Fluid Over load

[Danally]

My dad was in the hospital over the weekend. He could not breath and he was feeling dizzy. After a night full of tests they determined that he had a fluid over load. He went away on vacation and ate and drank too much. I am looking for some information for him. How much fluid should he drink each day??? The doctor told him how dangerous this is. I want him to live a long life. Does anyone have any suggestions for him? How do I get him to care enough about himself to do the right thing?

[G-Ma]

I was told 32 oz a day.  I have done 40 but feel better at just 32.  I measure that amount each morning and just try to work on that during the day.  Some days are ok, and some are just dive into a 5 gallon bucket of water and drink.   

[cherpep]

I normally try to keep it to 3-16 oz beverages a day.  Some say that's too much, but I just haven't been able to get it under that. 

I just heard from a friend (kidneys work fine) that they drink anywhere from 12-24 cans of Diet coke a day at work.  I find that unbelieveable, but others witnessed that he's telling the truth.  YIKES!!  I swear that they must hear water swishing when he walks!

[Danally]

My dad said he can have about 36 ounces a day. Before this incident he just drank what he wanted. I think he is in denial abou his illness.

[monrein]

I find salt to be the key to keeping fluid in check.  Even not much salt can make us super thirsty and also hold fluid in the tissues.  I stick to about 30 oz a day max as I don't do well with much fluid on and in the long run it is much better for the heart to not get overloaded.

It's hard to convince your Dad to take more care if he's in denial about what has to be done.  Many of us patients go through some form of "denial" or rebellion about this stuff, but the plain stark truth is we only hurt ourselves by doing so and we frustrate the living daylights out of those who care and want us to feel better and live as long as possible.

Keep telling him how much you care and how much there is for him to learn, then send him here (if he'll come).

Thanks for being so caring.   

[RichardMEL]

Your father should keep note of his weight change between dialysis sessions - which essentially will be his fluid gain give or take a little bit. The "idea" or suggested max change between treatments is 2kg and 3kg on "weekends" (ie: a 2 day break). I usually keep mine to 2kg between all treatments (weekends are real hard sometimes.. specially in summer!).

The other thing to do is listen to your body. I find if I have a little too much I can *feel* the fluid in me, and feel bloated etc.. and when it gets more extreme you will have trouble breathing etc.

If your dad finds it difficult it might be an idea to weigh himself on a regular basis at home (I do this) just to keep track of where he's at and try to not let the change get over that 2kg mark. Obviously over time you will find that some people can handle having more on (and thus pulling more off) and others can't. You just need to determine your "safe" limit. Mine's about 3.2kg so keeping to 2kg over means I'm well within tolerance for me.

[HSM]

When I started dialysis I was told for some whose kidney's had completely failed they should only be drinking 750ml a day (max) and someone who still passes urine is entitled to drink 1500ml a day. So if he doesn't go to the bathroom at all anymore he really has to be careful with the amount he drinks, maybe even set a limit for himself if that helps.

[RichardMEL]

I found the official document I got from the dietician on fluid when I started dialysis. It states a per day limit of 500ml plus the equivalent of your urine output.

Well frankly if you ask me that's nigh on impossible!!  For me I find it hard to stick to 1000ml a day sometimes lol.  It would be very challenging to stick to 500+output (I only pass about 100-200ml a day currently) Specially for those that don't pass anything. As I said above I think the "2kg between sessions" is a good sensible guide for most patients.

[monrein]

Maybe it's because I'm a fairly small person and I only do 2 and a half hour runs, but 2 kg is too much for me to remove at one go.  This past Monday I had 1.8 kg on but couldn't get it all off at one shot.  1.4 was my limit and I felt like poop.  I don't pee much at all.

[RichardMEL]

I think that just underlines that everyone has different limits. Also I suspecf fhat 2kg limit is for oz patients where we normally do 4 or 5 hour runs at a lower pump speed (I do 350 and that's the highest they will go) so I am sure the longer run time means an overall lower UFR which the body can tolerate better.

[monrein]

Definitely RM.  They don't like to take off more than 1 kg per hour here.  When I used to do 5 hours I could remove much more too.  Of course I was also half my age then too.   Nah, that can't be it. 

[RichardMEL]

This is where profiling can help. I like profile 6 for example - which takes off a large amount first for 30 mins, then goes to UFR 100 for 30 mins, then a less amount than the first for 30 mins, and so on stepping down. For me, I can tolerate a large UFR (eg: ~1800) for 30 mins, then down to 100 to let the body refill - that way more can be taken off easily and by the end of the session you're down to a next to nothing UFR so if anything goes wrong or you need to come off, you're pretty much at your goal. All these little things can help.