How do you approach management for recurrent stone formers who sleep over 8 hours per day and fail to reach 2.5 liters of daily urine output on 24 hour urine stone risk studies?

I suggest the patient plan a schedule by which they drink 2.5 L per day. To get started, I suggest they set their phone to alert them when it is time to drink the requisite amount of fluid, preferably water. After a while, this becomes an automatic habit.

Stephen B. Erickson, MD

I know of no data that hours of sleep affect stone risk. So the question is what to do when a patient cannot reach a volume goal. Volume goal is set by the saturations present and stone type, and is just one factor, so I will consider the case when a 2.5-liter 24-hour volume is essential because of the totality of the situation. When that happens, I show the patient the information and why the volume needed is as it is. As for a method beyond that, I suggest placing 1/2 liter water bottles in the fridge at bedtime, and assuring all of the water is consumed by bedtime the following day. I rarely make provision for nocturnal fluids except in cystine stones when drugs fail. Fred Coe