| The proper role for nutritional support and hydration in terminal patients remains controversial. Since disconintuing such support often is the final act that leads to death (or permits the patient to die of their underlying condition) the question of patient comfort or quality of life is critical. Most of the clinical data suggest that dying patients do not benefit from artificial hydration or nutrition and that comfort measure (e.g. ice chips) are adequate. Some recent literature: |
| Guidelines on artificial nutrition versus hydration in terminal cancer patients. European Association for Palliative Care.Step I involves assessing the patient concerning the following: 1) oncological/clinical condition; 2) symptoms; 3) expected length of survival; 4) hydration and nutritional status; 5) spontaneous or voluntary nutrient intake; 6) psychological profile; 7) gut function and potential route of administration; and 8) need for special services based on type of nutritional support prescribed. Step II involves the overall assessment of pros and cons, based on information determined in Step I, in order to reach an appropriate decision based on a well-defined end point (i.e., improvement of quality of life; maintaining patient survival; attaining rehydration). Step III involves the periodic reevaluation of the decision made in Step II based on the proposed goal and the attained result. Nutrition 1996 Mar;12(3):163-7 |
| Dehydration
symptoms of palliative care cancer patients. The symptoms considered were thirst, dry mouth, bad taste, nausea, pleasure in drinking, fatigue, and pain. Associations were sought between these symptoms and predictor variables (fluid intake, plasma osmolality, sodium, and urea) and confounding variables (age, medications, oral disease, and mouth-care regimen). No association could be demonstrated between thirst (the principal outcome of interest) and the predictor or confounding variables. The symptoms appear to be rated moderately severe, but there is no demonstrable association between severity and fluid intake. Burge FI . J Pain Symptom Manage 1993 Oct;8(7):454-64 |
| Comfort care for terminally ill patients. The appropriate use of nutrition and hydration.In all patients, symptoms of hunger, thirst, and dry mouth could be alleviated, usually with small amounts of food, fluids, and/or by the application of ice chips and lubrication to the lips. Complaints of thirst and dry mouth were relieved with mouth care and sips of liquids far less than that needed to prevent dehydration. Food and fluid administration beyond the specific requests of patients may play a minimal role in providing comfort to terminally ill patients. McCann RM, JAMA 1994 Oct 26;272(16):1263-6 |
| The sensation of
thirst in dying patients receiving i.v. hydration. Little relationships was found between level of thirst and the amount of i.v. fluids received, blood urea nitrogen (BUN), or sodium blood levels. In addition, although 70% of the patients had fluid retention signs, there was little correlation between these signs and the amount of fluids received. Musgrave CF,J Palliat Care 1995 Winter;11(4):17-21 |
