<<I work with a 30 y old diabetic who needs dialysis since a few months.
So far she is coping fairly well but she had been drinking up to 3 litres/d
until then and now suffers from severe thirst, cannot resist it and comes
to dialysis (3x/week) with up to 8 kg of weight gain. The staff tell her to
pull herself together.>>
I wonder if her diabetes is well-controlled? Perhaps her thirst is due to
intermittent glucose-induced polyuria?
Secondly, I wonder if she has a salt--losing nephropathy? In that case she
would need a little extra salt perhaps? You could send off a urine for
sodium level although I am sure the renal staff have already done a 24 hour
collection for electrolytes etc.
Thirdly, perhaps the dialysis staff get so worried at her state coming in
that they ultra-filtrate too much water off her and leave her very thirsty
afterwards. It is one hell of a job for the poor patient to take off
something in the region of 8 litres at one dialysis session---perhaps they
are not taking off that much? But if they are, she is bound to feel awful
(and thirsty!) afterwards.
Fourthly, some doctor in the unit needs to clinically assess her and make a
guess at her "dry weight" which means not dehydrated and not clinically
overloaded. Then the staff should try to dialyse her down to that weight
each time.
Finally, thirst is a physiological mechanism and while renal
failure/dialysis modifies the relevance of it a bit, I think that anyone
with that sort of thirst needs a proper clinical review. Preferably with
an experience nephrologist.
Hope that helps
Declan
Once upon a time, in galaxy far far away, I was a renal registrar for the
greatest empire the universe has ever known.........
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