Nutrition by Hypodermoclysis

Abstract

It is possible to administer fluid subcutaneously at a rate so slow that the forces of diffusion and perfusion are able to transfer that fluid to the circulation at a rate equal to the rate of its delivery. In clinical practice, fluid can be delivered subcutaneously in the presence of hyaluronidase at about 1 ml per minute without the accumulation of edema. Thus, 1500 ml can be delivered in 24 hours at a single site, and 3000 ml of fluid can be delivered at two sites in 24 hours. This procedure, called hypodermoclysis, is used for hydration. It is particularly useful for the aged patient in the long-term care institution when it will save the patient from the dangers of hospitalization and save society from its costs.

Subcutaneous Fluids in Elderly Hospital Patients with Cognitive Impairment

“…Sehen and SingerEdelstein [1] reviewed 1,850 s.c. infusions given to 270 patients in acute and long-stay geriatric beds and concluded that the s.c. route was the method of choice for adminis tering fluid to elderly patients in nonurgent situations. Other writers have reported simi lar findings [2][3][4], Lipschitz et al [7] demon strated using radioisotope tracers that normal saline (with hyaluronidase) given subcuta neously was rapidly and fully absorbed into the bloodstream.…”

“…The s.c. route is reported to be associated with little pain or discomfort compared with the i.v. route [3],…”

“…Paper presented at the Spring Meeting of the British Geri atric Society, Torquay, April 1995. in nonacute situations [1][2][3]. Subcutaneous fluids are particularly useful in elderly pa tients in whom veins may be fragile or oc cluded.…”

The prevalence and risk factors for age-related macular degeneration in rural–urban India, Sankara Nethralaya Rural–Urban Age-related Macular degeneration study, Report No. 1

“…Alternatives include oral fluids given by a caregiver with close observation of adequate intake; use of tube feeding with supplemental free water (since commercial formulas do not contain enough free water to replete someone who is dehydrated); and hypodermoclysis, the subcutaneous infusion of isotonic or hypotonic solution (87).…”

Continuous subcutaneous delivery of medications for home care palliative patients—using an infusion set or a pump?

“…Hydration can be administered as a bolus of 500 cc over 1 h twice a day with hyaluronidase as a 12-h overnight infusion or as a continuous infusion. The maximal volume administrated with hyaluronidase is about 1 cc in a minute without edema; thus, 1,500 cc in each of the two sites gives 3,000 cc in a 24-h infusion [6]. Randomized controlled trials showed that hyaluronidase use is not necessary in routine subcutaneous infusion [7,8].…”