Congestive Heart Failure

ICD Referral Guidelines
ICD Referral Guidelines

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:

  1. Weigh yourself daily
  2. Weigh yourself at the same time every day-before breakfast is best.
  3. Use the same scale all the time
  4. Wear the same amount of clothes when you weigh yourself
  5. Empty your bladder before weighing
  6. Record your weight on a daily record
  7. 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
  8. 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.
  9. You should drink no more than 2000 ml (8 glasses or cups) of fluid per day, or whatever amount is prescribed for you.
  10. 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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  Version 2.0, July 2004
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