Fluid Control for Dialysis Patients – 47 Tips

January 31, 2016 | By Stu | Filed in: Uncategorized.

Fluid control frustration

Any dialysis patient will tell you that keeping your fluid levels down between dialysis treatment is probably the biggest challenge they face. Certainly in your author’s case, this has proven a constant battle

The diet can be adjusted to, the interminable hours in the chair can be whiled away in a number of ways, but that damned fluid restriction bites us on the ass constantly.

I’ve always looked for hints and tips to help keep my fluid down between dialysis treatments. Some work, some don’t.

So here’s a collection, in no particular order of every tip and trick I could find after about many hours of exhaustive research. If you have a tip that’s not in the list, I’d love it if you could leave a comment below. If you’ve tried some of these and they work, or don’t, please also let us know.

I haven’t used all of these, so I can’t vouch for the success that you may or may not have with them.

I’ve broken this list up into three sections, click on the links below to go straight to them

Things to buy

Things to do

Food related

Things to buy

  1. Mouth Spray: There are a multitude of mouth sprays available on the market. I personally use Ultrafresh Cool Mint but there are plenty of others available Some people might find some of these a bit hot on the tongue but it works for me in stimulating saliva.
  2. Breath Strips: Similar to mouth sprays, breath strips can stimulate the production of saliva, holding off that thirst for a little longer. There are a huge variety of breath strips available for you to choose from. Though they all seem to be produced by Listerine
  3. Buy a Bag of Ice: This is one I used with great success before I bought my own ice maker. Ice from the shops or gas station is typically less dense than ice you make in your freezer. This ice is nice and soft, and a cup of it actually contains considerably less fluid that a cup of ice you made yourself. This is good because it helps keep your fluid down, but it’s also less likely to damage your teeth if you chew on it.
  4. Get an Ice Maker: These can now be had for less than $100, and it may just be the best investment you ever make in your health. They produce nice soft ice that is less likely to damage your teeth, and you’ll always have ice on hand for when you get thirsty
  5. Chewing Gum: An oldie but a goodie, chewing gum stimulates the production of saliva, getting rid of that horrible dry mouth
  6. Use an Aquatally Cup: I’ve spoken previously about the Aquatally Cup and their dodgy research methodology in the dialysis space. Your mileage may vary with this, but some will find it a great way to keep track of their fluid intake. There are many other cups with volume marks on them that you can use as well.
  7. Frozen Juice Box: Not sure what these are called in other parts of the world, but this is a small (200ml) box of fruit juice  with a punch hole for a straw available here in Australia. These are great because they contain a pretty small amount of actual fruit juice so potassium is not really an issue. I freeze these then cut off the top and eat the ice with a spoon. They take over an hour to get through, so a great icy treat for a hot day.
  8. Whiskey Stones: This one’s a little out of left field, but dammit I love these things. I happen to run a laser engraving business, and I came across these as a laser engraveable gift. Whiskey stones are small square stones (about half an inch cubed) that you put in the freezer, then take out and place in your drink to keep it cold. The benefit of whiskey stones over putting ice in your drink is that they don’t melt, diluting your drink. Any dialysis patient will tell you that if they’re limited in how much they can drink, dammit they’re going to drink things that they enjoy. Being a scotch and coke man myself, I love the fact that when using whiskey stones, I don’t get melted ice in my drink, it’s still ice cold, and full of that lovely schotchey and cokey taste, right down to the last drop!
  9. Spray Bottles: Get a spray bottle of water and spray it in your mouth. This is is a bit of a controversial one, there’s been some talk of chemicals in the Evian spray in particular (nitrogen is used as the propellant, but remember nitrogen makes up 78% or the air that you breathe), but some people swear by this. You could always just get a spray bottle and fill it with water and some lemon juice or peppermint extract. The benefit of the Evian spray is that it’s a small bottle that can easily be stored in a purse or bag for use when you’re out and about.
  10. Get Good Digital Bathroom Scales and Use Them: I spoke previously about this in my post about the Aquatally Cup. It’s a simple act of getting a good set of scales, and using them regularly to keep an eye on your fluid gain. I get on my scales at least a dozen times a day. This has the added benefit that you might actually discover that you can have an extra drink before you head off to dialysis
  11. Sugar Free Candy: A great one for the diabetics among us, but also good for everyone, sugar free candy helps get the saliva glands working without the added sugar that can make you thirsty.
  12. Mouth Moisturising Spray: I personally haven’t tried these, but some people swear by them. The idea is that they freshen the mouth and stimulate the saliva glands
  13. Buy a Humidifier: This is one I haven’t tried, but have read that some people swear by it. A humidifier adds moisture to the air, thus reducing the dryness of the air that you breathe in. I imaging that this would be particularly useful at night in dry climates, stopping you from waking up with a parched, dry mouth and throat in the morning
  14. Zooper Doopers: Again, not sure what these are called in other parts of the world, but these are flavoured ice tubes, containing about 50ml of fluid. You just get them, pop them in the freezer, and grab one when you need a nice, icy treat. Just be a bit careful with these, as they contain a lot of sugar, which can make some dialysis patients thirsty.

