From the Guidelines
The standard fluid restriction for a CHF exacerbation is typically 1.5 to 2 liters per day (1500-2000 mL/day), which may be considered in patients with severe symptoms of HF, especially with hyponatraemia. This recommendation is based on the European Society of Cardiology guidelines for the diagnosis and treatment of acute and chronic heart failure 1.
Key Considerations
- Fluid restriction is not recommended for all patients with mild to moderate symptoms, as it does not appear to confer clinical benefit 1.
- Patients should be aware of the importance of monitoring their weight and recognizing signs of fluid retention, such as sudden unexpected weight gain of 0.2 kg in 3 days 1.
- In such cases, patients may increase their diuretic dose and should alert their healthcare team, while being cautious of the risks of volume depletion with excessive diuretic use 1.
Implementation and Monitoring
- Patients should be instructed to measure and track all fluid intake, including water, beverages, soup, ice cream, and other liquid foods.
- Practical strategies include using smaller cups, spreading fluid allowance throughout the day, and keeping a daily log of intake.
- The restriction helps reduce volume overload, which is a key factor in heart failure exacerbations, by decreasing the heart's workload and reducing pulmonary congestion and peripheral edema 1.
- The fluid restriction should be maintained during the acute phase and potentially adjusted during maintenance therapy based on the patient's clinical status, severity of heart failure, and response to treatment.
From the Research
Standard Fluid Restriction for CHF Exacerbation
- The standard fluid restriction for congestive heart failure (CHF) exacerbation is not universally defined, but studies suggest that individualized fluid restriction can be beneficial 2, 3.
- A study published in the European Journal of Cardiovascular Nursing in 2016 proposed that tailored fluid restriction based on body weight (30 ml/kg per day) seems to be most reasonable 2.
- Another study published in the European Journal of Heart Failure in 2013 found that individualized salt and fluid restriction can improve signs and symptoms of CHF with no negative effects on thirst, appetite, or quality of life in patients with moderate to severe CHF and previous signs of fluid retention 3.
- The optimal fluid restriction strategy may vary depending on the individual patient's condition, such as the presence of hyponatremia or decompensated heart failure 2.
Fluid Restriction Guidelines
- The European and American guidelines have recommended salt and fluid restriction for patients with CHF, despite scarce scientific evidence 3.
- A study published in 2021 found that adding metolazone to furosemide therapy was not independently associated with death or re-hospitalization in patients with severe acute decompensated heart failure 4.
- Other studies have shown that metolazone can have an additive diuretic effect when associated with furosemide in patients with congestive heart failure 5, 6.
Key Considerations
- Fluid restriction should not be recommended to all heart failure patients, but temporary fluid restriction can be considered in decompensated heart failure and/or patients with hyponatremia 2.
- Education, support, and planned evaluations can increase adherence to temporary fluid restriction 2.
- Individualized dietary advice and support can also be beneficial in improving signs and symptoms of CHF 3.