FLUID RESTRICTIONS AND CKD
Fluid restrictions are the amount of fluid a patient can drink as a kidney disease patient. This means the patient has to watch the amount of water or fluid they drink, be wary of certain foods that contain fluids which can add to their fluid intake.
It is quite common for Chronic Kidney Disease (CKD) patients to be put on fluid restrictions. It is also quite difficult for CKD patients to get used to fluid restrictions imposed on them to keep them alive; especially when they’ve been drinking normally for a long time.
Circumstances always dictates this imposition but doctors or dietitians have no choice because it’s their duty of care to their patients to make sure they are giving them the right advice to help with their decision.
FLUID MEASUREMENTS
To get the right fluid allowance for you, they measure your urine output over 24 hours. This means you go home with a 2 litre bottle to collect urine in. This you bring in the next day to the hospital. They use this as an indicator of what you’re producing over 24 hours. That’s how they know what restrictions to recommend.
Of course, it is easy to cheat the system but I will advise anyone thinking of doing that, to desist. It is your health. You decide.
I found it hard at first with the fluid restrictions but I had to adjust. First, the recommendation was 450ml fluid allowance a day including fluids used for cooking and everything else. It was a little too low as I was starting to “dry out”. Dry out means my body didn’t have any residual fluid so when I went on my machine for dialysis, the machine took a lot of fluid off so it caused me really painful cramps. Then they had to adjust it to 750ml to stop the cramps. I guess my muscles were just shrivelling continuously.
CRAMPS AND FLUID OVERLOAD
Has any of you ever had really serious cramps? Well, these cramps felt like all my limbs were being bend out of shape so my fingers, toes, back, neck etc were out of shape whilst contracting. I usually had to drink water to get me right again. It would take about an hour to settle or the nurses ended the dialysis so the machine didn’t take too much fluid off.
On the flip side, take too much fluid on board and you swell beyond recognition. However, I never looked so good with just the right fluid onboard. (Infact, I took most of my wonderful pictures during this time because I have always been slim). Fluid gets into every muscle in your body including your lungs and you can’t breathe. You start to wheeze and the only thing that can help is to go on the machine and do dialysis. I have experienced this too.
FLUID OVERLOAD
I remember the day this happened and wasn’t sure how I had gone over my limit, (my restrictions were changed to 750ml a day) but I felt it during the night. It was difficult to sleep or breath properly. I thought this was it. Waiting till morning to get to the hospital felt like an eternity. What I didn’t know was that the fluid had gone to my lungs and causing the breathing difficulty.
As soon as I walked into the training unit, the nurse in charge saw me wheezing and she said “fluid overload”. She immediately instructed the nurses looking after me to put me on the machine and take off 4 litres of fluid.
I guess I will have to explain how they arrived at that decision to take off 4 litres of fluid. Now, before the patient gets on the machine, they weigh themselves to know their weight. Their dry weight is already known; so the subtract their current weight from their dry weight. The resultant difference is the total fluid the nurses input into the machine to take off. This is quite cool, isn’t it? Any way, it worked.
DIALYSIS TIMES
So the nurses took 4 litres off and I was able to breathe again by the end of the session which takes a minimum of 3 and a half hours. For me, I did dialysis 4 times a week (Mondays, Wednesdays, Fridays and Saturdays) and each time 3 and a half hours. It wasn’t the same for everybody though. It depended on what your needs were. Some people had to be on 5 time a week for 2 hours each time or every day of the week for 1.5 hours (this might be for people who can’t sit for long times).
MENTAL HEALTH AS A KIDNEY DISEASE PATIENT
There were patients who didn’t like dialysis and so were difficult to manage. They dictated what times and how long they went on. Some don’t even want to get out of their houses to go for dialysis. They would have to call to tell the hospital they weren’t coming for treatment. It wasn’t because they wanted to be difficult but believe me, dialysis messed with your head. A LOT!!! Some people like me used to just cry, until we felt better, then go in, and cry some more. Our nurses were really patient. They’re all my heroes and heroines.
It was so bad that some people revolted against the rules that were in place. Where they’ve been put on restrictions and told what they should avoid, they just ignore anyway. Their excuse was they were going on the machine and it will take it off. The logic though.
Well, I always get side-tracked. Back to fluid restrictions, so these restrictions were important to us to keep us alive. As I said earlier it was difficult when you start but once you can hack the restrictions, you can string it along like a boss. I did.
6 HACKS FOR YOUR FLUID RESTRICTIONS
- Once you are given your restrictions, measure and pour your exact fluid restrictions into a jug. When you want to drink something, measure that same amount and remove from the jug. That way you know what you have left. For example, if I’m drinking a mug of tea (I was on 750ml a day), I already know that mug is 300ml, so I pour out 300ml from the jug so I’m left with 450ml in the jug and so on.
- Since your fluid restrictions include fluid you use for cooking, you have to take that into consideration too. So you watch how much rice you eat. There’s a formula to the amount of water is in a cup of cooked rice. I would say 1 cup of dry rice to 100ml of water. Take that out of the jug. You’re left with 350ml of water.
- To assuage your thirst, you can suck on boiled sweets like tomtom sweets, peppermint or just the natural way God made you, swallow saliva.
- My special way that worked really well for me was to get ice trays with about 100ml of water. I lined the bottom of the tray with just enough water to make thin ice that I could chew. The nurses advised me to suck ice cubes; but chewing ice can do damage to your teeth. Thin ice is just right and you can eat only 3 of the thin ice and you’re fine for the next couple of hours.
- Cutting out salt from foods you eat or cutting out snacks that contain salt like crisps, groundnuts whether boiled or fried. You might think you couldn’t go without salt but you get used to it. I did. You can use spices like Knorr cubes and other spices to give your food taste but you do need to cut out salt.
- Soups are also part of the fluid restrictions like Pepper soup or any soups that you might drink on its own. That will be part of your fluid allowance.
MASTER YOUR FEAR
The fluid overload is the consequences of not keeping to your fluid restrictions which can kill the patient if not treated quickly. It causes high blood pressure and something called oedema, pulmonary oedema, this is what I was talking about earlier when the fluid goes to your lungs. It starts from the ankles until it gets to the lungs; that’s why most people with fluid overload start to swell and sometimes die before they can be treated. This is as a result of their lungs being compromised.
Do not be scared. You only need to make sure that you get straight on the machine and get the fluid off. There is no DIY way of getting the fluid off than dialysis. I only had difficulty understanding what was happening to me when I had my first episode of fluid overload; after that, I knew exactly what to do.
Fluid restrictions isn’t hard to master. It might be daunting at first but once you get used to it and can manage it, your health will improve appreciably.
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