The time for a response to a natural disaster can be varied and depends on the size and scope of the disaster, how many people are involved, and the access that emergency responders have to the affected area. Patients who require medical equipment for survival are particularly vulnerable to any disruption in the services that supply the equipment and the electricity needed to power it. Being prepared can buy the time you need for emergency services to be restored.
Kidneys and Dialysis
Dialysis is a medical procedure that aims to do the work of the kidneys in patients with kidney failure. The end stage renal disease that leads to the need for dialysis is caused by many medical conditions that can include uncontrolled blood pressure, diabetes, lupus, drugs and kidney damage suffered from starving the kidneys of oxygen. This oxygen starvation can be caused by blood loss and severe low blood pressure from an accident or a medication that causes a severe drop in blood pressure. Kidneys help regulate the amount of fluid in the body and regulate levels of sodium, potassium, calcium, phosphorus, and bicarbonate. By controlling the levels of these minerals, the kidneys are able to balance the amount of fluid the body needs to function properly. The kidneys also play a role in the maintenance of red blood cells by secreting 85 percent of the blood-forming signal erythropoietin, with the remainder 15 produced by the liver. With failure of the kidneys, the body's ability to regulate fluid and mineral levels is significantly affected, as is the ability to maintain an adequate blood count.
Dialysis Diets
Diets for patients on dialysis need to be significantly modified. A consultation with a nutritionist is helpful to plan an individual diet regimen. Fluid balance is a key to protecting the heart. Since urine is no longer formed, fluid collects in the body, causing the heart to work harder to pump against all the buildup of fluid. Potassium levels can affect the heart rhythm and elevations can cause irregular heart rhythms. Phosphorus helps regulate calcium deposition in bones and an elevation will cause a loss of calcium from the bone tissue, leading to weak, brittle bones. Eating protein in the form of meats is necessary to maintain and repair muscle. But when kidneys fail, urea -- a waste product of breaking down meat protein -- can build up and become poisonous to the body. During a natural disaster, dialysis maybe difficult to obtain for an uncertain amount of time, as such, it is important to maximize the type of foods that will cause the least amount of fluid and toxic buildup.
Foods To Limit or Avoid
In order to manage fluid intake, the National Kidney and Urologic Information Clearinghouse recommends avoiding salty foods that increase thirst and keeping an accurate account of all fluids taken in. Fruits and vegetables with a high water content include melons, grapes, oranges, tomatoes, lettuce and celery -- all should be limited. Fluids should be taken in small amounts and all should be counted. Foods with high potassium contents should be minimized as well. These include apricots, avocados, bananas, beets, Brussels sprouts, cantaloupe, clams, dates, figs, kiwi, lima beans, melons, milk , nectarines, oranges, peanuts, pears, potatoes, prune juice, raisins, sardines, spinach, tomatoes, winter squash, and yogurt. Foods available during a natural disaster can be limited, so the amount of potassium taken in can be reduced by cutting the portions in half if high potassium foods are all that is available. Reducing potassium in potatoes can be accomplished by dicing or shredding them prior to boiling them. Phosphorus is usually managed by taking a phosphate binding drug, but can also be managed with antacids like calcium carbonate if needed. Foods that should be limited include milk, cheese, beans, peas, colas, nuts, and peanut butter. Proteins should also come from high quality sources such as lean meats, chicken, fish, and egg whites.
Dialysis diet
An all-encompassing dialysis diet is difficult to generalize because individual nutritional requirements vary widely and should be discussed with a physician and a renal dietitian. Generally, foods that are fresh and not processed will be lower in sodium. The Washington Manual of Medical Therapeutics recommends a renal diet of total calories of 35 to 50 calories per kilogram of body weight per day, a sodium intake of 2g to 4g per day, potassium intake of 40 milliequivalents per day and 800mg of phosphorus per day. Canned and packaged foods will have nutritional labels that can be monitored. The United States Department of Agriculture National Nutrient Database is a searchable library with the information needed to maintain a good level of nutrients -- you can find a link to it in the References section. It is advisable to review a diet plan with a dietitian and review which foods are available in the area and maintain a supply of those foods at home in case of an emergency.
References
- "Hazzard's Geriatric Medicine and Gerontology"; Mark Unruh, et al.;2009
- "Goodman & Gilman's The Pharmacological Basis of Therapeutics"; Robert F. Reilly, et al.;
- National Kidney and Urologic and Kidney Clearinghouse: Eat Right to Feel Right on Hemodialysis
- USDA: Nutrition Database
- "The Washington Manual of Medical Therapeudics"; Daniel H. Cooper, et al.;2007
