Sunday, March 11, 2012

Fluids and Dehydration

The topic of Dehydration comes up frequently for those undergoing chemotherapy.

"Dehydration occurs when you lose more fluid (and electrolytes) than you take in, and your body doesn't have enough water and other fluids to carry out its normal functions. If you don't replace lost fluids, you may get dehydrated.

Common causes of dehydration include intense diarrhea, vomiting, fever or excessive sweating. Not drinking enough water during hot weather or exercise also may cause dehydration. Anyone may become dehydrated, but young children, older adults and people with chronic illnesses are most at risk".

Being dehydrated can make you feel very tired (and sometimes weak and dizzy). When you are going through chemotherapy you already feel more tired than usual. Add dehydration to the mix and your “normal” treatment related fatigue can increase exponentially.  
Dehydration can be sneaky. You may feel that you are already drinking plenty of fluids. Long ago I learned that you don’t just ask a patient, “are you drinking enough fluids?” because the answer is always yes. I  learned that you always ask “about how many glasses of fluid are you drinking in a day?”  "What is the size of the glass?"   Invariably I find out that the person thinks they are drinking a lot more than they actually are.
Some patients really do drink a lot and yet still can become dehydrated. The general rule is if you think you are drinking enough, drink some more. 
I have yet to meet a patient who doesn’t feel better when they come in and get a bag (1 liter) of IV fluids for hydration. They are amazed with the level of energy that they have afterwards. 
Why don’t people drink as much as they should? We are all guilty of this.  If you are busy, you don’t think about it. With cancer patients, it may be one more thing to think about in a day when they barely have the energy to remember to get showered and dressed in the morning.
We know this.  We just ask you to do what you can.   It might help you to be more conscious of how much you are drinking, even if that means writing it down daily in a notebook using old fashioned tally marks.

Some patients fill up a pitcher at the beginning of every day.  When that is gone they know that they are done drinking for the day.

It is easy to say drink more, but if you feel queasy and can barely get solids down, drinking liquids can be difficult to do.  It may be helpful for you to know that there are “fluids” in places that you might not realize.

Jello is technically a liquid. A popsicle is technically a liquid.  Anything that  becomes a liquid at room temperature will count as "fluid" and will help you to keep properly hydrated.  
Can’t get down a full cup of liquid?   Maybe you can get down a popsicle every 1-2 hours. 1 popsicle = 90 cc. Can’t imagine getting down another glass of water? Try a bowl of strawberry jello with a little whipped cream.  A bowl is about 160cc of fluid. Soup, milk shakes, popsicles, all are considered“fluids” at the end of the day, and may make it easier for you to stay hydrated.
Can’t stand the taste of water or just not a water drinker? Crystal Light, Mio, True Lemon products are some examples of flavorings you can add to water to help get them down.  Ask your oncology nutritionist or dietician, as many clinics get free samples of these to give to patients.


Maybe you have always loved your tap water but due to the metal taste from chemo you are having a hard time getting it down. Try bottled water and add some of the flavors above. Make sure it is cold. It is usually easier to get “cold stuff” down.
Not eating or drinking much else during the day? Make your own popsicles with "Pedialyte" or any liquid that you used to enjoy in drink format, but try freezing it. Same goes for fruit juice. Love cranberry juice? Buy a cheap popsicle form/maker for your freezer and make your own popsicles.  Pedialyte is a mild electrolyte replacement drink that they give to kids. 
Adults can also try sports drinks.  Gatorade is everyone's first impulse to buy when they think they need more fluids or electrolyte replacement (can also be used to make popsicles).  Just be mindful as Gatorade and a lot of sports drinks have a lot of sugar in them which can actually cause increased diarrhea in some patients. 
Frappes and milkshakes count as fluids, but may also give you some extra protein and calories that you may be needing too.  If you like Carnation Instant Breakfast or Ensure  and need the extra nutrients that those provide,  you can try freezing those liquids into popsicles too.
Did you eat cereal in the morning? How much milk did you pour over it?  That amount of milk counts for your daily total of fluid.  An individual sized milk carton is 240cc or 1 cup of fluid.
Did you eat a can of soup at lunch?   One bowl is 160 cc’s.   A warning, just be careful as soups and many canned items contain a lot of sodium, so if you have puffy feet from some types of chemo (Docetaxel), you may not want to eat a lot of sodium/soups. 

Try to alternate your fluids so you don’t get bored and so that you have a little variety.  Also if you just drink one kind or one flavor of a beverage, I promise you that when chemo is over just the thought of that beverage will make you queasy or disgusted.

How much fluid should you have per day?  We usually say 8 to 10 glasses of fluid per day.  That would be about 1500 to 2000cc per day (1.5 to 2 liters) but some folks may require more.  Ask your doctor, nurse or nutritionist.  If you are a chemo patient and also have cardiac or heart issues, you need to discuss how much fluid you should have daily with your medical team.
Try keeping track of your fluid intake for a week and see if you notice any difference in your fatigue levels.
So next time when your nosy nurse asks you (with the suspicious hairy eyeball expression) “Are you really drinking enough fluids?” you can confidently say “yes, miss nurse smarty pants, I had 2 liters per day x 5 days”. This will shut her up and impress her!!!
One more thing....we won’t deprive you of your daily cup of tea or coffee, but they don’t really count in your calculations of fluid ingested. That is because tea and coffee tend to dehydrate you. They make you urinate a lot. So try to limit these to 1 or 2 glasses a day at the most.

Hopefully by tanking up on your fluids, you will feel a little less fatigued!!!
Here are some basic “amounts” or conversions for popsicles, jello etc so that you can figure out how much fluid you had in a day.
Fluid measurements
1 ounce = 30 cc
8 ounces = 240 cc
1 cup = 8 ounces = 240 cc

Sample measurements
Coffee cup = 200 cc
Clear glass = 240 cc
Milk carton = 240 cc
Small milk carton = 120 cc
Juice, Jell-o or ice cream cup = 120 cc
Soup bowl = 160 cc
Popsicle half = 40 cc
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