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Jefferson Hospital Comprehensive Renal Diet
Name___________________________________
Date____________________________________
Diet Restrictions:
_____________grams protein
_____________milligrams sodium
_____________milliequivalents potassium
_____________milligrams phosphorus
_____________calories
_____________mL fluid
Dietitian_________________________________________
Phone number____________________________________
Jefferson Hospital Nutrition Department- (412) 469-5797
12/01
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1.
Introduction
When the kidneys are not working normally, waste products (the result ofwhat we eat) build up in the blood. If you are not on dialysis, you need to followyour diet carefully to control this build up. Dialysis treatments can remove some ofthese byproducts, however they will still accumulate in your system betweentreatments. Renal diets are very individual. Your diet may include any or all of thefollowing restrictions.
CaloriesIf you are a diabetic, it is likely that you will be asked to follow a calorierestriction to help control your blood sugar. Calories are also important to those whoare not diabetic because they determine whether you will gain or lose weight. If youare not a diabetic, you may be asked to eat extra foods with sugar in them to helpyou maintain your weight. This diet contains a list of high calorie, free foods thatcan help. If your diet is low in calories, your body may burn the protein you eat and
possibly your bodys muscle protein for energy. Therefore, a diet adequate incalories is important to prevent malnutrition.
ProteinNormally, protein byproducts are excreted from the body in the urine.
However, if the kidneys are not functioning normally, this protein byproduct, calledurea, builds up in the blood. A blood test called BUN (blood urea nitrogen) showshow much of this byproduct is in your blood. If your BUN is very high, you mayfeel nauseated and tired. If you are not on dialysis, you will need to follow a verylow protein diet to keep these byproducts low. However, patients on dialysis areoften allowed higher amounts of protein in their diet since the dialysis machineremoves these byproducts. If your BUN is low, you may not be eating enough
protein. The amount of protein that you should eat will be determined by yourdoctor or dietitian.
2.
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SodiumThe balance of fluid in your body is regulated in part by the mineral sodium.
Too much sodium in your diet can cause you to retain too much water. This iscalled fluid overload and may cause a sudden increase in weight, shortness of
breath, swelling of the feet, legs or hands, high blood pressure or heart failure. Tablesalt is rich in sodium as are processed foods, smoked or cured meats, salted snacksand canned foods such as soup and canned vegetables. Salt substitutes can behelpful, but read label carefully to see if the product contains sodium or potassiumwhich may also be restricted in your diet.
FluidWhen the kidneys are no longer functioning normally, fluids can accumulate
in the body. Fluid overload can develop if you drink too many liquids. Many foodscount as a fluid such as all beverages including milk, juice, water, coffee, tea, softdrinks and alcohol. Any food that melts at room temperature counts as a fluid toosuch as jello, ice cream, popsicles and ice cubes. If you are told to limit your totalfluid intake each day, then you must count these items as part of your fluidallowance.
PotassiumThe mineral potassium helps to keep your nerves and muscles working
normally. Your heart is a muscle that is also regulated by how much potassium is inyour blood. Too much potassium in your blood can cause your muscles to be weakand can affect your heart beat. A very high potassium level in your blood could evencause your heart to stop beating. Potassium is found in almost all foods. The amountin some fruits and vegetables is very high, so you will be asked to avoid these foodsor only eat very small amounts. Follow portion sizes carefully so that you dont goover your potassium allowance.
3.
Phosphorus and CalciumKidney disease causes your body to have an imbalance of calcium and
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phosphorus. Normally, your kidneys filter out the extra phosphorus that you may eatin food. When too much phosphorus builds up in your blood, the body tries tocorrect this by taking calcium out of your bones. This leads to weak and brittle
bones. High phosphorus levels in your blood can also cause your skin to be itchy.Some foods are very high in phosphorus such as dairy products, nuts and seeds,chocolate and dried beans, peas and lentils. Some people can control their
phosphorus levels with diet alone, but many kidney patients need to takephosphorus binders also. Your doctor will prescribe which ones to take and howmany you need daily. It is important to take these binders WITH your food so thatthey can bind as much of the phosphorus in the food as possible. Many phosphorus
binders contain calcium which helps to normalize calcium levels in the blood. Yourdoctor will decide if you need additional calcium or vitamin D supplements.
