Fluid intake around the time of GBCA administration or chelation should not be an excessive amount, but should be only moderately more than one would normally drink.Too much fluid may be undesirable.

Unlike the majority of my blogs on Gd and heavy metals, which are based on hard data or pre-existing science, my views on drinking fluid are based on my own theory of compensation methods of the kidney function system. Normal 24 hr urine volume is generally in the range of 1200 to 2000 ml, and individuals with increased urine elimination is in the range of 3500 to 4500 ml.

Over the years it has surprised me that individuals who normally have very high urine volumes are over-represented among GDD sufferers. On the surface peeing out a lot of fluid suggests that lots of Gd should be eliminated. My opinion is that in fact the opposite may be happening: more Gd is retained..

How could this happen?

My opinion is that when urine volume is around 4000 ml, which is almost the total fluid content of blood turned over in 1 day, the kidney has to make massive shortcuts to preserve the life of the person. For example if sodium is urinated at the same rate of fluid then serum sodium would drop to a level that would result in seizures and death. The same is true of atleast 10 additional cations/ electrolytes/ metals, that if they were not conserved then the patient would experience severe illness and death. So, to do this, requires the kidneys to retain many cations in a non selected fashion, and Gd and other heavy metals may slip into that retention mechanism.

This is my recommendation. It is clear to me that a person should be well hydrated at the time of any contrast agent (Gd- or iodine- based) administration, which means you don't feel like drinking anything, but not that you feel sick because you drank so much. Drinking too much may result in the opposite effect than desired. The same is true at the time of chelation.

The bottom line, be well hydrated when getting iv contrast or undergoing chelation, but not too much. This also falls into the Goldilocks rubric.

Richard Semelka, MD