The Role of Hydration in Managing ALS

Gema Ramos, RN, Care Services Coordinator, ALS United Greater Chicago

Staying hydrated and taking in an adequate amount of fluids is very important for an individual with ALS.

Liquids help with many important body functions, including:

• Producing saliva
• Eliminating wastes
• Preventing constipation
• Carrying energy and oxygen throughout the body

Appropriate fluid intake helps with airway clearance by:

• Keeping mucous thinner (easier to cough up thin vs. thick, sticky mucus)
• Regularity of bowel movements
• Kidney and urinary tract health
• Metabolism of food and medication
• Regulating body temperature
• Lubricating joints and tissues
• Saliva/secretion management (liquids help in thinning saliva and easing the movement of saliva towards the back of the mouth).

Changes in Fluid Intake

However, fluid intake can pose the greatest challenge when swallowing abilities are poor for an individual with ALS. If a person is afraid of choking on liquids, he or she may intuitively drink less, but this leads to chronic dehydration. Chronic dehydration happens slowly over time and is often not recognized. When one is dehydrated, even just a 1.5% loss of body water can decrease mental and physical function. The more dehydrated one becomes, the thicker the secretions. The treatment of thick secretions involves a combination of fluid management and sometimes the use of medications. The first step is to avoid dehydration.

Fluid Intake and Mobility Changes

Some individuals with ALS with mobility challenges may limit fluid intake to decrease the need for toileting assistance and to reduce leakage episodes. Poor hydration can lead to constipation and dehydration. Schedule regular bathroom trips to facilitate bowel and bladder training and to avoid accidents.

Symptoms of Dehydration

Dehydration can cause symptoms that may make it more difficult for individuals with ALS. Symptoms of dehydration include:

• Increased thirst
• Dry skin
• Darker urine color
• Poor appetite
• Fatigue
• Nausea
• Mild confusion
• Thicker phlegm in the back of the throat

Preventing Dehydration

Aim to prevent dehydration before it happens. Six to eight glasses of liquid should be consumed each day. Water is at the top of the list, but juice, decaffeinated iced tea, and milk also provide hydration.

Individuals with ALS who have difficulties drinking thin liquids such as water may be able to drink something a bit thicker such as juice or thickened liquids. Specially designed powders and gels can thicken beverages to make them easier to swallow. Gelatin, as well as ice pops, are other possible fluid options. Liquids can also be added to foods by using sauces, cream, and gravy.

Help keep track of your fluid intake by measuring your daily fluids and storing them in a pitcher, thermos, or plastic bottle. This can help serve as a visual reminder of how much fluid you need to drink for the day.