Vitamins and Minerals
People with kidney disease need to take special vitamin supplements. Yourdoctor will likely prescribe a vitamin specifically for kidney disease. It is importantthat you only take the vitamins prescribed by the doctor. Some over the counter
products contain minerals and some fat soluble vitamins that could be harmful topeople with kidney disease. Also inform your doctor of any herbal remedies youmay be taking, since some of these can interfere with medications you may be
prescribed.
How to follow this diet:Foods that you are allowed to eat are divided into 6 food groups. Each food
group will list what you are allowed to eat and the portion size for one serving.There will be a list of foods to avoid at the end of each food group. It is important tostay away from the foods on the avoid lists, because they are either too high in
potassium, sodium or phosphorus to be included in your allowed foods. If one ofyour favorite foods is on the avoid list, let the dietitian know so she can try to fit itinto your diet if possible.
At the end of this booklet, there is a sample meal plan to show you how youmight plan your meals for the day. This is just a sample, you do not have to eat thefoods listed there. As long as you stay within the amounts allowed on each food list,you will be within the restrictions of your diet.
4.
Milk List
Select ________ servings per day.
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One serving is:
skim milk
cuplow fat milk
cupwhole milk
cupevaporated milk, reconstituted
cup
nonfat dry milk, reconstituted cupvanilla or strawberry ice cream
cup
AVOID
buttermilkcommercial foods made of milk
condensed milklow sodium milkmalted milkmilkshakesall other types of ice cream except vanilla or strawberryinstant chocolate milk mixeschocolate milk or chocolate flavored milk drinkshot chocolatecocoa or malt beveragescustard
puddingeggnogyogurt
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5.
Meat and Meat Substitute List
Select _________ servings per day.
One serving is 1 ounce unless otherwise indicated:
Meat, poultry and fishbeefchickenduck
eggsall fish and shellfish are allowed, if canned, use low sodiumlamb
pork, freshtongue, unsaltedturkeyveal
Cheese is high in phosphorus, only use 2-3 ounces of the following cheeses weekly:(one serving is 1 ounce unless otherwise indicated)
brickbriecolbycottage cheese 1/4 cupmonterey jackmuensterneufchatelmozzarellaswiss
ricotta1/4 cup
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6.
Meat and Meat Substitute List (continued)
AVOID
anchoviesbreaded fish and poultrybologna, pastrami, salamicaviarcheese other than those allowed, especially American cheese, cheese spreads ordips and any kind of processed cheese food
chilichipped or dried beefcold cuts and other luncheon meatscorned beefdried and salted coddried peas, beans and lentilsham, curedherringhot dogskosher meats
loxlow sodium luncheon meatsnuts and seedsorgan meats
peanut buttersalt porksardinessausagesoybeanstofu
7.
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Bread and Starch List
Select _________ servings per day
One serving is:
Breadbagel
hard roll (4 in. across)
1
hot dog or hamburger bun
French or Italian bread
1 slicepita bread (6 in. across)
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1raisin bread
1 slicesoft roll or bun (2 in. across)
1taco shell
2tortilla, corn or flour (6 in. across)
1white or light rye bread
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1 slice
Muffins/Biscuitsbaking powder biscuit, made from scratch (2 in. across)
1cornbread (2 by 2 in.)
1plain or corn muffin, made from scratch
1
Pancakes/Wafflespancakes, made from scratch (5 in. across)
1waffles, made from scratch (4 by 4 in.)
1
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8.
Bread and Starch List (continued)
Dry cereals (one serving is 3/4 cup)If diabetic, avoid sweetened cereals.
