Free water restriction

[jam2007]

Can anyone explain to me? I had a pt with hyponatremia (not sure which type), she had apparently been taking laxatives and drinking a ton of water..and we put on a free water restriction. I am not understaning why they can have other fluids which contain water but not "free water".

Thanks!

[Virgo_RN, BSN, RN]

Taking laxatives and drinking a ton of water sounds like someone with an eating disorder, like anorexia nervosa, for instance.

[moe1802]

Free water restriction is when a person can't go around drinking alot of water alone for a variety of reasons like

bottles of water. I hope you are getting what I mean.

[southernbeegirl, BSN, RN]

Why?

...

i was going to ask the same thing, lol

[southernbeegirl, BSN, RN]

VERY informative thread! thanks guys.

[jam2007]

i was going to ask the same thing, lol

That's kinda what I wanted to know..why!

From what I read it seems like plain ole' H2O can dilute sodium, but if it's mixed with anything (including tea, juice,etc) it doesn't pose the same risk.

[Whispera, MSN, RN]

Whether sodium is deleted or not depends on whether the osmolality of the drink is the same as what the body is supposed to have...all very complicated! Some drinks, even if not plain water, can pose a risk.

[makes needs known]

Simply put, the more water she drinks the lower the na concentration will be in her blood. If you have a 1/2 glass of salt water, and you add water to it, you will have water that is less salty. Some people have problems regulating sodium levels. Some are on no added salt diets, some are on fluid restrictions.

[talaxandra]

I agree with all you wrote, taxalandra, just didn't know where the low sodium came in. Definitely if someone is hypervolemic, he/she is hyponatremic, if the body is working "normally." Water dilutes sodium. I'm thinking the psychogenice polydipsia has more to do with opioid receptors being happy due to lots of things, not just sodium-lack.

And as I reread it you're quite right - even though it's called hyponatremic polydipisia syndrome nothing says it's the hyponatremia rather than another factor that causes the dopamine response. Hmm - could I possibly have been wrong? Surely not

[loompamedic]

Free water restriction generally refers to anything that's not straight water. The reason being that straight water will make your patient relatively more hyponatremic. This is contrasted from a fluid restriction where you limit anything they drink. It's usually divided between dietary and nursing. However, I have a hepatologist on my floor whom considers 'free water' as any fluid...so I would ask them what they mean, and if they are wrong (like my hepatologist), ask your nurse manager to have them clarify.