Dehydration and Hydration in the Terminally Ill: Care Considerations

Abstract

Debate continues about whether to withhold or withdraw intravenous, subcutaneous, or nasogastric hydration in the terminally ill. Nurses may be confronted with situations where the terminally ill patient or family must make a decision regarding hydration. Therefore, nurses must be knowledgeable about terminal dehydration literature and research. This article is a review of the literature on terminal dehydration. The focus is on the definition of terminal dehydration, physiological benefits and disadvantages of terminal dehydration, rationale for hydrating, review of research in terminal dehydration, physiological basis for comfort in the terminally dehydrated, and suggestions for research and practice.

Acceptability of an Advance Directive That Limits Food and Liquids in Advanced Dementia

“…Most research studies about terminal dehydration concluded that dehydration is not causing discomfort beyond dryness of the mouth that can be easily managed by ice chips or artificial saliva spray. 23 If both food and liquids are stopped, dehydration is isotonic and causes less thirst than hypertonic dehydration that occurs only when the intake of food is discontinued. 24 Dehydration may make dying more comfortable by limiting secretions in the respiratory and gastrointestinal system, decreasing the need for suctioning and risk of vomiting and diarrhea.…”

“…Decreased urine production may be also beneficial in incontinent individuals because it results in less irritation of the skin. 23 Dehydration causes release of vasopressin and there is some evidence that endorphins are coreleased decreasing the perception of pain. 25 Another mechanism by which stopping intake of fluids and food may increase comfort is through increased formation of ketone bodies.…”

Evaluation and treatment of cancer-related fluid deficits: volume depletion and dehydration

“…TD occurs naturally from decreased oral intake and increased renal, gastrointestinal, skin, and lung losses. TD has the same pathophysiology and subtypes of fluid deficit, with isotonic being the most common [53,103,111]. Debate continues about whether to withhold or withdraw hydration (Table 7) [33,78,107].…”

“…Terminal dehydration (TD) is used to describe fluid deficit in the terminally ill with water and electrolyte disorders in the last days of life [53,76,81]. TD occurs naturally from decreased oral intake and increased renal, gastrointestinal, skin, and lung losses.…”

The Ethics of Withdrawing Artificial Food and Fluid from Terminally Ill Patients: an end-of-life dilemma for Japanese nurses and families

“…2,3 The lack of knowledge that scientifically justifies giving or not giving AFF to terminally ill patients also prevails internationally. [4][5][6][7] In Japan, the norm is that patients with appetite loss or swallowing dysfunction are given AFF. A recent survey shows that the percentage of patients with AFF during the week of their death was 60-90% in two palliative care institutions; it was 100% in a large university hospital.…”