Apple Jacks Puffed RiceCaptain Crunch Puffed WheatCocoa Krispies Rice ChexCocoa Pebbles Rice KrispiesCookie Crisp Rice ToastiesCornflakes Special K Crispy Rice Sugar Frosted
FlakesFrosted Rice Krispies Sugar PopsFruit Loops Sugar SmacksFruity Pebbles TeamflakesHoneycomb Trix
Cooked cereals (one serving is 3/4 cup)Cream of RiceCream of WheatFarina
Malt-O-Meal
Crackers/Snacksanimal crackers
7breadsticks, unsalted (4 in. long)
2butter crackers
5graham crackers (2 by 2 in. square)
2Matzoh
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1melba toast
5milk crackers
1popcorn, popped and unsalted
2 cups
pretzels, unsalted
3/4 ozrice cakes
2saltine crackers, unsalted
6soda crackers
6
9.
Bread and Starch List (continued)
Pasta/Grains
noodles, cooked
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cuppasta, cooked
cupwhite rice, cooked
cup
Desserts
If diabetic, limit desserts to only once per day and count as a starch serving.
One serving is:angel food cake
1 avg piecearrowroot cookies
3danish- plain, apple or cherry
1 smalldonut- cake type or jelly
1small
gelatin dessert
cuplemon cookies
2
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plain sugar cookies
2popsicle
1pound cake
1 avgpiece
shortbread
4sponge cake
1 avgpiece
sugar wafers
5vanilla wafers
5white cake with icing
1small piece
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10.
Bread and Starch List (continued)
AVOID ALL OF THESE ITEMS
BreadsBoston brown bread
buttermilk rollsdark rye bread or rolls
pumpernickelrolls prepared from refrigerator dough or packaged mixeswhole grain breads
Cerealsbaby cereal
Maltexbran cereal
MaypoCheerios Mini
WheatsCorn Bran Nutra
GrainCorn Chex
OatflakesCount Chocula oatmealCracklin Bran oat bran
cerealsCW Post Product 19Fiber One
Quaker 100% NaturalFruit N Fiber raisin
cerealsgranola type cereals Super Sugar Crispinstant hot cereals RalstonGrapenuts
Shredded WheatHeartland TotalKix
Wheat ChexLife
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WheatenaLucky Charms Wheaties
11.
Bread and Starch List (continued)
AVOID ALL OF THESE ITEMS
Crackers/Snacksall potato snacks, including potato chops and potato sticksall salted snacks and crackers
bacon flavored snacks and crackerscheese crackerscorn chipsflavored tortilla chips
pork rinds
Desserts
browniescakes and cookies with chocolate, coconut, nuts or raisinscaramelscheesecakefudgemilk chocolate
pies
Muffins/Biscuitsall commercial muffins and all types of bran muffins
English muffinsmuffins and biscuits prepared from packaged mixes or refrigerator dough
Pancakes/Wafflescommercially frozen pancakes and waffles
pancake and waffle mixes and commercial batter
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Pasta/Grainsbaking mix (Bisquick, Jiffy) self rising flourbread stuffing mix soybean
flourdried peas and beans wheat germrice and noodle mixes wild rice or brown
riceseasoned bread crumbs
12.
Vegetable List
The potassium content of vegetables varies widely. You will notice that some of these
foods have very small serving sizes. These items are higher in potassium, so be surenot to eat more than the portion indicated, or you will go over your potassiumallowance. Any low potassium food can become a high potassium food if you eat toomuch of it.
Select ___________ servings per day.
One serving is:asparagus
4 spears or
1/4 cupbean sprouts, mung
cupbeets and beet greens
1/4 cupbroccoli, raw or cooked
cup
brussel sprouts
cupcabbage
cupcarrots, canned or fresh, cooked
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cupcarrots, raw
medcauliflower
1/3 cupcelery
1 outerstalk or 1/4 cup
collard greens
1/4 cupcucumber, pared
cupeggplant
cupendive
cupescarole
cupgreen beans
cupkale
cuplettuce, iceburg
1 cuplettuce, romaine
cupmixed vegetables
1/4 cup
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mushrooms
1/3 cupokra
1/4 cup
13.