Things to do

  1. Brush Your Teeth: This might seem a bit basic, but it’s certainly true from my experience that a minty fresh mouth can stave off that thirst for a while. Just be careful not to take a couple of big mouthfuls of water when you’re rinsing! 😉
  2. Smaller Cups: Try having your morning coffee or all of your drinks in a smaller cup. This will give you the satisfaction of having a drink, without the added fluid of using a full sized cup
  3. Lemon Ice: While I’ve never found this one particularly successful, some people swear by freezing ice cubes with a splash of lemon juice.
  4. Frozen Fruit: This is one I love. Freezing grapes, orange wedges., berries or pretty much any other fruit. Of course you’re going to need to keep an eye on potassium if freezing fruit
  5. Lemon Juice in Ice Water: An old favourite, the lemon juice gives the ice water a freshness, while also stimulating saliva production to keep the mouth moist.
  6. Tax Your Kids: My kids have grown up with a dad on dialysis, so I have them well trained. Every time they have a drink, they offer me a mouthful. I call myself the tax man, because I take a small tax every time they have a drink. (They also do this if they’re having food they know I have to be careful with, such as bananas, chocolate bars or ice cream.)
  7. Save Your Drinks: This is a good one if you know you’re going somewhere where you’re going to want to have an extra drink or two. I use this one a lot if I know I’m going to a party that night. I’ll skip or dramatically reduce the size of my morning coffee and my drink with lunch. I know it’s a hard thing to do, but it’s awesome to go to a party knowing you can have three or four drinks when you’re there. You get to feel almost “normal”!
  8. Don’t Get Drunk: I love me an alcoholic beverage or nine. My particular poison is scotch and coke. Being a middle aged Aussie male, I’m also partial to an ice cold brew. I’ve learned the hard way that getting drunk, even if you do it on a low volume alcohol such as straight spirits, caused two problems. Firstly, being drunk tends to make you lose your self control. This can cause you to make bad fluid and food decisions that you might regret. The second one is hangovers. The standard cure for a hangover is lots of fluid. Yeah you’re not going to want to do that!
  9. Think Twice About the Weed: I’m not going to stand in judgement of those who partake in the occasional toke or two. I’ve been known to enjoy a little reality detachment from time to time, and if anybody deserves to take themselves outside of their day to day problems, it’s the dialysis patient. But there are two side effect from smoking weed that can cause problems for the dialysis patient. Firstly, smoking weed can make you thirsty, like really thirsty!. This combined with the relaxed feeling from the weed can lead you to make bad fluid consumption decisions. Secondly, weed can make you really hungry. This can lead you to make bad food consumption decisions. All of a sudden, that big bag of Cheetos can look awfully good.
  10. Keep Busy: This is one you’ll find in every other list about keeping your fluid down on dialysis. Because it works. Keeping busy can take your mind off the thirst that would drive you crazy if you were to sit around and think about it.
  11. Frozen Water Bottle: This is another that I’ve used with great success in the past. Put a bottle of water in the freezer until it’s frozen, then take it out and just drink the water as it melts. This has the twin benefits of helping you to keep track of your fluid intake, and the secondary benefit that that water is soooo damned cold!. You could even put a few drops of lemon juice or something else you like in the water before you freeze it.
  12. Eat a Piece of Fruit: Obviously you’re going to want to keep your potassium limits in mind when doing this, but a nice cold crisp apple can do wonders to sate a thirst and get the saliva flowing. Obviously this will help keep the doctor away as well! 😉
  13. Fizzy Cold Water: This is not one I’ve used, but some dialysis patients swear by it. Especially with a few drops of lemon juice or something similar for a nice cold drink with little phosphate or potassium.
  14. Drink Only When Thirsty: This one seems kinda obvious, until you actually think about it. Do you automatically have a coffee when you get up in the morning? Automatically pour one out when you sit down for a meal? Well try not doing that. Try only drinking when your body actually tells you that you’re thirsty. You might be surprised how little you drink during the day when you cut out the “automatics”
  15. Freeze Ginger Ale: Another one that I love. Drink the ginger ale as it melts. It’s nice and cold, and really helps get those saliva glands working.
  16. Rinse and Spit: You’ll need a little self control for this one, but rinsing and spitting nice cold water wets your mouth without adding to your fluid intake. Be careful not to start swallowing though!
  17. Strong Mint Before Drinking Water: Eating an extra strong mint or using a mouth spray before drinking cold water can give your mouth the shot of freshness you’re after. Remember to drink small sips though, as you don’t want to get that burning feeling in your mouth.
  18. Splash Cold Water on Your Face, Hands and Wrists: It’s a well known fact that you lose a lot of your body heat through your face, hands and wrists, splashing cold water on them can help drop your core body temperature, decreasing your desire to drink.
  19. The Old Spoon in the Freezer Trick: When I was researching for this article, this one came up a couple of times. I have to admit that I’ve been doing this dialysis thing for twenty years and never heard of it. Apparently you put a metal spoon in the freezer, and when you’re thirsty, take it out and suck on it. I guess the idea is that it cools your mouth down without you taking any fluids. Must try it!
  20. Use Kids Sippy Cups: The idea here is that these cups are smaller than the normal cups you’d drink from. You also get the benefit that the sippy cups make you work for your drink, theoretically slowing your drinking down.
  21. Sweat: Another oldie but a goodie. Many seasoned dialysis pros use this one. When you sweat you lose fluid. So a solid workout, or even some time in a sauna can help you drop enough fluid for an extra drink (talk to your doc before you jump in a sauna – you’ll lose important electrolytes such as sodium and potassium in a sauna, which can be dangerous.)
  22. Slurpees and Crushed Ice: These have much less fluid than a cup of the same size filled with soda or water. They’re still a decent sized drink, and they’re nice and cold.
  23. Cut Out Milk: This has the double benefit of helping to keep your phosphate under control, as well as the fact that for some people, milk makes them thirsty.
  24. Delay the Next Drink: Do you automatically reach for the coffee first thing in the morning? Don’t drink that glorious cuppa Joe first thing when you’re still half asleep, wait an hour so you can really enjoy it. Or maybe wait a couple of hours and you’ll discover you don’t really need it at all.
  25. Cut Your Drinks in Half: This works surprisingly well. When pouring out a drink, try just half filling the cup. The trick to this one is to savour every mouthful. Swirl it around in your mouth for a while before you swallow.
  26. Buy Mini Cans of Soda: Most of the soda manufacturers are now producing 200ml cans (around 7 oz) as compared to the standard 375ml (around 12.5 oz). These are great for a quick cold drink without the guilt associated with drinking a whole can or bottle.

