Thirst-Something To Think About

[NDXUFan]

Thirst is a powerful, primitive, primal survival mechanism

Thirst simply cannot be resisted - no matter how much the patient tries.

The inevitable result ...?

Another 4 kg (4 litres) is gained and ... it all starts over again

http://www.nocturnaldialysis.org/lowbp.htm

The sad facts of a typical dialysis day (for most) ...

The patient struggles in for HD on a Monday morning after a 'long break', that weekend off for dialysis staff that forces a 68 hour break for without dialysis on each and every facility-based dialysis patient ...

The arrival scenario ...?

The patient is short of breath with a 'thumping' heart and a 4 kg weight gain in excess of the weight recorded at the end of the previous Friday's dialysis ... and remember: a 4 kg weight gain equates to a 4 litre retention of ingested fluid

The dialysis plan ...?

Remove 4 litres over 4 hours HD ... or about 1 litre/hour for every hour of dialysis

The dialysis result ...?

Cramp, nausea and a horrible 'flat' - that awful moment when the blood pressure drops and the eyes roll back in a dead faint

The treatment response ...?

A frantic 'revival' effort with intravenous (IV) fluid - when the whole object of the session has been to remove 4 litres of fluid

The treatment outcome ...?

The patient goes home, washed out, exhausted and thirsty-as-hell.

The rest of the day is 'written off' to allow recovery

Meanwhile ...

The patient immediately starts to drink fluid (when knowing its wrong) to slake a raging thirst.

Why ...?

Because a rapid reduction of blood volume stimulates

THIRST

http://www.nocturnaldialysis.org/lowbp.htm

[NDXUFan]

Yes, 3 times per week is not enough. Indiana University would argue that the bare minimum should be 5 days per week. Based on seven and half years on dialysis, I would have to agree with that assessment. Diabetic thirst is the worst thing on this earth. I had normal health for years and I can tell you that there is nothing like diabetic thirst. I would not wish it on anyone on this board, it is He!! on earth.

[NDXUFan]

With 6 night/week NHHD, it isn't like that at all ...

1. Imagine dialyzing (but while you sleep) ... for 8-9 hrs out of every 24 hrs

As NHHD is for 8-9 hours and not just 4, there more than twice as long to remove any excess fluid

2. Imagine dialyzing every 24 hrs, not just every 48-72 hrs

As NHHD is pretty much every night (6 times/week and not 3 times/week), fluid is also being removed twice as often

Do your mathematics ... it's quite simple really ...

Twice as long + twice as often = a 4 times slower rate of fluid removal

This means dialysis which is four times as gentle