Questioning Medical Advice Limiting Water in CHF

[ofonorow]

I am consulting for a heart patient who is age 65, was a life-long heavy smoker until his heart attacks/bypass surgery about 4 years ago. He has a pacemaker, and is on 4 heart medications, e.g. pacerone for the pacemaker, coumadin (also supposedly for the pacemaker), and 2 other standard medications, but until recently, not a diuretic. His vitamin C bowel tolerance is less than 1 gram, and he has been taking 2-3 packets of Livon Lypo-C for the past 4 years, for which I credit his existence.

He takes a lot of supplements, including Uniqu-E, magnesium, coQ10, and Life Extension Mix, etc. He has also had weekly IV Chelation treatments (with added vitamin C) for the past 4 years, and the alt. doc has prescribed other supplements that I know little about. His ejection fraction is estimated around 30%, but lower after an acute case of "water around the heart." In the emergency room last week, they measured "bnp" which was either 1100 or 1600 - depending on the doctor he spoke with when he came in. (Anything over 900 is considered severe heart failure) and gave him Lasix (a diuretic) IV which apparently worked, and his bnp was 300 when he was discharged after constantly urinating. He has never had any problems with his kidneys.

The advise I am questioning is that they told him to restrict his water intake to no more than 3 glasses and put him on Lasix pills. This advice has him depressed because he like me wonders why they would want him dehydrated? (Wouldn't the body try even harder to hold on to the little water it is getting?)

This advise seems as assinine as some other advice he has been given over the years (e.g. to restrict his intake of leafy green vegetables because they contain vitamin K!? He is not supposed to eat salads?!? And I know what coumadin does and can do, etc. e.g. create rock-hard arteries.)

As a little more background, about 3 weeks ago, he and his wife both came down with some kind of infection, which lead to him developing walking pneumonia. He had a severe (painful stomach) reaction to the antibiotic prescribed for the pneumonia, but kept taking it for the full recommended time, maybe 2 weeks. Then his ankles started swelling (edema). Then shortly before his heartbeat became erratic, he had flu-like symptoms. Johnwen has been more than kind to respond to my private messages, and he and Dr. Levy (also kind to respond) and both suspect an underlying viral infection may be involved in the current acute problem.

The specific question is given the new drug lasix, does dehydrating the patient make any sense at all to anybody?

[Johnwen]

The specific question is given the new drug lasix, does dehydrating the patient make any sense at all to anybody?

At this point in his care I would say "Yes" but for say 5 to 7 days then he can probably go to standard for it which is 2 quarts of liquid from all sources in 24 hours. Translates to 8oz of water every 3 hours. For about 5 to 7 days then Hopefully by then he'll be out of the woods and get things back to the way they were for him and off the P Pills.
Signs to watch for are confusion (Higher then normal) feeling run down and not getting better but worse. Yellow tint to the whites of the eyes, dark thick apperring urine, blood in urine.
He needs to also watch his BP. Any of these changes are associated with loss of necessary electrolytes and he'll need to seek help on this. Once he's off this therapy things should stabilize and he can get a good idea of what went haywire.