Emphasize importance of fluid control this summer
Emphasize importance of fluid control this summer
The heat of the summer may be the last straw for your patients trying to limit the amount of fluid they drink each day. Some physicians suggest you revisit the instructions you give your CHF patients to see if there is any room to drink a bit more each day. But the main message is to reassess patients according to their NYHA class and whether they need to be on diuretics, says cardiologist Gerre Lutz, MD, associate professor of medicine at Emory University in Atlanta.
Controlling fluid intake is tough enough without the heat, says Lutz. Not only is it common for CHF patients to have a dry mouth, but their control centers in the brain continue to send the signal that the patient is thirsty.
Now add summer months to the picture, where Lutz says patients "already are looking for any excuse to give in." Summer may be the most difficult time all year to stick with the CHF program. And any sort of fluid intake can cause problems. Lutz notes one of his patients developed pulmonary edema after eating two watermelons.
He cautions against sounding too strict with the patient and notes many problems can be avoided by handling this situation according to the patient’s functional class.
Patients in class III and IV CHF should not be out in the hot sun in the first place. Keeping them in a cool environment can do a lot to avoid temptation for more fluid.
With patients in class I and II disease, much depends on whether or not the patient is on a diuretic. Lutz adds at Emory about half of his patients are on diuretics. If they are not on diuretics, it’s probably OK to drink 200 cc to 300 cc of fluid — about a typical 8-ounce glass. Then have the patients pay extra attention to how much they weigh each day.
With patients on diuretics, the doctor will have to decide if the patient should:
decrease the dose;hold the dose;
allow the patient to drink a bit more fluid than usual.
Then, continue to be vigilant about weighing.
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