[mrs.captain.kangaroo]

Hi, when dealing with a hemodialysis patient with fluid restriction of 1000-1500 ml /day, is the fluid in food consumed (esp. those w/ high water content such as fruit and vegetables) considered as part of the fluid restriction?
I see recommendations for hemodialysis patients with that fluid range and wonder if that takes into account the fluid in foods or is it just for beverages?


Thanks for any help understanding this.

[amidate]

Usually we tell our patients anything that is liquid at room temperature counts in their total fluids for the day. Of course if the patient is eating a large amount of vegetables and they are coming in with a large amount of weight on every treatment you may need to work with that patient and help them moderate their intake.

[jnette]

Agree with the above.. anything that turns liquid at room temps.

Just watch that watermelon in the summer, though!!!

[diabo]

1500 cc fluid restriction applies to total liquid in any form. That should equal around 2 1/2 kgs. to be pulled off every other day, and perhaps 3 1/2 to 4 after the weekend. (Some is lost through sweat and breathing) These restrictions only apply to those who do not urinate. If they still urinate a fair amount, they need to drink more. Many patients get afraid and confused by the general rule and end up in a dehydrated state, which isn't at all good.

[GeauxNursing]

Originally Posted by diabo

1500 cc fluid restriction applies to total liquid in any form. That should equal around 2 1/2 kgs. to be pulled off every other day, and perhaps 3 1/2 to 4 after the weekend. (Some is lost through sweat and breathing) These restrictions only apply to those who do not urinate. If they still urinate a fair amount, they need to drink more. Many patients get afraid and confused by the general rule and end up in a dehydrated state, which isn't at all good.

wow. my patients aren't afraid. We have steady 4, 5, 6 kg weight gains on a daily basis. Sometimes more.

[diabo]

I'm certainly not saying that most of the patients comply. On the contrary. But some do. One of our ladies has been on dialysis for 25 years. Now THERE'S some compliance for ya. Fluid overload eventually enlarges the heart, turning it into big, inefficient muscle. Most dialysis patients die from heart failure.

[mrs.captain.kangaroo]

Thanks for all the help. It seems pretty difficult and would require a lot of monitoring day to day with your diets and fluids.
25 years! I didn't think anyone could survive much longer than 5-10 years on hemodialysis?

[DeLana_RN]

Originally Posted by mrs.captain.kangaroo

Thanks for all the help. It seems pretty difficult and would require a lot of monitoring day to day with your diets and fluids.
25 years! I didn't think anyone could survive much longer than 5-10 years on hemodialysis?

The average survival on dialysis is 5 years, which means that many of these pts don't even live this long due to their comorbidities (uncontrolled HTN and/or diabetes leading to cardiac complications, CVA, or other problems). A few, however - the very compliant ones in general - do live much longer. We have a pt in the clinic where I used to work who has been on hemo for some 30 years (she chose not to get a transplant, she manages just fine on dialysis). There are a few others as well.

As for fluid restrictions, the dieticians help to explain this to the pts (how much they should drink based on their individual residual function - how much they still urinate - and other factors). They also suggest ways to cut fluid intake (e.g., ice chips). Nurses, of course, reinforce this teaching.

Fluid non-compliance is a huge problem for many pts, as pp pointed out. Nursing staff must explain the reasons for this; I like to use the garden hose analogy ("Picture your blood vessels as a garden hose. The more fluid it contains, the higher the pressure inside the hose/vessel. This increased blood pressure damages organs and causes the heart to enlarge and eventually fail"). Pts can usually relate to this (which doesn't mean they'll be compliant

DeLana

[traumaRUs]

And...pts with ESRD die from heart-related complications usually related to fluid overload.

[Natkat]

As I understand it, the fluid in food can be excreted as insensate loss - that is lost when the patient exhales, sweats, as evaporation from the skin, excreted in feces, etc. So fluid restriction is usually limited to what is liquid at room temperature, as someone else mentioned. So in general, no, the liquid in food is not figured into this amount.

Personally I think it would be awful not to have a beer, a cup of coffee, a smoothie or a glass of lemonade just because you enjoy the experience. I suppose it gets easier with time, but I know I'd be sad if I couldn't have a cup of coffee whenever I felt like it. Wow.