By Christina Lund, RDN, LD
As temperatures rise in Las Vegas, inevitably I find that my dialysis patients struggle to manage their fluid intake. Some patients are so good about following their fluid restriction that they dehydrate themselves and become constipated and lethargic. Others are so thirsty that they drink too much and come to dialysis with too much fluid in their bodies. This puts them at higher risk for cramping, swelling of hands and feet, high blood pressure, sudden drops to low blood pressure during their dialysis treatments, shortness of breath (sometimes from fluid in the lungs), and heart problems like a fast pulse, weakened heart muscles, and an enlarged heart, leading to heart failure. The key is finding the right balance for your own body and circumstances.
To determine the appropriate amount of fluid that you can safely consume each day is often determined one of two ways. The first is to aim to gain NO MORE fluid between treatments than 5% of your dry weight (or adjusted dry weight if you are obese). For an 80kg person, this would be 4 kg. The second method for limiting fluid is to aim to gain 1 kg per day between dialysis treatments. Going from a Monday to Wednesday (2 days), this would be 2 kg, and from Friday to Monday (3 days), this would be 3 kg. 32 ounces (or about 1 L) of liquid = 1 kg of fluid. If you no longer urinate, then please follow the fluid restriction strictly how it is prescribed. If you still urinate, then you still get rid of some of the fluid you put on between treatments, so that you can drink a bit more. The most accurate way of determining how much you can drink if you still urinate is to collect and measure your urine output for 24 hours, then add 1 liter. Example – 16 ounces of urine output + 32 ounces = 48 ounces (1.5 L) per day.
Some factors also play into increasing your fluid allowance. First, sweating profusely from exercise or being outside in the Vegas summer heat, will cause fluid losses that you may replenish. Vomiting and diarrhea are also ways that the body would increase fluid losses. Ask me how to determine the right way to determine how much to replace.
To keep fluid intake under control, try a few of these tips:
- Stay out of the sun.
- Limit spicy and salty foods since they make you thirstier and retain more fluid. Limit sodium to 2000mg daily.
- Limit foods with high fluid content like gelatin, watermelon, soup, gravy and frozen treats. Ask me for a list of the fluid content of fruits, vegetables, and other foods.
- Sip beverages or suck on ice so that you can savor the liquid longer. Use small cups or glasses for your beverages.
- To battle dry mouth, use chilled mouthwash or brush your teeth more often throughout the day. Sucking on hard candy or a wedge of lemon or lime will also help.
- Use a spray bottle to mist your mouth.
- Mint spray: 1 tsp. peppermint extract with 8 ounces water (taste improves overnight)
- Lemon spray: ½ cup lemon juice with ½ cup water
- Crystal Light in the spray bottle
- Plain water in the spray bottle
Take medications with mealtime liquids.
If you have diabetes, maintain good blood glucose levels. High blood glucose levels increase thirst.
Restricting your fluid intake is challenging, but so worth it. Ask other dialysis patients for suggestions on what they do. The reward is that you will feel better during your dialysis treatments, avoid cramping and blood pressure fluctuations, and stay healthier.