1. Fluid Restricted Diet Alaine Mills, Dietetic Intern 1/21/2013-1/22/2013

2. What is a Fluid?  A fluid is anything that is liquid or anything that melts at room temperature.  Some foods do not necessarily seem liquid, but must be counted as part of a patient’s fluid intake since they are liquid at room temperature or have liquid as a major ingredient.

3. Why Does a Patient Need a Fluid Restricted Diet?  For a patient who is on fluid restriction, excessive fluid can lead to fluid overload  Fluid overload causes complications, such as  swelling  shortness of breath  congestive heart failure  fluid in the lungs  fluid in the abdominal area

4. Diet Orders  Common diet orders you may see a fluid restriction with:  Renal Diet  Cardiac Mediterranean Diet

5. Traditional Examples of Fluids  Water  Milk  Coffee  Tea: Hot and Iced  Juice  Soda  Lemonade  Nutritional supplements, such as Boost®

6. Other Examples of Fluids  Ice cubes  Soup  Gelatin and Jell-O®  Ice cream  Sherbet  Sorbet  Freezer pops/Popsicles

7. Exceptions  These foods contain water, but not a significant amount and should not be counted as a part of a patient’s fluid restriction  Pudding  Oatmeal  Grits  Fruits  Vegetables  Custards

8. Planning the diet  A patient’s fluid restriction should be broken down into milliliters (mL’s) per tray  If a fluid restriction is in place, but the amount per tray is not specified, clarify with the nurse before providing the patient’s tray  Ask if it is total fluid or free water  Foods that are liquid at room temperature should be counted by milliliters (mL’s)  Fluid is usually ordered in the form of cubic centimeters or “CC’s”  1 mL is equal to 1 cc

9. Conversions  Milliliters can be converted from ounces or cups as follows:  30 ml = 1 fl oz  120 ml = 4 fl oz or ½ cup  180 ml = 6 fl oz or ¾ cup  240 ml = 8 fl oz or 1 cup  960 ml = 32 fl oz or 1 qt

10. Fluids in the Regular Diet

11. Amount of Fluid in Commonly Served Items  Small bottled water: 8 oz or 240ml  Tea (in small clear cup): 8 oz or 240ml  Pre-thickened water cup: 4oz or 120ml  Apple, Orange, Prune Juice in cup: 4 oz or 120ml  Milk Carton (skim, 1%, 2%, chocolate and whole): 8 oz or 240ml  Coffee in black mug: 8 oz or 240ml

12. Nutritional Supplements

13.  Some items have less free water than other fluids, because of other ingredients.  Boost Plus, Boost Glucose Control, Resource Breeze, Resource Diabetishield  ~200ml  Novasource Renal  170ml

14. Fluid Content of Foods

15.  These foods should be counted as a part of the allowed fluid for the day  Soup (6 oz) in black bowl: 150ml  Jello (2 ½ Oz) in dessert dish: 100ml  Ice cream/Sherbet (4 oz): 95ml  Popsicles (whole) : 80ml  Pre-thickened water cups (4oz): 120ml

16. What is a Free Water Restriction?  A free water restrictions means patients can have all fluids EXCEPT WATER.  All other fluids can be served as usual