DCM, FLUID RESTRICTION AND CREATININE LEVELS

[Vivi2711]

Respected & dear colleagues,

Kindly condone me for disturbing you. Today I consulted my cardiologist. My serum creatinine level has gone up from 1.6 to 1.9 mgs/dl, urea 45 mg/dl, Eloctrolytes (serum) Sodium 140 mEq/l, Potassium 4.7mEq/l, choloride 103 mEq/l, bicarbonate 26 mEq/l and hb 10.5gm%. Bp was 90/60 both arms.

My cardiologist wanted to raise the fluid restriction from 1 litre to 1.5 litres daily. He has also advised to stop losartan with potassium 25 mg daily and wanted to continue with spironolactone plus toresemide (diuertic)10 mg daily for 5 days and 5 mg for two days. Apart from the above carvedilol 3.125 mg twice daily, atorovastatin 10 mg once daily, clopidegril 75 mg once daily and metformin 500 mg once daily has been advised to continue. A review has been scheduled after 2 months.

Kindly tender your invaluable advice as to whether this would suffice to reduce creatinine and at the same time balance my fluid levels so as to avoid PND or other forms of dyspnea.

With warm regards and utmost respects,

M. Vivekanandan

[Chappychap]

Hopefully someone who is on the same medication will be able to tell you what effect it has on their metrics. However, for a technical medical question like this it might also be worthwhile phoning the BHF cardiac nurses who can provide expert advice.

Good luck!

[Vivi2711]

Thanks Chappychap for your kind advice

[Hidden]

I am a retired nurse, I will take a swing at this. It is like walking on egg shells for docs trying to manage heart failure and fluid balance. Essentially they try to keep you on the “ dry” side but if they see the creatinine and bun( blood urea nitrogen) creeping up, it may indicate you are dehydrated a little too much. So they give you a little more fluid to compensate hoping not to tip the scale too far one way or the other. Also complicating the delicate balance is how much sodium you ingest, too much sodium will encourage fluid retention but not enough can cause problems. Diuretics like to wash out your good electrolytes such as potassium and sodium. All of the pieces of the puzzle need to fit, which is the hard part for the docs

[Love100cats in reply to Hidden]

Only a nurse or retired one could make so much sense of the fluid question. It's my most irritating issue. I stick to 8 cups of fluid per day and no salt most of the time but yesterday had cheese for lunch and my poor feet are puffy again. So I shall take a little extra furusemide tonight to try and get back to normal as I want to go out tomorrow and need shoes on! My kidneys are starting to protest so just had blood test but not had results yet. It's like being on a seesaw. Is there a home urine test you can do to check kidney function?

[Hidden in reply to Love100cats]

No home test that I know of. Re taking extra Ladin, most cardiologist will tell their patients if weight is up a certain amount, then take additional pill. It’s a catch 22 as you are finding out, meds are not without issues. Do you count how many milligrams( mg) of sodium you are allowed daily? Are you weighing daily? Last question, is it a cardiologist of GP managing your fluid balance? Here in our nearest town, the Cardiology group has a CHF clinic( congestive heart failure), they really do a great job managing this hard issue, unstable patients are seen 1-2 times weekly by nurse practitioner.

[Love100cats in reply to Hidden]

Oh if only! I was seeing h.f. nurse every 3 months! But I've been discharged now into the hands of my g.p. who I see once a year for medication review. Since leaving hospital I've not see a cardiologist or any consultant but I did see an Arrhythmia nurse on two occasions last year. On top of all this I'm a heart failure patient with a.f. caring for my husband a heart failure patient. I try not to moan but it feels very scary. My husband is losing a lot of weight and looking very unwell. A g.p. came 4 weeks ago. We had never seen him before. He was here about 5 mins and just checked the meds list. Oh and he's insulin dependent diabetic too. We don't see any local nurses though my husband is registered house bound. I've always been an optimist but it's Waring a bit thin now. I'm 77 my husband 79.

[Hidden in reply to Love100cats]

Yes, aging is not for the faint of heart! I’m in the US and worked as a home care nurse for the last 25 yr I guess. We always had the HF patients weigh every day if they could safely stand on a scale. That would help us decide how much fluid they were gaining. Try and be fairly rigid with your sodium intake. With him losing weight and being a diabetic, that is even harder to deal with. You might ask about homecare and see if it could be a possibility.

[Love100cats in reply to Hidden]

Thankyou for your sound advice. I weigh myself daily but I'm the same which is good for the heart but not for weight loss but I have underactive thyroid, on meds, so I think that doesn't help. We have home care two mornings but he doesn't want hands on care but I see that he will have to soon. Thank you again.

[Vivi2711 in reply to Hidden]

Respected Hoski,

Thanks a lot for your kind advice. You had explained it so deeply in a nutshell. I shall be more cautious in future bearing in mind your words.