Subcutaneous dextrose for rehydration of elderly patients – an evidence-based review

Abstract

BackgroundIn the Rehabilitation and Aged Care Services Program at Southern Health in Victoria, saline hypodermoclysis is a relatively common method of rehydration. However, there were questions about the safety and effectiveness of subcutaneous infusion of other fluids and, in particular, dextrose solutions. This review aimed to assess the safety and effectiveness of rehydration of elderly patients with subcutaneous 5% dextrose solutions compared with intravenous 5% dextrose solutions.MethodsWe searched the Cochrane Library, Medline, IDIS, CINAHL, Current Contents, Premedline, Australasian Medical Index, the Joanna Briggs Institute, the US National Guideline Clearinghouse and bibliographies of retrieved articles. Searching was undertaken in July 2003. Studies selected were primary studies (or systematic reviews of primary studies) providing evidence as to the effectiveness and safety of subcutaneous infusion of dextrose solutions for rehydration of elderly patients. We included articles published in English in the last 10 years. Data were extracted by a single researcher.ResultsFrom our search we identified 15 potentially relevant articles. We obtained the full text of these articles to determine their relevance. After application of the inclusion criteria, four articles remained for appraisal including one systematic review, two randomised controlled trials and one cohort study.ConclusionThe four studies appraised all provide evidence that appropriate volumes of subcutaneous dextrose infusions (in the form of half-normal saline-glucose 5%, 40 g/L dextrose and 30 mmol/L NaCl, or 5% dextrose solution and 4 g/L NaCl, or two-thirds 5% glucose and one-third normal saline) can be used effectively for the treatment of dehydration, with similar rates of adverse effects to intravenous infusion. The evidence in this area is limited, and larger randomised controlled trials using validated outcome measures would be useful to confirm these results.

ESPEN guidelines on nutrition in dementia

“…There is little discomfort inserting and maintaining the s.c. infusion, and patients are less likely to interfere with s.c. infusions than with i.v. lines [220]. There is evidence that hypodermoclysis is as effective as i.v.…”

“…The infusion of fluids into the subcutaneous tissue e hypodermoclysis e is an easy, effective and safe hydration technique in mild to moderate dehydration, particularly in cognitively impaired patients [219,220,222,223]. There is little discomfort inserting and maintaining the s.c. infusion, and patients are less likely to interfere with s.c. infusions than with i.v.…”

“…hydration [221,222]. The infused electrolyte solutions should be isotonic, it is recommended that the infused volume should not exceed 3000 mL per day (max.1.500 mL per infusion site), however in the majority of the reported cases, the infused daily volumes do not exceed 1000 mL [218,220,222,223]. The s.c. application is not suitable for patients needing larger volumes, hypertonic or electrolyte-free solutions.…”

Basic-Level Emergency Medical Technician Administration of Fluids and Glucose via Enzyme-Assisted Subcutaneous Infusion Access

“…1,3 Literature addressing medical care in austere settings or MCI situations includes the importance of capability for use of alternative approaches (e.g., hypodermoclysis) for fluid administration. [16][17][18] In some cases, personnel who are qualified to start IVs may not be available during a disaster or may be deployed elsewhere. In other cases, during rescue efforts, customary sites for IV access may not be accessible to the provider.…”

Subkutane Flüssigkeitssubstitution bei betagten Patienten während Hitzewellen

“…Jahrhunderts Komplikationen berichtet, die retrospektiv auf eine ungeeignete Indikationsstellung zurückzuführen waren [2]. Seit den 90 er Jahren wurden zahlreiche Studien zur Sicherheit des Verfahrens veröffentlicht [17,26,30,36,38].…”