Contents

Search

artificial hydration in terminally ill patients

Ethical issues: 1) there is no right answer 2) ethically & legally there is no difference between witholding & withdrawing treatment 3) some patients or families believe that hydration must always be provided even if it causes discomfort, usually based on personal or religious beliefs 4) little benefit in the dying patient & may cause unwanted symptoms Adverse effects: 1) fluids may prolong the dying process 2) pulmonary symptoms a) increased secretions with dyspnea b) cough c) congestion d) "death rattle" 3) increased urine output a) need for catheterization, bedpan, urinal or commode b) urinary incontinence 4) edema, ascites, fluid accumulation 5) vomiting, bloating, diarrhea 6) increased pain 7) general risks associated with tubes, IVs, etc Laboratory: - intravenous hydration will reduce the BUN/creatinine ratio Notes: Palliative effects of dehydration:* 1) easier to breath a) reduced pulmonary secretions b) less coughing & congestion c) relief from choking & drowning sensation d) no need for pharyngeal suctioning 2) decreased GI fluid; less vomiting, bloat, diarrhea 3) decreased edema & peripheral fluid accumulation 4) diminished pain a) less pain from edema b) electrolyte imbalances act as natural anesthetics, with diminished level of consciousness & less suffering 5) no need for restraints used to prevent a patient from removing tube or IV * Dry mouth is the most frequent complication of dehydration in the dying patient. Sips of water, ice chips & lubricants can alleviate this symptom. Hunger & thirst are rarely a problem. Prognosis (in absence of hydration): 1) death will generally occur within days of ceasing intake 2) often the patient survives much longer than expected 3) terminally ill patients not given artificial hydration may actually survive longer than those that are hydrated

Related

end of life

General

intravenous hydration

References

  1. VHA Program Gide 1140.10, chapter 2, Principles of Palliative Care and/or Hospice Medicine, Sept 13, 1996
  2. MacDonald N. Ethical Issues in Hydration and Nutrition, chapter 8, pg 153-163
  3. Foregoing Life-Sustaining Therapy. Forgoing Medically Provided Nutrition & Hydration, chapter 6, pg 103-113
  4. Handbook for Mortals. Foregoing Medical Treatment, Chapter 11, pg 129-138
  5. Bruera E, Hui D, Dalal S, et al. Parenteral hydration in patients with advanced cancer: a multicenter, double-blind, placebo-controlled randomized trial. J Clin Oncol. 2013;31:111-1118. PMID: 23169523 - Reitschuler-Cross EB, Arnold B. ACP Journal Club. Parenteral hydration did not improve dehydration or quality of life in advanced cancer. Ann Intern Med. 2013 Mar 19;158(6):JC10. PMID: 23552960