special lecture about fluid balance during the month of Ramadan when all moslems fast fr om Dawn to sunset and need orientation about how to keep fluid balance especially during summer season and in patients with chronic diseases.

2. Fluid Balance in diabetics during
Ramadan
BY
DR . ABDELRAHMAN A MOUKHTAR
Consultant Internist @ KSAFH
2018

7. About 75% of Body Weight
Adult has 45 litres of water in the body:
Total Body Water
Intracellular
30 Litres
Extracellular
15 litres
Tissue Fluid 12L Plasma 3L

10. Water gains and losses
Gains Losses
Water 1300 ml urine 1700 ml
Food 1000 ml insensible losses ..
Metabolism 400 ml faeces 200 ml
lungs 300 ml
skin 500 ml
Total 2700 ml 2700 ml

12. During fasting hours
when no food or drink
is consumed, the
body uses its stores
of carbohydrate and
fat to provide energy
once all the calories
from the foods
consumed during the
night have been used
up.
BUT
???????????
The body cannot store water

15. How efficient is this???
Several studies have indicated that healthy individuals who refrain from food
and drink during the daylight hours of the month of Ramadan dehydrate.The
water deficit is, however, corrected at least partly by the resumption of eating and
drinking at the break of fasting during the night hours from sunset to sunrise
During the daylight hours of Ramadan fasting, practising
Muslims are undoubtedly dehydrating at a rate that is
determined by the loss of body water minus the amount of
metabolic water that is produced over this period.
Acute changes in total body water are best characterized by
repeated measurements of body mass.

16. Euhydration was maintained by a drop in non renal losses (Leiper & Prastowo,
2000).
Fluid balance parameters measured during weekly periods before, during and
after Ramadan

17. In a study on 16 Sudanese healthy males aged 20–22 years,
urine output was significantly lower than in the prefasting and post-
Ramadan fasting periods and continued to fall as fasting proceeded .
In contrast, urine osmolality tended to increase throughout the month of
Ramadan and became markedly elevated at the end of Ramadan.
(Mustafa et al, 1978)

18. However, overnight urine output (16:00–08:00 of the following day)
remained unchanged .
On the other hand,
urine osmolality in the morning (08:00–12:00) and afternoon (12:00–
16:00) samples, which corresponded to the abstinence period, was very
high.
These findings indicate effective water conservation both by maximal
urinary concentration and reduced urine output.
Further, the relatively constant dilute osmolality of the urine during the overnight
periods demonstrates that the subjects were adequately rehydrated during the
night hours.
In another study in 20 Malaysian Ramadan fasters aged 20–45 years, the
afternoon urine collection (12:00–16:00) was constantly lower
than the prefasting levels throughout the month of Ramadan .
(Shirreffs, 2003)

19. Several alternatives have been used to give estimates of
hydration status of individuals

20. Despite these minor changes
• No detrimental effects on health have
as yet been directly attributed to
negative water balance at the levels that
may be produced during Ramadan.
Leiper et al, European Journal of Clinical
Nutrition (2003) 57, Suppl 2, S30–S38.

21. How about the
Diabetics???

24. RECOMMENDATIONS

25. Water gains and losses
Gains Losses
Water 1300 ml urine 1700 ml
Food 1000 ml insensible losses ..
Metabolism 400 ml faeces 200 ml
lungs 300 ml
skin 500 ml
Total 2700 ml 2700 ml

26. Recommendations
&
Maximize Gains Minimize losses

27. Recommendations
Maximize Gains

28. 1)Drinking enough water throughout the night:
An easy way to remember to drink water is to associate it with a common,
daily act. ( phone ring , commercial advertisement , between prays )
Drinking your water in one go will cause your body to flush it out soon
after. It’s best to sip water throughout the non-fasting hours of the day

30. 2) Consider the water content of the
foods & beverages:

31. Recommendations
Minimize losses

32. Minimize losses

33. 1) Control your blood sugar to avoid Osmotic
diuresis
Food that contains a lot
of sugar (such as Ramadan sweets) can really dehydrate you, while
fruit is perfect for providing extra water. So, instead of ending your iftar
feast with piles of sweets, eat a couple of slices of watermelon or an
orange.

34. Minimize Renal losses
2) Avoid drinks containing caffeine (especially
at Sahour)
Caffeine has a diuretic effect
that increases urine production, thus flushing out salt and water from the body.

35. 3)Avoid spicy or salty food

37. Minimize extra renal losses by (sweating):
 Avoid undue exposure to heat during day time.
 Be careful when picking your daytime clothes during Ramadan. The color
of your shirt, the fabric of your pants, and the layers of clothes all play an
important role in keeping your body temperature as low as possible.
 Cold showers. Cold showers help in many ways to rehydrate you during
the month of Ramadan.
 If you are in an office, wet a small towel with ice water and apply the
towel to your forehead, the area around your ears, the base of your neck,
the upper back, and the chest.

38. Avoid intense exercise during day time.

39. LAST and by no means the LEAST
• Never to ignore your body needs.
If you ignore your body signals this is
the worst mistake in any fast .