Vegetable List (continued)
onions
cupparsnips, cooked
1/4 cuppeppers, sweet, green or red
cuppotatoes, specially prepared (see instructions) cupradishes
10each or 1/4 cup
rutabaga
1/4
cupsquash, butternut
1/4 cupsquash, spaghetti
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cupsquash, summer
1/3 cupsweet potatoes, boiled
1/4cup
tomato, low salt canned
1/4
cuptomato, fresh
medtomato juice, unsalted
1/4cup
tomato sauce, low salt
1/4cup
turnip or turnip greens
cupvegetable juice cocktail, low sodium
1/4cup
watercress, raw
1 cupwax beans
1/4
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cup
Special instructions to reduce potassium content of potatoes, turnips and rutabagas:
1. Peel and slice vegetable into small pieces.2. Let stand overnight or for at least 2 hours in a large amount of water. For eachcup of vegetable, add 5 cups of water.3. Drain, rinse and drain again.4. Cook in a large amount of water as in step 2.5. Drain. If desired, freeze small portions for later use.
14.
Vegetable List (continued)
AVOID
artichokebaked beansbaked potatoesbreaded vegetablescanned vegetables containing saltcarrot juicechickpeas, lentils and split peascorndried or canned beans, including canneloni, kidney, lima and garbanzofrench fried potatoes
instant or frozen potatoespeassauerkraut, pickled vegetables, pickles and olivesspinach, cookedsuccotashtomato juice or sauce containing saltwinter squash (acorn, etc.)
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vegetable juice cocktailvegetables packed in cream, butter or cheese sauceyams
15.
Fruit List
The potassium content of fruits varies widely. You will notice that some of thesefoods have very small serving sizes. These items are higher in potassium, so be surenot to eat more than the portion indicated, or you will go over your potassiumallowance. Any low potassium food can become a high potassium food if you eat
too much of it.If you are diabetic, use only fresh, unsweetened or juice packed canned fruit.
Select___________servings per day.
One serving is:apple
1 smallapplesauce
cupapricot, canned, juice packed
3 halvesblackberries
cup
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blueberries
cupboysenberries
cupcherries
10 fresh or cup
fig, canned
3fig, raw
1
fruit cocktail
cupgrapes
10grapefruit
med or cupmandarin orange sections
cupmango, raw
mednectarine
medorange
med
passionfruit
1 medpeach, fresh
medpeach, canned
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cuppear, fresh
medpear, canned
cuppersimmon
1pineapple
cupplum
1fresh or 2 canned
16.
Fruit List (continued)
pomegranate
med
red raspberries1 cup
strawberries
cuptangerine
1 medwatermelon
1 cup
Juicesapple
cupapricot nectar
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cupcranberry
1 cupcranberry-apple
cupcranberry-grape
cupcranberry-raspberry
cupgrape
cupgrapefruit
cuporange
1/3 cuporange-grapefruit
cuppear nectar
cup
peach nectar
cuppineapple
cuppineapple-orange
cuppineapple-grapefruit
cup
AVOIDall dried fruit including prunes, raisins, dates, figs, apricotsapricots, rawavocado
bananascantaloupe
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honeydewpapayaplantainprune juicestar fruit
17.
Fat List
Select __________ servings per day.
One serving is:
butter or margarine 1 tspliquid nondairy creamer
2 TBSPshortening
1 tspvegetable oil
1 tsp
whipped topping1/4
cupwhipping cream
1TBSP
The following fats are high in sodium, limit choice to one per day.mayonnaise
1 TBSPsalad dressing:Catalina
1 TBSPFrench
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1 TBSPItalian
1 TBSPRanch
1 TBSPRussian
1 TBSPThousand Island
1TBSP
The following fats contain protein, phosphorus or potassium. Limit choice to oneper day.cream:half and half
2TBSP
light
2 TBSP
cream cheese1
TBSPpowdered nondairy creamer
2 TBSPsour cream
2 TBSP
AVOIDavocado
bacon, bacon fat, ham fat and salt porkgravy mixes and salted gravynuts, seeds and olives
18.
