Coping with a fluid restriction
Avitum
Why do I have to be careful with how
much I drink?
One of the main functions of the kidney is to balance fluid in the body.
In kidney failure a common problem is not getting rid of excess fluid.
Which causes fluid overload. This can cause high blood pressure,
long-term damage to blood vessels and even damage to the heart.
Your fluid restriction depends on your urine output which may
decrease as time goes by. Your care team will tell you how much you
can drink.
To help keep thirst under control spread your fluid evenly through the
day by using small cups. You can also gargle with iced water, suck
ice cubes (still contain 10-15mls of fluid per cube), or chewing gum.
Avoid salt and salty foods, e.g. crisps, bacon, and soup, as this will
increase your thirst.
Remember to be careful of hidden fluids, e.g. water for tablets,
gravies, custards, and milk on cereal.
Why do I need to be on a fluid allowance?
The fluid allowance for each patient is calculated on the basis of urine
output, plus 500mls in a 24-hour period. The 500ml approximately
covers the loss of the fluid through the skin and the lungs.
The weight gains between dialysis sessions should be no more than
1-1.5 kg on a one day gap and 1.5-2.5 kg over 2-3 days. Generally
speaking the smaller you are the less weight you should gain.
If large amounts of fluid need to be removed during dialysis it can
make you feel ill. Your blood pressure may fall, and you may feel light
headed or sick. This is called hypotension (low blood pressure).
Therefore, it is important to always keep to your fluid allowance.
What do you mean when you talk about
my dry weight?
When you start dialysis you will hear about your dry weight. This is
the weight your body should be without excess fluid. It is also the
weight we use to calculate how much fluid you have put on between
dialysis sessions and therefore how much we need to remove each
dialysis session.
Your dry weight can change over time. It may need to be increased
after a few months if you start eating more now that you are on
dialysis and feeling better. However, it could also need to be
decreased if you have been unwell and lost weight.
What happens if I drink too much?
 If the water content of the body reaches high levels, the
accumulating fluid causes the body to swell usually starting at the
ankles, due to gravity and may spread up the body. If not treated,
the excess fluid will settle in the lungs causing a life-threatening
condition called pulmonary oedema. Shortness of breath is one the
main symptoms of this. Several episodes will cause damage to the
heart.
 We can try to remove the excess fluid with dialysis, but if you keep
drinking too much the damage will eventually become permanent
and may leave you with chronic breathing and heart problems.
Dehydration
If you find that you’re feeling faint (hypotensive, low blood pressure)
at home after your dialysis please mention it to your treatment nurse
as this may means we need to increase your dry weight.
You may also become dehydrated in very hot weather.
In the summer you will be given advice on what is safe to drink, and
your fluid restriction may need to be increased.
How can I manage what I drink?
The fluid restriction is one of the most difficult aspects of dialysis for
many patients to cope with, and is not easy. But there are a number
of tips you can follow to help you throughout the day.
 Make sure you know what your fluid restriction is.
 Avoid eating salty foods as this will make you thirsty.
 Use a smaller cup or glass. It feels better to have a full small
glass than half a large glass!
 If you use the same cup then you know how many you can have
in a day. But make sure you know how much it holds.
 Some people suck on ice cubes (but remember this is part of
your fluid restriction), or suck on boiled sweets if they feel thirsty
(be careful if you are diabetic!).
 Be aware of hidden fluids in foods such as melons, watermelon,
soup, gravy and frozen treats like ice cream. This is all fluid.
So what next?
Now you have read through this a nurse or doctor will come back to
answer any other questions you might have. Remember, you can ask
questions at any time.
There will be other booklets for you to read later that will include the
following topics:
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Hemodialysis – a brief introduction
How does hemodialysis work?
Looking after your vascular access
Managing your fluid intake
The dialysis diet
Common drugs used on dialysis
Increasing your independence
Transplantation
We hope that this will help you to adapt to dialysis, helping you to feel
better.
Remember, you can ask questions about your treatment at any
time.
B. Braun Avitum AG | Schwarzenberger Weg 73-79 | 34212 Melsungen | Germany
Tel. +49 5661 71-2624 | Fax +49 5661 75-2624 | dialysis@bbraun.com | www.bbraun-dialysis.com