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My Care Team says that they want me to lose weight and restrict my fluid: How do I go about that?

Monitoring Your Weight and Fluid Intake

Get a good scale

To be useful, weight data should be reasonably accurate. If you don't have a reasonably accurate scale, buy one as it is a good investment in your own health. You don't need a super-expensive doctor's scale, but your scale should be accurate to a pound or so. Electronic scales that use a strain gauge instead of moving parts are less expensive and plenty accurate; that's what I use.

Many scales read a little high or low all the time: what scientists call “systematic error.” As long as it's only a few pounds and remains the same, this is no problem as long as you always use the same scale. But if a scale reads high one day and low the next, it's yet another source of confusion: the last thing you need. Try stepping on a scale four or five times in succession. If it reads the same weight within a pound or so each time, it's fine. If the weight jumps all around, for example 170, 172, 168, 175 on successive weighing, get rid of it and get a better scale.

Keep in mind the variation among scales when you're traveling. If you're visiting a friend and happen to step on his scale and it says you've gained 10 pounds overnight, odds are it's the scale, not you.

Start a logbook

The best way to keep your weight records is in a loose-leaf binder or on a calendar.

Weigh yourself every day

Monitoring your weight is important because your weight is one way to tell if your heart function is worsening and/or your medications are working to reduce excess body fluid. Fluid retention can be a sign of worsening heart failure or a sign that your medications need to be adjusted. When you weigh yourself:

  1. Use the same scale.

  2. Wear similar clothing each time you weigh yourself or wear nothing at all.

  3. Weigh yourself at the same time each day (for example, when you get up in the morning.

  4. Weigh yourself before eating and after urinating.

  5. Record your weight in a diary or on a calendar.

  6. Call your care team if you gain 3 pounds in one day or 5 pounds in one week.

  7. Follow the guidelines below if you notice any signs of increased swelling or fluid retention. You may be retaining fluid if your belt feels tighter, your belly seems more swollen, your clothes don’t fit as well, your feet and ankles become swollen, your shoes become tight; or your shoe laces seem shorter.

If you should gain fluid weight try diet/fluid modification first:

  • Eliminate and additional 500 mg of sodium* from your diet for two days (today and tomorrow) and

  • Decrease the liquids you drink by 360 cc (1 and ½ cups) for two days (today and tomorrow).

  • If you do not notice a decrease in body fluid or a decrease in weight after restricting sodium and fluid for two days, call your doctor or nurse. Your medications may need to be adjusted.

*Ask your health care provider for a complete listing of foods high in sodium.

Monitor your fluid intake

If your doctor requires you to restrict your fluids, record the amount of liquids you drink/eat every day. You may need to restrict your fluids to 8¼ cups (which is equal to 2 liters OR ~64 ounces) every 24 hours.

Recording your fluid intake will help ensure that you are not taking in more fluids than expected. It is a good idea to write this information on a calendar.

To record your fluid intake, you will need to learn the number of cc’s or ml’s in common servings. Some sample measurements are below.

Fluid Measurements

  • 1 ml = 1 cc

  • 1 ounce = 30 cc

  • 8 ounces = 240 cc

  • 1 cup = 8 ounces = 240 cc

  • 4 cups = 32 ounces = 1 quart or liter= 1000 cc

Sample Measurements

  • Coffee cup = 200 cc

  • Clear glass = 240 cc

  • Milk carton = 240 cc

  • Small milk carton = 120 cc

  • Juice, gelatin or ice cream cup = 120 cc

  • Soup bowl = 160 cc

  • Popsicle half = 40 cc

Note that some foods, as listed below, are "fluid" foods:

Fluid Foods

  • Pudding

  • Gelatin (Jell-O)

  • All soups (thin or thick)

  • Popsicles

  • Ice cream

Keep a record of daily fluid intake until you feel at ease with your fluid restriction and can figure out your fluid intake without measuring liquids.

One way to keep track of your fluid intake: Fill a 2-quart pitcher or 2-liter soda bottle to the top with water and place it in an accessible place in the kitchen. Every time you drink or eat something that is considered a fluid, remove the same amount of water from the pitcher/bottle. When the pitcher/bottle is empty, you have had your limit of fluids for the day.

Note: being thirsty does not mean your body needs more fluid. You need to be careful NOT to replace the fluids that diuretics (water pills) have helped your body get rid of. Here are some tips for decreasing dry mouth:

  • Snack on frozen grapes or strawberries

  • Suck on ice chips (not cubes), a sucker or a washcloth soaked in ice-cold water

  • Cover your lips with petroleum jelly, flavored lip balm or lip moisturizer

  • Suck on hard candy or chew gum (sugarless)

  • Avoid milk or ice cream products, as they increase thirst

Record your urine output, as recommended by your doctor. Recording your urine output will help ensure that you are not taking in more fluids than expected.

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