Condiments
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Allowed herbs, spices and condiments:
allspice macearrowroot marjoram
basil mintbayleaf mustard (limit to 1
TBSP per day)caraway seed nutmegcardamon onion powder cayenne pepper oreganocelery powder paprikacelery seed parsleychili powder parsley flakes
chives pepper cinnamon poppy seedscloves poultry
seasoningcoriander rosemarycumin saffroncurry sagedill sesame
seedsdry tapioca sugar substitute
(like Equal or Sweet&Low)fennel tarragongarlic powder thymeginger tumericketchup (limit to 1 TBSP per day) vinegar
Allowed flavorings and extracts:
almond peppermint
lemon rummaple vanillamint walnut
19.
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Avoid All Of The Following Condiments:
anise nutsbaking soda onion flakes
salt free baking powder onion saltbouillon or broth picklesbarbeque sauce relishescelery salt salt (including lite salt, seasoned salt, seachili sauce salt, vegetable salt)cooking wine salt substitutegarlic salt soybeans
prepared horseradish soy saucekitchen bouquet steak saucelemon pepper seasoning sunflower seeds
meat tenderizer tabasco sauceMSG (monosodium glutamate) wheat germ
worcestershire sauce
Soup is an item that is difficult to fit into the renal diet unless you are makinghomemade soup from fresh stock such as chicken or vegetables with only thepermitted seasonings. You can use low sodium canned soups, but read the labelto be sure of the sodium content. Also check for added potassium in the lowsodium canned soups. Regardless, all soup counts as a fluid and must becalculated into your fluid allowance. Please avoid all regular canned soups,
those made with bouillon and any soup from a restaurant since these can bevery high in sodium.
One cup of broth based soup counts as one starch serving.Avoid creamed soup and bean soups due to potassium and phosphorus content.
20.
Concentrated sugars to use for extra calories.
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Not recommended for diabetics.
Candy:butterscotchcandy corngumdropshard candy
jelly beanslollipopsmarshmallowsmints (no chocolate)
Desserts:fruit ice
popsicles
Sweeteners/Accompanimentscranberry saucehoney
pancake syrup (imitation, not real maple syrup)jam or jellymarmalademolassessugar of any kind
AVOID
apple butter licoricecaramel malted milk
powdercarob Ovaltinechocolate real maple syrupcocoa powder
21.
Fluid Restriction
You are allowed ___________ccs (milliliters) or ______ cups of fluid per day.
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Anything that is liquid at room temperature counts as a fluid. This includesfoods like soup, jello, ice cream, sherbet, popsicles, fruit ice and ice cubes. All
beverages including milk, juice, coffee, tea, soft drinks, alcohol and water formedications count as a fluid.
Measure out your fluid restriction at the beginning of the day and place it in asee-through container in your refrigerator. Use this water to make your coffee andtake your pills. If you drink other beverages, measure the amount and pour the sameamount out of your pitcher of water. This way you can see how much fluid you haveleft for your day. When the water in the pitcher is gone, then you are done drinkingfluids for the day.
Common measurements
1 1/4 quarts = 5 cups =40 ounces =1200 ccs
1 quart = 4 cups =32 ounces =960 ccs
1 pint = 2 cups= 16 ounces= 480 ccs
pint = 1 cup
= 8 ounces= 240 ccs
cup = 4 ounces= 120 ccs
1/4 cup = 2 ounces =60 ccs
2 TBSP = 1/8 cup =1 ounce =30 ccs
Ways to stick to fluid restriction:Drink only when thirsty.Try not to drink to be social or out of habit.Use small glasses or cups.Drain all canned fruits and vegetables.Try to be active so you dont think about drinking.
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Put drinks in refrigerator to be chilled instead of adding ice.Take medication with applesauce or other soft food instead of water.
22.
Fluid Restriction (continued)
Tricks to control thirst:Keep blood sugar under control if you are diabetic.Brush your teeth more often or use mouth wash.Follow low sodium diet.Avoid being out in the sun if being in the sun makes you thirsty.
