As a Nephrologist treating all sorts of ailments, we often need to counsel on the merits of fluid restriction. Many of our patients are surprised to hear a kidney doctor ask to drink LESS WATER. “Wait, you want me to drink less water not more?” Don’t get me wrong, there are plenty of times when high fluid intake is essential, such as preventing kidney stones, polycystic kidney disease, prior to iodinated contrast exposure or to prevent or treat episodes of ‘dehydration’. There are just as many instances, however, when less is more and we actually ask folks to cut back. Diseases that benefit from fluid restriction include:
- Stage 5 Kidney disease
- Dialysis
- Cirrhosis
- Congestive Heart Failure
- SIADH and most Hyponatremia
So here is UreaAide™’s list; which we compiled from some of our Hyponatremia patients, registered dietitians, Nephrologists, and online sources borrowed from our dialysis colleagues. We call it our
Top Tips when you have to Fluid Restrict.
- Take small sips and measure your allotment.
Take small frequent sips to keep your mouth moist. It’s also helpful to know what 1 Liter looks like to get a sense of how to space that amount out over the course of the day. Get a bottle or a pitcher to monitor the amount of fluid.
2. Small containers. My dialysis patient mentioned he drinks 4, 8 oz bottles of water spaced throughout the day. When asked why the small bottles, he simply stated “I enjoy the feeling of being able to finish the entire bottle.”
3. Limit salt intake.
Salt intake leads to thirst. Thirst leads to increased fluid intake and overall frustration, so limiting sodium is key to managing a fluid restriction. Remember about 80% of the salt we consume in America, comes from what is already added to the food. Canned soups are notoriously high in sodium, and have added fluid (see #11). So read labels and make wise choices.
4. For a snack try eating frozen fruits.
Suck on frozengrapes, frozen berries, and cherries or use these instead of ice in your drinks. You can also use frozen rocks or plastic ice cubes to cool your drink without adding extra water.
5. Freeze your favorite drink and lick/sip on it all day.
6. Don’t forget if you’re eating Ice chips 1 cup of ice is about 60% water (based on our experiment
anyhow)
7. Try chewing gum or sucking some sugar free hard candy to keep your mouth moist.
8. Rinse your mouth out often, either with water or a dry mouth rinse like Biotene or Thera Breath. Just make sure it is alcohol free.
9. Avoid spicy foods. Spicy foods will make you crave more water, derailing the fluid restriction.
10. Control your blood sugar. High blood sugar leads to dehydration and higher osmolarity (concentration) which ultimately leads to intense thirst and Anti-Diuretic Hormone secretion. This will signal your body to hold onto water and ultimately drop your serum sodium lower.
11. Be careful with foods that have high water content. In the US, on average about 20% of our water comes from food. (In other countries like Japan its as high as 50%). Soups are an obvious source but also Jello, watermelon, papaya, gravy, and many desserts like popsicles and ice-cream contribute.
12. Take medications with your meals not in between them. This will help avoid extra times of liquid intake. You can also try taking medicines with soft food like applesauce instead of water.
13. This may sound crazy but try using a small 5 CC syringem(no needle) to squirt the water into your mouth. This trick really works well for one our patients. “I can go to that well 200 times a day for a sip and that works wonders for me.”
14. Freeze your glass. Try freezing a small glass to keep your drink ice cold without the need for added ice.
In closing, fluid restriction is an important tool for many diseases including heart failure, liver disease, advanced kidney disease and Hyponatremia. Combining these tips with mediations your doctor may prescribe such as diuretics, UreaAide™ Urea or Tolvaptan will help you feel great and keep your sodium number in range.