["Terminal" Dehydration, Part 2 : Medical Indications and Therapeutic Approach]

Overview

Journal Anaesthesist

Specialty Anesthesiology

Date 2018 Oct 28

PMID 30367210

Authors

U Suchner

C Reudelsterz

C Gog

Affiliations

Soon will be listed here.

Abstract

The approach in the clinical fluid management of the dying is still controversially discussed in specialist circles and also in the general population. In this article the importance of establishing the therapeutic indications is emphasized against the background of a lack of evidence. Options to achieve noninvasive objectification of assumed dehydration as well as assessment of the reversibility of the symptoms are shown and the importance of monitoring of all therapeutic actions is discussed. The pathophysiological foundation of reversible disorders of fluid homoeostasis are described and distinguished from the irreversible disorders leading to terminal dehydration. If clinically assisted hydration (CAH) is indicated, the hydration status must be assessed individually as well as in advance and all therapeutic measures must be constantly adjusted to the results of non-invasive monitoring procedures.

References

Dunlop R, Ellershaw J, Baines M, Sykes N, Saunders C . On withholding nutrition and hydration in the terminally ill: has palliative medicine gone too far? A reply. J Med Ethics. 1995; 21(3):141-3. PMC: 1376688. DOI: 10.1136/jme.21.3.141. View

Nakajima N, Satake N, Nakaho T . Indications and practice of artificial hydration for terminally ill cancer patients. Curr Opin Support Palliat Care. 2014; 8(4):358-63. DOI: 10.1097/SPC.0000000000000089. View

Morita T, Shima Y, Miyashita M, Kimura R, Adachi I . Physician- and nurse-reported effects of intravenous hydration therapy on symptoms of terminally ill patients with cancer. J Palliat Med. 2004; 7(5):683-93. DOI: 10.1089/jpm.2004.7.683. View

Sarhill N, Mahmoud F, Christie R, Tahir A . Assessment of nutritional status and fluid deficits in advanced cancer. Am J Hosp Palliat Care. 2003; 20(6):465-73. DOI: 10.1177/104990910302000610. View

Bruera E, Hui D, Dalal S, Torres-Vigil I, Trumble J, Roosth J . Parenteral hydration in patients with advanced cancer: a multicenter, double-blind, placebo-controlled randomized trial. J Clin Oncol. 2012; 31(1):111-8. PMC: 3530688. DOI: 10.1200/JCO.2012.44.6518. View

Craig G . On withholding nutrition and hydration in the terminally ill: has palliative medicine gone too far?. J Med Ethics. 1994; 20(3):139-43; discussion 144-5. PMC: 1376497. DOI: 10.1136/jme.20.3.139. View

NADAL J, Pedersen S, MADDOCK W . A COMPARISON BETWEEN DEHYDRATION FROM SALT LOSS AND FROM WATER DEPRIVATION. J Clin Invest. 1941; 20(6):691-703. PMC: 435099. DOI: 10.1172/JCI101262. View

Burge F . Dehydration symptoms of palliative care cancer patients. J Pain Symptom Manage. 1993; 8(7):454-64. DOI: 10.1016/0885-3924(93)90188-2. View

Bruera E, Sala R, Rico M, Moyano J, Centeno C, Willey J . Effects of parenteral hydration in terminally ill cancer patients: a preliminary study. J Clin Oncol. 2005; 23(10):2366-71. DOI: 10.1200/JCO.2005.04.069. View

10.

Schoonjans A, Forget P, Labriola L, Deneys V, Jadoul M, Pingaut I . Pleth variability index combined with passive leg raising-induced pulse pressure variation to detect hypovolemia in spontaneously breathing patients. Acta Anaesthesiol Belg. 2011; 61(3):147-50. View

11.

Elsayem A, Mori M, Parsons H, Munsell M, Hui D, Delgado-Guay M . Predictors of inpatient mortality in an acute palliative care unit at a comprehensive cancer center. Support Care Cancer. 2009; 18(1):67-76. DOI: 10.1007/s00520-009-0631-5. View

12.

Sato M, Kunisawa T, Kurosawa A, Sasakawa T . Pulse oximetry-derived pleth variability index can predict dexmedetomidine-induced changes in blood pressure in spontaneously breathing patients. J Clin Anesth. 2016; 34:318-24. DOI: 10.1016/j.jclinane.2016.05.012. View

13.

Keller G, Cassar E, Desebbe O, Lehot J, Cannesson M . Ability of pleth variability index to detect hemodynamic changes induced by passive leg raising in spontaneously breathing volunteers. Crit Care. 2008; 12(2):R37. PMC: 2447559. DOI: 10.1186/cc6822. View

14.

Dalal S, Del Fabbro E, Bruera E . Is there a role for hydration at the end of life?. Curr Opin Support Palliat Care. 2009; 3(1):72-8. DOI: 10.1097/SPC.0b013e32832531a5. View

15.

Lawlor P . Delirium and dehydration: some fluid for thought?. Support Care Cancer. 2002; 10(6):445-54. DOI: 10.1007/s00520-001-0334-z. View

16.

Nakajima N, Takahashi Y, Ishitani K . The volume of hydration in terminally ill cancer patients with hydration-related symptoms: a prospective study. J Palliat Med. 2014; 17(9):1037-41. DOI: 10.1089/jpm.2013.0557. View

17.

Zieschang T, Wolf M, Vellappallil T, Uhlmann L, Oster P, Kopf D . The Association of Hyponatremia, Risk of Confusional State, and Mortality. Dtsch Arztebl Int. 2017; 113(50):855-862. PMC: 5273588. DOI: 10.3238/arztebl.2016.0855. View

18.

Yamaguchi T, Morita T, Shinjo T, Inoue S, Takigawa C, Aruga E . Effect of parenteral hydration therapy based on the Japanese national clinical guideline on quality of life, discomfort, and symptom intensity in patients with advanced cancer. J Pain Symptom Manage. 2012; 43(6):1001-12. DOI: 10.1016/j.jpainsymman.2011.06.028. View

19.

Bergek C, Zdolsek J, Hahn R . Non-invasive blood haemoglobin and plethysmographic variability index during brachial plexus block. Br J Anaesth. 2015; 114(5):812-7. DOI: 10.1093/bja/aeu484. View

20.

Morita T, Tsunoda J, Inoue S, Chihara S . Perceptions and decision-making on rehydration of terminally ill cancer patients and family members. Am J Hosp Palliat Care. 2000; 16(3):509-16. DOI: 10.1177/104990919901600306. View