hydration and ivig

[norcalmom]

Should people be concerned about over hydration during ivig? My child was FLOATING for days around the ivig. As a distance runner,I know overhydrating is far more dangerous than de-hydration. People even die...below is the description of OVER hydration.

 

In addition, we are making our kids drink alot, and then the iv fluids get pumped in, so they cannot regulate intake with their thrist or fullness. In our case my son was very hydrated, still got the migraine, and a day of vomiting (more bile than you could EVER imagine just kept coming and coming..after the sixth time you would htink there was noting left - yet..there was a couple cups of pure bile every time). I know that the headache and vomiting were NOT related to hydration (but perhaps were realted to over hydration?).

 

____________________________________________________________________

Dilutional hyponatremia – why it is dangerous

 

Cells in the body are surrounded by extra-cellular fluid, which contains significant amounts of the electrolyte

sodium, dissolved in the water. If that extra-cellular fluid becomes diluted with excess water, the water will

migrate into the cells to keep the osmotic forces inside the cells balanced with those outside the cell.

Otherwise, the cell walls could rupture and the cell would die. That ingress of water can cause tissues to

swell and become puffy. The common example of that is seen in the hands, wrists and feet. While that’s

annoying, the real problem is that the swelling also happens to the brain ( encephalopathy ). That leads to a

number of problems which can result first in poor performance, but also could lead to DNF and possibly

death if not addressed.

Physiological signs of over-hydration

 

What can you expect to see with over-hydration? There are many diagnostic signs that a physician would

look for, but most runners aren’t physicians and can only go by what they can easily recognize. Digestion is

impaired. With the excess water comes stomach sloshing, poor absorption of food ( because you need an

adequate sodium concentration for absorption ), and vomiting. Salty foods taste unusually good if sodium is

simultaneously low. Thirst is low.

 

Neurological signs appear: dizziness, confusion, irritability, and possibly headache. If neurological signs

appear, the athlete is heading toward a medical emergency and steps need to be taken immediately to

prevent serious injury or death.

[nevergiveup]

Do they give any indication how much water someone has had that could cause these symptoms. I am interested in how much is a reasonable amount and how much is too much. They say stay hydrated up to 30 days post ivig. Since my dd gets them every 21 days that's all the time!

[nevergiveup]

Interesting. One thing I do know for sure, you need to be hydrated before ivig, it helps with side effects a lot. I am just not sure how much water is too much. I know not enough water produces MUCH worse side effects, my dd was in lots of pain when we didn't hydrate, now her symptoms are tolerable. How much is too much?

[norcalmom]

Yeah - I just dont' know (about any of it). I don't know how it may relate to ivig, I just wanted to warn people not to go too crazy, becasue there may be consequences. I didnt' know about this phenomenon when I ran my first marathon and I drank at every opportunity - water and gatorade - and at the end I weighed about 3 lbs MORE than when I started the marathon! I weighed in before and after out of curiosity. During training I used "a pint's a pound the world around" meathod of gaging how much. Theoretically, if you weigh a pound less after a run, then you sweat thru 16oz of water more than you took in. The calories don't add up to nearly as much as the water, they are negligible.

 

 

They used to tell people - drink, drink, drink, and drink before you are thirsty, by then you are already dehydrated. Which is what I see everyone doing with their kids for ivig. I don't think (as per ds's experience) there is neccessarily a correlation between hydration and migraine and vomitting.

 

Dehydration can casue a mild headache. My sons (and I think most people on the site) are talking about migrains. Probably more related to the ivig or aseptic menningitis than lack of fluids.

 

 

Its something to ask the doctors that do lots of ivig (or if amyjoy is reading this - ask the ivig suppliers - they would probably know more)- is it possible to overhydrate if kid is already really hydrated and then we push iv fluids into them on top of it? And, if so, what does that look like (nausea, headaches, voimiting...)? (as it does with runners that over hydrate?)

[nevergiveup]

Yes, being well hydrated DOES help prevent the migraine or lesson it. Go on gammagard web sites, or any immune deficiency web site, or cipd we sites, it is well known and well documented. I say more hydration than less, but please not overkill. I couldn't get my dd to drink too much anyway, she complains when her stomach is full. But normcal, yes hydration does reduce migraines, it is documented.

[amyjoy]

Its something to ask the doctors that do lots of ivig (or if amyjoy is reading this - ask the ivig suppliers - they would probably know more)- is it possible to overhydrate if kid is already really hydrated and then we push iv fluids into them on top of it? And, if so, what does that look like (nausea, headaches, voimiting...)? (as it does with runners that over hydrate?)

 

Hi there,

my understanding is that the extra saline that is given with the IVIG helps the IVIG disperse, through an appropriate blood volume. If a child comes in well hydrated, just the act of putting all of that extra globulin protein into their little blood stream would require extra fluid, which literally expands their blood volume. This is one of the reasons we constantly check blood pressure during the IVIG infusion.

 

For most of us, its too hard to drink sooo much water as to cause a super dilution of the blood. 90% of the people i see in my practice have mostly signs of dryness. When people get really puffy, from too much fluid on board, most often the problem is that the fluid is in the wrong place, its in the extracellular compartments instead of inside the cells or blood stream. This can be a fluid shift from an imbalance in electrolytes or proteins, or other issues such as heart, liver or kidney, or sometimes, toxicity or inflammation in the tissues. Everyone is a little different.

 

in adult medicine, we talk about optimal as drinking as much as half a person's body weight in ounces, so that a 130 pound mama would ideally drink 65 ounces of water per day. That's alot of water.

 

All of that said, it would be hard to overhydrate our kids post ivig, a small glass every hour with a bit of seasalt, or a little sports electrolyte drink, or even some watered down juice with a few granules of salt, will only help things to wash through. but many just don't feel like drinking anyway.

 

does that help?

amy

[norcalmom]

yes - thx amyjoy. I was thinking more pre-ivig. I started hydrating my ds 3 days prior, and I know they ran iv fluids both before the ig and after on both days...we wer taking along flight, so I was dirnk, drink, drink, bcs air travel can be dehydrating as well.

 

Its probably not a big concern, but like anything - sometimes too much of a good thing can be a bad thing. Esspecially if the kids are getting extra incentive to get hydrated with drinks like gatorade (salt) and other sugary stuff that might make them drink far more than they need to along with parents encouragement.

 

I was just throwing it out there to see if it could happen, or if there should be any concern about it.

 

thanks-