By Cheryl Patterson, R.D. Registered Dietician.


How do I get enough water??  We hear this question frequently at The Forbes Norris ALS Clinic.  Hydration is important and can become challenging with swallowing difficulties.  Here are 5 guidelines to remember.



It doesn’t have to be water!

All liquids, including thick liquids, “count” toward staying hydrated.  An 8 oz Boost Plus or Ensure Plus contains 6 oz water.  Smoothies, milkshakes and even Jello are mostly water.  Thicker liquids are less difficult to swallow because they move slowly, are easier to control in the mouth and are less likely to cause coughing.  An added benefit to water-alternatives is that every sip can provide needed nutrients and calories too.



A recommendation of “6-8 GLASSES” means “6-8 CUPS”,

or 48-64 ounces.  One measuring “cup” holds 8 liquid ounces.



Some people have always taken less liquid than recommended,

and have not needed more.



Estimates are based on body weight.

Adults with higher body weight may need even more than 8 cups.



Urine should be pale yellow, indicating adequate hydration.



It IS possible to be overhydrated, although this is unlikely.


A speech language pathologist (speech therapist) can provide you with many strategies for safely maintaining hydration and help you decide if it may be time to consider supplementing your oral hydration with the assistance of a PEG tube.

  1. Thank you so much for this information. I have just been diagnosed in November 2013 with this horrible disease. God bless the others with this damming disease.

  2. Thank you

  3. I had a PEG put in on Nov. 22, 2013 and just changed to a MIC KEY last Wed. March 10. Since I had the PEG, the first couple of weeks were an adjustment. I find that 6 boxes of ISO Source 1.5 by Nestle per day is maintaining my weight at 155 to 158 lbs. I’m on the Kangaroo Joey pump during the day @ 125 mil per hour and at night 100 mil per hour. I have experienced GERD for about 20yrs and a hiatal hernia was discovered a year ago. If I syringe water in or drink it out of a straw I get “full” and experience GERD. My urine is light to medium yellow. Any suggestions?
    Tim Brown

  4. My client can no longer swallow without aspiration. He is so reluctant to do everything with a peg. How to help him

    • Hi Lynn,
      Our job is to educate our clients. They are then responsible for all decision making. Perhaps actually seeing the aspiration visually through an instrumental evaluation like a modified barium swallow study (MBSS) or fiberoptic endoscopic evaluation of swallowing (FEES) would help him to comprehend better what is happening. He may already fully understand. A few of our clients will choose not to have a PEG and then we just provide the strategies that will keep them as safe as possible including, but not limited to, excellent oral hygiene and teaching the caregivers the Heimlich maneuver. I think one of the most important things we can do though is fully support our client’s right to choose the correct course for themselves.

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