Suck on lemon wedge. Wedges may be frozen first.Eat sour candy or chew gum to moisten your mouth.Suck on a few ice chips. Ice stays in the mouth longer than water, butremember that ice counts as a fluid too.Eat frozen fruit such as grapes, peaches or pineapple chunks.Try eating something like bread with margarine or jelly.
Allowed beverages:If diabetic, use sugar free, low calorie versions of these beverages.
alcohol as permitted by physicianClear carbonated beverages such as ginger ale, Sprite, 7-Upcoffee (limit to 1 cup per day due to potassium content)Hi-C (no orange)Kool-Aidlemonaderoot beertea, brewed or instant (limit to less than 2 cups per day due to potassium content)
AVOIDbeer, alecarbonated cola beverages such as Coke, Pepsi, Dr Pepperclub sodafruit punch and commercial fruit juice beveragesGatoradeKava coffee and specially flavored coffee drinksorange flavored drinks
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orange carbonated beverageswater treated with water softener
Also refer to milk list for additional dairy beverages to avoid.
23.
Sample Meal Plan
Your total allowance for the day: Milk:_______servingsMeat:_______servingsStarch:______servingsVeg: _______servingsFruit:_______servingsFat: _______servingsFluid restriction: _______cups per day
Breakfast Milk ______serving_________________________
Meat ______serving_________________________
Starch______serving _________________________ Fruit ______serving
_________________________Fat ______serving
_________________________
Lunch Milk ______serving_________________________
Meat ______serving_________________________
Starch______serving _________________________ Veg ______serving
_________________________
Fruit ______serving_________________________
Fat ______serving_________________________
Dinner Milk ______serving
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_________________________Meat ______serving
_________________________Starch______serving _________________________ Veg ______serving
_________________________Fruit ______serving
_________________________Fat ______serving
_________________________
Snack ______serving_________________________
______serving _______________________________serving _________________________
Fluid Restricted Diet
You are allowed ___________mL (milliliters) or ______ cups of fluid per day.
Anything that is liquid at room temperature counts as a fluid. This includesfoods like soup, jello, ice cream, sherbet, popsicles, fruit ice and ice cubes. All
beverages including milk, juice, coffee, tea, soft drinks, alcohol and water formedications count as a fluid.
Measure out your fluid restriction at the beginning of the day and place it in asee-through container in your refrigerator. Use this water to make your coffee andtake your pills. If you drink other beverages, measure the amount and pour the sameamount out of your pitcher of water. This way you can see how much fluid you haveleft for your day. When the water in the pitcher is gone, then you are done drinkingfluids for the day.
Common measurements
1 1/4 quarts = 5 cups =40 ounces =1200 mL
1 quart = 4 cups =32 ounces =960 mL
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1 pint = 2 cups= 16 ounces= 480 mL
pint = 1 cup= 8 ounces= 240 mL
cup = 4 ounces= 120 mL
1/4 cup = 2 ounces =60 mL
2 TBSP = 1/8 cup =1 ounce =30 mL
Ways to stick to fluid restriction:
Drink only when thirsty. Try not to drink to be social or out of habit. Use small glasses or cups. Drain all canned fruits and vegetables. Try to be active so you dont think about drinking. Put drinks in refrigerator to be chilled instead of adding ice. Take medication with applesauce or other soft food instead of
water.
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Fluid Restricted Diet (continued)
Tricks to control thirst:
Keep blood sugar under control if you are diabetic. Brush your teeth more often or use mouth wash. Follow low sodium diet. Avoid being out in the sun if being in the sun makes you thirsty. Suck on lemon wedge. Wedges may be frozen first.
Eat sour candy or chew gum to moisten your mouth. Suck on a few ice chips. Ice stays in the mouth longer than
water, but remember that ice counts as a fluid too. Eat frozen fruit such as grapes, peaches or pineapple chunks. Try eating something like bread with margarine or jelly.
Jefferson Hospital Nutrition Services (412) 469-5797
1/00