Congestive Heart Failure
How to Adjust Your Diuretic Dose
Congestive heart failure is not a static (unchanging) condition. Heart
failure may deteriorate for a variety of reasons. For instance: excessive
salt or fluid intake, intercurrent illness such as flu or pneumonia, cardiac
arrhythmias, anemia, medications which cause salt retention such as anti-inflammatory
medications, episodes of angina, heart attacks etc. al may worsen heart
failure. Sometimes however, the patient with heart failure worsens for
no apparent reason. The educated patient must know how to anticipate deterioration,
and to know how to react to it in order to correct the deterioration before
it becomes serious. Just as when steering a car, the heart failure patient
must adjust to changes in their condition in order to stay on course.
A little too wet and they become congested and short of breath. A little
too dry and they become weak, fatigued and dizzy.
When your doctor examines your neck, he is looking at your veins to assess
how much fluid is in the circulatory system. Although the patient cannot
do this, paying attention to your condition, particularly how you feel,
how much swelling is present at the ankles and your body weight can give
a pretty good indication of your fluid status. A little bit of swelling
of the ankles at the end of the day is normal and indicates sufficient
fluid in the circulatory system to allow a weakened heart to pump normally.
Moe than a trace of swelling at the ankles indicates fluid excess. His
fluid may re-enter the central circulation when you lie down, awakening
you with shortness of breath or forcing you to sleep on several pillows
for comfort. Similarly if your weight goes up by more than 2-3 pounds
(1.0 kg) in one day or by 5 pounds (2.5 kg) over a week, the body may
be retaining too much fluid and worsening heart failure may ensue.
To monitor your own fluid status:
- Weigh yourself daily
- Weigh yourself at the same time every day-before breakfast is best.
- Use the same scale all the time
- Wear the same amount of clothes when you weigh yourself
- Empty your bladder before weighing
- Record your weight on a daily record
- The weight at which there is just a little bit of swelling in the
ankles at the end of the day is your ideal weight-try and maintain it
- When taking diuretics avoid drinking too much in the way of fluids,
even if your mouth is dry and you feel thirsty. This could counter the
effect of the diuretic and dilute the body’s salts causing weakness
and confusion.
- You should drink no more than 2000 ml (8 glasses or cups) of fluid
per day, or whatever amount is prescribed for you.
- If your weight goes up by more than 2-3 pounds (1.0 kg) in one day
or by 5 pounds (2.5 kg) over a week adjust your diuretic according to
the diuretic sliding scale or call your nurse or doctor.
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