Potassium-specific food diary

Meals, snacks and drinks should all be recorded. Please make sure it includes what your child usually eats. For example, by including at least 1 week day and 1 day at the weekend.

Please give as much detail as you can regarding the type of food eaten, including any ingredients if the dish is homemade, as well as portion size.

There are a few short questions after completing the log below which will help us analyse the diary.

Day 1

Date: //

Day 2

Date: //

Day 3

Date: //

Other questions

Do you use any salt substitutes? If so, what brand?
Yes
No
Comments:

How do you cook your vegetables? Please list them from your most frequently used method to those you use less often where possible.

Does your child’s school provide your son or daughter with fruit at break times? Please include details of what is available and what your child chooses if you know this.
Yes
No

Does your child take any vitamin supplements? If so, please give details of the brand and dose and include those you buy and those prescribed for your child.
Yes
No

If you use tinned fruit, do you use that tinned in syrup or juice? Please comment if you include the syrup or juice, or drain it out.

Thank you for taking the time to complete this food diary.

Please send the completed dairy back to: Renal Dietitian, Sheffield Children’s Hospital, Western Bank, Sheffield, S10 2TH or email it to: scn-tr.sch.dietetics-noreply@nhs.net. Please include your child’s name, hospital number or date of birth.

A dietitian will be in touch with any advice as soon as possible or as agreed with you in person.