Fluid restriction is a standard treatment for heart failure, although not all patients will require one. Because your heart does not pump blood effectively and efficiently, fluid can build up throughout the body, resulting in weight changes, swelling, fatigue, and shortness of breath. A fluid restriction aims to reduce the amount of fluid in the body and ease the workload on the heart.
Read on for a comprehensive guide to fluid restriction and heart failure. You will learn why you may need a fluid restriction, what counts as a fluid, how to track your daily intake, and how to be sure you are not retaining too much fluid and endangering your health.
Do You Need a Fluid Restriction?
The quick answer is “maybe”.
It depends.
The primary reason that you may need a fluid restriction is heart failure causes fluid retention!
Depending on your body and the progression of heart failure, a fluid restriction may be required. Some people manage their heart failure just fine without it, but others really struggle. It’s more a matter of your body and how it responds to heart failure. More advanced stages of heart failure are more likely to require fluid restriction.
While there are medications called diuretics that help your body get rid of fluid–usually by causing you to increase your urine output—sometimes medications are not enough.
And some people don’t tolerate high doses of those drugs and need to take things a step further. Before we get into the details of fluid restrictions, let’s do a deep dive into fluid retention.
Fluid Retention
It’s common for people with heart failure to experience a buildup of fluid in the body tissues. If you think about what happens in heart failure, this makes sense.
The heart cannot pump blood effectively to all your organs, including your kidneys. Even if they are healthy, in this situation, the kidneys cannot eliminate extra fluid because the blood isn’t getting to them as effectively. The whole system just slows down, and fluids build up.
Fluid buildup can happen quickly, or it can sneak up on you.
Let’s face it. You are your own best advocate.
It is so important to pay attention, check in on your body and look for signs.
Signs of Fluid Retention
Edema
Edema is the name for the swelling that comes from fluid retention. Edema is most noticeable in people’s ankles, lower legs, and feet.
You may notice the swelling just by looking.
Your shoes may feel tight.
Your socks may make larger than usual “indentations” in your legs where the elastic digs in.
Another way is to press your finger onto your legs or feet. Healthcare professionals often use this method. If the skin stays depressed–like it has a little pit in it that doesn’t quickly bounce back, you likely have edema.
Here is how healthcare clinicians grade edema. It’s a subjective scale which means the stage may vary slightly depending on who is doing the evaluation.
- Grade 1: Immediate rebound with 2mm (millimeter) pit.
- Grade 2: Less than 15-second rebound with 3 to 4 mm pit.
- Grade 3: Rebound greater than 15 seconds but less than 60 seconds with 5 to 6 mm pit.
- Grade 4: Rebound between 2 to 3 minutes with an 8 mm pit.
So in severe edema, pit or dent made from your finger would be visible for 2-3 minutes.
*This is meant to be informative and not to substitute for a professional evaluation. If you try this, be gentle. Don’t bruise yourself or break the skin. These are guidelines to help you anticipate problems and communicate with your physician.
Weight Changes
One of the best ways to tell if you are retaining fluid is to take a daily weight. Weight gain of more than a pound or two may indicate increased fluid retention. In addition, a small gain that continues over a period of time is equally concerning. Look at it this way, a ½ pound gain over ten days is a five-pound gain!
Keeping track of these fluid shifts and letting your doctor know is so important. Quick action can prevent an exacerbation!!!
Shortness of Breath and Chest Tightness
Excess fluid makes you feel bad–really bad!
Fluid in and around the lungs causes shortness of breath. It can put pressure on your lungs and heart. Your chest may feel tight. You may experience pain caused by the pressure.
Your body is communicating that something is wrong.
And don’t forget, that extra fluid is extra weight for you to drag around, which taxes your heart even more.
Fatigue
There are many things that can cause you to feel tired.
But increased fatigue is definitely a sign of fluid retention or CHF exacerbation.
It is so easy to ignore fatigue or chalk it up to a normal part of your condition, your busy life, or a bad night’s sleep! And while fatigue may be something that heart failure patients experience, increasing fatigue is a warning sign that something isn’t right.
Learn to listen to your body, and report changes in your energy levels to your physician.
How Do You Manage a Fluid Restriction?
How does fluid restriction work?
Based on your body size and the severity of your disease, your doctor will give you a specific fluid limit each day.
It will be up to you to track your fluid intake from all sources, and make sure you stay within your limits. The allowed fluid should be enough to keep you hydrated and give your body what it needs.
Fluid Restriction Chart
Common fluid restrictions are between 1200mls and 2000mls per day.
A fluid restriction is typically given in milliliters or cc’s which can be confusing if you are used to dealing in ounces and cups. I did the conversion for you!
The most common amounts for a fluid restriction are 1200mls, 1500mls, 1800mls, and 2000mls.
See my helpful chart for translating milliliters to ounces and cups.
| Milliliters or cc’s | Ounces (oz.) | Cups |
| 1200 (1.2 liters) | 40 | 5 |
| 1500 (1.5 liters) | 51 | 6.25 |
| 1800 (1.8 liters) | 61 | 7.5 |
| 2000 (2 liters) | 68 | 8.3 |
What Counts as a fluid?
Aside from the obvious liquids we consume as beverages–coffee, tea, water, juice– it is important to add other foods you might forget about.
