It's a Fine Balance.....

Homeostasis.  

It's the balancing act your body does every minute of the day to keep you alive, basically the baseline status quo.  

Acid/base balance. Potassium/sodium/calcium levels. Hormone regulation.

And fluids.  To maintain "status quo" the amount of fluid IN must equal the amount of fluid OUT. Everybody understands the "fluid in" part.  The "fluid out" is more complicated.  

Fluids exit the body in two ways:

1) Sensible losses.  This is the "out" that you are aware of, like urine, tears, and sweat.

2) Insensible losses. This is the "out" that you generally don't notice, like exhaling, bowel movements and, well, sweat. 

Insensible losses can dramatically increase with acute illness. Coughing blows an entire lungful of water out. Fever increases respiratory rate to do the same. 

All of the other balances are similar, and much of homeostasis is managed by the kidneys. 

Babygirl has been fortunate in a way.  Her native kidneys produced a lot of urine despite their failure, and Jorge's kidney has been continuing to get rid of water and potassium. Before her first transplant, we had to collect a 24 hour urine sample.  Her bottle was nearly full, but the other kids, barely any.  The difference this makes in terms of quality of life is dramatic.  REALLY dramatic.  Imagine being allowed only 2 cups of liquid a day, or less. Imagine trying to figure out if you are sweating enough to justify a few extra sips of water on a hot day. Imagine that you always need to remember that fruit, veggies, and other foods have variable water content that have to be considered in the fluid balance.

A gallon of water weighs 8 pounds.  Imagine THAT settling into your legs and feet because your kidneys are not getting rid of any of what you take in. Many if not most of the people on dialysis do not urinate AT ALL. 

Babygirl is VERY self-aware. And she is VERY careful.  She recently found a cute little pink mug at the thrift store.  It took me a while to realize that it wasn't the cute part or the pink part that attracted her to it. It was the "little" part.  It's easier for her to go easy on the fluids if she has smaller servings, smaller containers. 

She did a 24 hour collection recently.  I noticed that the amount of fluid isn't what it was a year ago, perhaps down by half. I've noticed she hasn't been running to the bathroom as often while we are out-and-about. This gradual decline in what remains of the transplanted kidney's function will ultimately have a big impact on her quality of life. 

Fortunately, home dialysis can be done every day if needed to get the retained fluid out.  Unfortunately, home dialysis takes an hour for set up/clean up and 4 hours to run. Add in 1-2 hours a week to move heavy supplies in, and sort things out. Patients on home hemodialysis need to stay awake the entire time, so unlike peritoneal dialysis, one cannot sleep through it. Babygirl looked at me the other day and said, "This feels like a full time job."

Five hours daily at 4 days a week currently? Grimly time consuming but not quite full time.  Add three additional days and it will be.

DeeDee