artificial hydration in terminally ill patients
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Introduction
Ethical issues:
- there is no right answer
- ethically & legally there is no difference between witholding & withdrawing treatment
- some patients or families believe that hydration must always be provided even if it causes discomfort, usually based on personal or religious beliefs
- little benefit in the dying patient & may cause unwanted symptoms
Adverse effects
- fluids may prolong the dying process
- pulmonary symptoms
- increased urine output
- need for catheterization, bedpan, urinal or commode
- urinary incontinence
- edema, ascites, fluid accumulation
- vomiting, bloating, diarrhea
- increased pain
- general risks associated with tubes, IVs, etc
Laboratory
- intravenous hydration will reduce the BUN/creatinine ratio
Notes
Palliative effects of dehydration:*
- easier to breath
- reduced pulmonary secretions
- less coughing & congestion
- relief from choking & drowning sensation
- no need for pharyngeal suctioning
- decreased GI fluid; less vomiting, bloat, diarrhea
- decreased edema & peripheral fluid accumulation
- diminished pain
- less pain from edema
- electrolyte imbalances act as natural anesthetics, with diminished level of consciousness & less suffering
- 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):
- death will generally occur within days of ceasing intake
- often the patient survives much longer than expected
- terminally ill patients not given artificial hydration may actually survive longer than those that are hydrated
More general terms
Additional terms
References
- ↑ VHA Program Gide 1140.10, chapter 2, Principles of Palliative Care and/or Hospice Medicine, Sept 13, 1996
- ↑ MacDonald N. Ethical Issues in Hydration and Nutrition, chapter 8, pg 153-163
- ↑ Foregoing Life-Sustaining Therapy. Forgoing Medically Provided Nutrition & Hydration, chapter 6, pg 103-113
- ↑ Handbook for Mortals. Foregoing Medical Treatment, Chapter 11, pg 129-138
- ↑ 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: https://www.ncbi.nlm.nih.gov/pubmed/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: https://www.ncbi.nlm.nih.gov/pubmed/23552960