Heart Failure

Fluid Intake and Congestive Heart Failure

01/07/2009

Question:

My 74 year old father was recently placed on a very "low salt" diet for his congestive heart failure. He has other serious medical conditions (diabetes, high blood pressure, arteriosclerosis)which are controlled by medication. He was told to limit his intake of fluids but no one defined "limit". His body must need some fluids to operate correctly. How much is too much or too little?

Answer:

Thanks for your question. A low salt diet and fluid restriction are often used as treatment for Congestive Heart Failure (CHF). CHF is a condition when the ventricles of the heart are not pumping adequately (or at a reduced capacity) and fluid "backs up" behind the heart and lungs leading to shortness of breath and fatigue. The mineral sodium attracts water. So, low sodium diet is recommended for CHF to prevent fluid from accumulating around the heart and lungs. An adequate amount of fluid for your father to consume per day depends on how much he weighs, and how much medication he is taking. Diuretics are often prescribed for the treatment of CHF. These medicines remove excess sodium and water in the blood by increasing urine output. Normal urine output is at least ~ 500 ml/day. Patients on diuretics may urinate over 2 liters of fluid per day (depending on their medicines and fluid intake). If your dad is on high doses of diuretics (> 30 mg/day), he should not restrict fluid too much or he may become dehydrated. A general way to evaluate your fluid needs is to use 1 ml (milliliter) per calorie need. So, if your father weighs 180 pounds, he will need approximately 2200 calories per day (~12 calories per pound) for weight maintenance. This means he should consume approximately 2 liters (2000 ml) of water per day. If he must restrict fluid, he should decrease this fluid amount to approximately 1500 ml/day (1.5 liters). This amounts to ~ 6 eight ounce glasses of fluid. Keep in mind that juice, coffee, soup broth, etc. counts as "fluid" (not just water). Foods that melt also count as fluid (such as ice, popsicles, ice cream, jello, and sherbet). This amount (1500 ml/day) is adequate to keep him hydrated without being "fluid overloaded" or dehydrated. Some physicians will restrict fluids to 1200 ml/day. This typically is not dangerous, but certainly difficult to comply with. Be sure to use his "dry weight" when assessing weight. This is generally considered the normal weight of an individual when they are NOT fluid overloaded from an exacerbation of CHF. Other recommendations for heart disease are to limit high fat and high sodium foods. In general, the less processed foods your dad eats, the better. Canned soups, V-8, breakfast and lunch meats, ham, pickles, olives, fast foods and cheese should be limited due to the high sodium content. Foods should also be cooked without extra salt and butter. Fried foods and greasy meats should be limited as well as high fat desserts and high fat dairy foods to prevent further arteriosclerosis. If your father is overweight, weight loss would benefit all of the chronic diseases you mentioned. He may wish to see a Registered Dietitian for a full diet assessment and instruction. A dietitian can give him dietary information, and also assess the quality of his diet and overall nutritional status. Given his chronic conditions, your father may have drug-nutrient interactions which should be evaluated and treated. Good luck to you both!

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Response by:

Lisa Cicciarello Andrews, MEd, RD, LD
Adjunct Faculty
University of Cincinnati