- All soups and broths count as liquids
- Ice cream, milks, sherbet, water ice, popsicles, pudding, gels, and slushies count as fluid (These should be consumed in moderation anyway, as their nutritional value is typically low)
- Sauces and gravies count as fluid
(I’ll give you a pass on salad dressing as long as you are not using too much!)
It is important to note that all foods contain some water. While it’s true that fruits and vegetables have a higher percentage of water than something dry and crunchy like a cracker, we generally do NOT count fruits and vegetables in the fluid restriction.
Look…I know that watermelon is 90% water, but we had to draw the line somewhere! Use it to your advantage.
And fruits and vegetables are foods with SO MUCH nutritional value; the benefits far outweigh the risks from any fluid present. Check out my article on the best diet for heart failure. Click the link below!
The Best Diet for Heart Failure Patients
You would have to eat a whole lot of salad and apples to reach a significant fluid amount!
So count up your fluids–don’t forget the fluids you use to take your medications–minimize unhealthy fluids, and eat your fruits and vegetables!
*See my article “Does Heart Failure Cause Weight Loss?” for tips on using your fluid allowance to provide additional calories for weight gain.
Tips for Managing a Fluid Restriction
Container Method
Here is an ingenious method. I don’t even remember where I first heard it, but it works so well.
Buy a container with ounces or milliliters marked off, whichever you prefer. Fill it with your fluid allotment for the day.
As you drink fluids, remove that amount from the container.
So you are not actually drinking from the container, although you could! You are simply removing the quantity of fluid from the container that matches what you consume.
If you have six ounces of coffee and four ounces of juice at breakfast, pour off ten ounces of fluid.
Do this throughout the day every single time you consume fluids.
If you have a bowl of soup and aren’t sure of the amount, do this:
Eat and enjoy your soup! Once you are done, pour water from the container to the same level in the bowl. Easy peasy without any measuring!
You will work your way through your pitcher as the day goes on. By the end of the day, the pitcher should be nearly empty.
Pros:
Provides a visual reference.
Helpful when you aren’t exactly sure how much fluid something contains–like your bowl of sherbet or soup.
Cons:
You will be making trips back and forth to the pitcher or carrying it around with you.
It works best when you are staying in one place. It’s much less convenient if you are running errands and out and about!
Phone App
Many free or inexpensive apps help you track fluid. An app on your phone is likely the best method for people on the go. Here are some recommendations.
- Daily Water Tracker Reminder
- Hydro Coach
- WaterMinder
- Water Drink Reminder
- Aqualert
- My Water & Drink Reminder
- Drink Water Reminder
- Water Time Drink Tracker & Reminder
Paper Chart
Some people really like a good old piece of paper and a pencil.
Buy a small notebook and write down every bit of fluid you consume. Note how you feel, symptoms, swelling, or any other observations you have.
It’s simple and straightforward. You will also get some math practice!!!
Spreadsheet
A simple spreadsheet may be your choice. It only needs to be two columns–one for the name of the fluid and one to sum up the numbers.
The best part is that the spreadsheet will sum it up for you. Like the container method, this works better if you are home or have your laptop with you.
*If you want an excel or google spreadsheet, drop me a message, and I will send you one.
There are many ways you can track your fluid intake. The most important thing is to DO IT!!!
Tips for Managing Thirst
You may do perfectly fine with a fluid restriction without experiencing thirst.
But you may experience occasional dryness in the mouth. You may find yourself thinking a lot about fluids.
Here are some tips to make a fluid restriction easier and to quench your thirst without overdoing it on fluids.
- Avoid dry foods like crackers and toast
- Avoid extremely spicy foods
- Avoid salty foods (You already know that!)
- Carry a mint or small piece of candy
- If mints increase your thirst, choose a fruity flavor
- Freeze fruit like grapes–frozen grapes are delicious and one of my favorite treats!
- Rinse your mouth with water if it is feeling dry
- Suck on ice cubes or small frozen juice cubes (Just be sure to count them in your fluids)
- Use smaller cups, bowls, and glasses for your fluid. (This visual really helps your brain feel satisfied with your drink. Pour four ounces of water into a six-ounce cup and then pour it into a twenty-ounce cup, and you will see what I mean!)
Signs of Dehydration
I would be remiss if I didn’t include a note about dehydration. The risk of dehydration is real if you are on a fluid restriction.
Less isn’t more. So if you have a 1500ml fluid restriction, having only 1000mls isn’t better. Your body needs to be hydrated. Your organs need fluid to work properly.
A fluid restriction is a careful balance, and “not enough” is just as bad as “too much”!
And dehydration can damage your kidneys, causing serious health problems.
Signs of dehydration include:
- Dark urine
- Lightheadedness
- Dizziness
- Rapid heartbeat
- Headache
- Dry mouth, lips, and eyes
Remember that you need to be your own best advocate. If you are worried about dehydration, call your doctor and get checked.
Do not ignore symptoms or a general feeling that something just isn’t right.
To Sum it Up
Only your physician can determine if you need a fluid restriction. I think this goes without saying, but…
Do not put yourself on a fluid restriction if you don’t need one!!!
If you are given a fluid restriction, follow it. Take it seriously!
Use the tips and tricks above to track your fluids, manage thirst, and stay healthy.
Pay attention to your body and learn to recognize the signs that something isn’t right. Remember that both fluid overload and dehydration are possible.
Communication with your physician is essential.
Let me know what has worked for you. Drop me a line. And don’t forget to sign up for my email list so you don’t miss out on new articles and important information.
