.
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