Food related

  1. Use Herbs in Cooking Instead of Salt: Keep your sodium levels low by using herbs to give food that flavour kick without increasing sodium intake. Be careful if you’re using salt replacements as they often use potassium chloride, which can be deadly for dialysis patients
  2. Avoid Sodium: While this might sound obvious, high sodium levels are a two edged sword for dialysis patients. One is that sodium just makes you thirsty, making it harder to stick to your fluid limit, the second is that high sodium levels make it more difficult for dialysis to remove fluid from your body on dialysis. This is especially true for those doing peritoneal dialysis.
  3. Keep Your Sugar Under Control: This is also a two edged sword. For diabetics, high sugar levels make you thirsty, making it harder to stick to your fluid limit, but even for those not afflicted with diabetes, sugar can make you thirsty as well. Another issue with high sugar levels presents for those doing peritoneal dialysis. PD relies on the differences is sugar levels between your blood and the PD solution to draw fluid across the membrane. If your sugar levels are too high, you’ll have trouble removing fluid.
  4. Keep an Eye on Fluids in Food: This is one that surprisingly, some people are not aware of. There’s a whole bunch of fluid in foods such as cooked pasta, soup, casseroles, yoghurt, custard and ice cream. Remember to keep this in mind when you’re planning your fluid intake for the day
  5. Don’t Automatically Have a Drink with your Meal: Do you automatically sit down with a glass of water or soda when you eat? That’s 300-400ml of fluid you’re not getting back. Instead of automatically drinking with each meal, try not doing that. That would be another drink you can have at some other time during the day.
  6. Only Drink When You Eat: The opposite of the one above; save your drinks for meal times. A coffee with breakfast, a soda with lunch, maybe a wine or beer (with your binders of course!) with dinner? If you’re going to be limited to a few drinks a day, you might as well enjoy them with a nice meal.
  7. Use Mrs Dash to Flavour Your Cooking: This one came up again and again in the forums when I was researching this article. Apparently Mrs Dash tastes great, and has low potassium AND low phosphate. Whaaaat? Something that tastes great AND is OK for us dialysis patients to eat? Wow!

Did I miss anything, do you think I’m an idiot and some of these things don’t work? I’d love to hear from you in the comments below.

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