["Terminal" Dehydration : Differential Diagnosis and Body of Evidence]

Overview

Journal Med Klin Intensivmed Notfmed

Specialties Critical Care
General Medicine

Date 2019 Apr 11

PMID 30968188

Citations 1

Authors

U Suchner

C Reudelsterz

C Gog

Affiliations

Soon will be listed here.

Abstract

Dehydration in palliative care patients can be associated with increased morbidity and mortality and is nevertheless therapeutically controversial. This article provides an overview of possible causes of dehydration at the end of life and places special emphasis on "terminal" dehydration in the dying. Empirical attitudes of healthcare professionals and persons concerned (patients and relatives) as well as evidence-based findings on "terminal" dehydration are elucidated and the limitations are described. Finally, it is concluded that the appropriate detection of the mode of dehydration (including its underlying pathophysiology) as well as the clinical evaluation of the "reversibility" of the symptoms after fluid therapy, is of central importance in establishing the indications for clinically assisted hydration (CAH).

Citing Articles

[Ethical implications in the therapeutic management of dehydrated patients at the end of life].

Suchner U, Reudelsterz C, Hill A, Stoppe C, Gog C Med Klin Intensivmed Notfmed. 2020; 116(4):312-321.

PMID: 31940062 DOI: 10.1007/s00063-019-00648-0.

References

Wildiers H, Menten J . Death rattle: prevalence, prevention and treatment. J Pain Symptom Manage. 2002; 23(4):310-7. DOI: 10.1016/s0885-3924(01)00421-3. View

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

Waller A, Adunski A, Hershkowitz M . Terminal dehydration and intravenous fluids. Lancet. 1991; 337(8743):745. DOI: 10.1016/0140-6736(91)90342-m. View

de Graeff A, Dean M . Palliative sedation therapy in the last weeks of life: a literature review and recommendations for standards. J Palliat Med. 2007; 10(1):67-85. DOI: 10.1089/jpm.2006.0139. View

Brooker S . Nutrition, Dehydration before death. Nurs Times. 1992; 88(2):59-62. View

Miyashita M, Morita T, Shima Y, Kimura R, Takahashi M, Adachi I . Physician and nurse attitudes toward artificial hydration for terminally ill cancer patients in Japan: results of 2 nationwide surveys. Am J Hosp Palliat Care. 2007; 24(5):383-9. DOI: 10.1177/1049909107300552. View

Holmes S . The oral complications of specific anticancer therapy. Int J Nurs Stud. 1991; 28(4):343-60. DOI: 10.1016/0020-7489(91)90061-7. View

Good P, Cavenagh J, Mather M, Ravenscroft P . Medically assisted hydration for palliative care patients. Cochrane Database Syst Rev. 2008; (2):CD006273. DOI: 10.1002/14651858.CD006273.pub2. View

Bruera E, Bush S, Willey J, Paraskevopoulos T, Li Z, Palmer J . Impact of delirium and recall on the level of distress in patients with advanced cancer and their family caregivers. Cancer. 2009; 115(9):2004-12. PMC: 2752862. DOI: 10.1002/cncr.24215. View

10.

Bush S, Bruera E . The assessment and management of delirium in cancer patients. Oncologist. 2009; 14(10):1039-49. DOI: 10.1634/theoncologist.2009-0122. View

11.

Collaud T, Rapin C . Dehydration in dying patients: study with physicians in French-speaking Switzerland. J Pain Symptom Manage. 1991; 6(4):230-40. DOI: 10.1016/0885-3924(91)90013-t. View

12.

Musgrave C . Terminal dehydration. To give or not to give intravenous fluids?. Cancer Nurs. 1990; 13(1):62-6. View

13.

Klein Remane U, Fringer A . [Voluntary Refusal of Food and Fluid in palliative care: a mapping literature review]. Pflege. 2013; 26(6):411-20. DOI: 10.1024/1012-5302/a000329. View

14.

White I, Hoskin P, Hanks G, Bliss J . Morphine and dryness of the mouth. BMJ. 1989; 298(6682):1222-3. PMC: 1836273. DOI: 10.1136/bmj.298.6682.1222. View

15.

Good P, Richard R, Syrmis W, Jenkins-Marsh S, Stephens J . Medically assisted hydration for adult palliative care patients. Cochrane Database Syst Rev. 2014; (4):CD006273. PMC: 8988261. DOI: 10.1002/14651858.CD006273.pub3. View

16.

DEN Hartogh G . Continuous deep sedation and homicide: an unsolved problem in law and professional morality. Med Health Care Philos. 2015; 19(2):285-97. PMC: 4880626. DOI: 10.1007/s11019-015-9680-3. View

17.

Andrews M, Levine A . Dehydration in the terminal patient: perception of hospice nurses. Am J Hosp Care. 1989; 6(1):31-4. DOI: 10.1177/104990918900600112. View

18.

Arends J, Bachmann P, Baracos V, Barthelemy N, Bertz H, Bozzetti F . ESPEN guidelines on nutrition in cancer patients. Clin Nutr. 2016; 36(1):11-48. DOI: 10.1016/j.clnu.2016.07.015. View

19.

Cheater F . Clinical revision series. 11. Xerostomia in malignant disease. Nurs Mirror. 1985; 161(3):25-7. View

20.

Siegler M, Weisbard A . Against the emerging stream. Should fluids and nutritional support be discontinued?. Arch Intern Med. 1985; 145(1):129-31. DOI: 10.1001/archinte.145.1.129. View