Major points

1. The primary goal of fluid management in patients with heart failure is to reduce cardiac workload and minimize hospital readmissions.
2. Daily fluid intake should be limited to 1,500–1,800 mL.
3. Daily salt intake should be limited to less than 5 grams (approximately equal to 1 teaspoon of salt).

4. Patients should measure their body weight every morning after waking up and keep a record of both fluid intake and output.   

What is "Fluid Management for Heart Failure Patients"?

Heart failure, commonly referred to as "cardiac weakness," is the heart's inability to pump sufficient blood to meet the body's needs, resulting in physical discomfort. Due to the reduced cardiac output, patients may experience decreased urination, lower limb edema, headache, nausea, coughing, fatigue, and weakness. In severe cases, shortness of breath may occur. Therefore, treatment should include medication, cardiac rehabilitation, diet, and fluid management. The goal of fluid management is to reduce the heart’s workload and lower the risk of hospital readmissions.
 

What should I pay attention to?

Daily fluid intake should be limited to 1,500–1,800 mL. Daily fluid intake formula: Previous day’s total output (including urine, vomit, stool, or drainage) + 500–700 mL. If your body weight increases by 1 kg in one day or more than 2 kg within three days, or if you develop symptoms such as shortness of breath, persistent cough, or swelling in your legs or feet, please return to the cardiology clinic as soon as possible.

Home self-care principles:

1. Fluid intake considerations: Fluid intake includes water content from both liquids and solid foods.
   1. Liquid foods: This includes water taken orally, water with medication, beverages, soups, milk, nutritional supplements via nasogastric tube, and intravenous fluids.
   2. Solid foods: To estimate water content, refer to the Food and Drug Administration’s Food Nutrition Database (latest version). Choose foods with lower water content, prioritizing solid foods. Note that vegetables and fruits generally contain high water content.
   3. Daily water distribution method: Patients or caregivers should calculate the total daily water content from meals and prepare the allowable drinking water in a bottle for accurate measurement.
   4. Recommended daily water distribution is as follows: 50% of the total daily allowance between 7:00 AM and 3:00 PM, 40% between 3:00 PM and 11:00 PM, and 10% between 11:00 PM and 7:00 AM. For example, if daily fluid intake is limited to 1500 mL, consume 750 mL from 7:00 AM to 3:00 PM, 600 mL from 3:00 PM to 11:00 PM, and 150 mL from 11:00 PM to 7:00 AM.
      
2. Salt Intake Considerations: Follow a low-salt diet. 
   1. Daily salt intake should be less than 5 grams, which is approximately equal to 1 teaspoon of salt, 6 teaspoons of soy sauce or black vinegar, or 12 teaspoons of ketchup. When cooking, use alternatives such as vegetable oil, green onions, or garlic instead of salt to enhance flavor.
   2.  Avoid preserved or processed foods, as they can make you feel thirsty.
3. When you feel thirsty, moisten your lips with a cotton swab, apply lip balm, rinse your mouth and spit out the water, chew gum, or slowly suck on an ice cube until it melts. Be mindful of the amount of ice you consume.
4. Use a graduated urinal or commode to measure your urine output each time. 
5. Every morning, after waking and using the bathroom, weigh yourself wearing the same amount of clothing and record your weight. Bring this record to your doctor's appointments for reference.

References

1. Kato, N. P., Nagatomo, Y., Kawai, F., Kitai, T., & Mizuno, A. (2024). Fluid restriction for patients with heart failure: current evidence and future perspectives. Journal of Personalized Medicine, 14(7), 741-754. https://doi.org/10.3390/jpm14070741
2. McDonagh, T., Metra, M., Adamo, M., Gardner, R., Baumbach, A., Böhm, M., Burri, H., Butler, J., Celutkiene, J., Chioncel, O., Cleland, J., Coats, A., Crespo-Leiro, M., Farmakis, D., Gilard, M., Heymans, S., Hoes, A., Jaarsma, T., Jankowska, E., Mebazaa, A., & Heymans, S. (2021). 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: developed by the task force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC) with the special contribution of the Heart Failure Association (HFA) of the ESC. European Heart Journal, 42, 3599-3726. https://doi.org/10.1093/eurheartj/ehab368
3. Thapa, K., Das, S., Pathak, P., & Singh, S. (2021). Assessment of thirst intensity and thirst distress, and the practices for its management among heart failure patients admitted to the cardiology unit. Journal of the Practice of Cardiovascular Sciences, 7(1), 36-40. https://doi.org/10.4103/jpcs.jpcs_8_21