How do you advise an ESKD patient who wants to drink pickle juice to reduce intradialytic muscle cramps?

Salt is addicting! Acknowledge that changing habits is hard. Make a case that the reason for cramps is RATE at WHICH fluid is being removed.

Ask the patient to recall the days when the goal of fluid removal was low. During those treatments, the risk and occurrence of cramps were less likely when com...

I've never been asked by a patient about drinking pickle juice to reduce intradialytic muscle cramps. Drinking pickle juice, like using high dialysate sodium content; this may be successful in decreasing the transcellular fluid shifts that contribute to muscle cramping, but at the expense of a high ...

The discussion above highlights how little we know about the pathophysiology of cramping and lack of evidence-based treatments. While intradialytic muscle cramping is the topic of the current conversation, cramping commonly occurs off dialysis as well. In fact, it is not uncommon even in PD patients...

I’m okay with one ounce in the setting of noticeable cramping, whether or not the patient has ESRD. In small amounts, this is not a deal breaker, and patients swear by it, at least down here in the southeast. If they can be careful about the amount (1 oz per any day, no more), I’ll fight the sodium ...

Patient has to understand that pickle juice is rich in sodium and therefore drinking just a cup of it is like consuming instantly almost one third of the daily recommended dietary intake of sodium. Intradialytic muscle cramps may be severe and therefore need to be addressed by the dialysis care team...

Try to educate patient. Explain where sodium is, specially non chloride that makes up 1/2 Na intake.

I use this formula: target UF 10 ml/kg/h so to do this patient cannot gain volume in interdialytic period over a percent of dry weight equal to number of hours of treatment.

So if patient's UF for 4 ...