The Sensation of Thirst in Dying Patients Receiving IV Hydration

Abstract

Cancer patients in the terminal phase of their disease often experience fluid deficits. This is mainly due to their inability to ingest adequate amounts of oral fluids to meet the body's physiological demands. In order to correct this deficit, intravenous (IV) fluid programs are often instituted. This pilot study was conducted on a group of terminal patients hospitalized in an oncology unit who died while receiving IV fluids. It sought to assess the effects of these fluids on their level of thirst. Data were collected on 30 patients in the last 24 hours of life. However, of the 30 patients only 19 were sufficiently alert to be able to verbally evaluate their thirst intensity. Of the 19 patients, six experienced mild thirst, eight moderate thirst, and four severe thirst. This was in spite of IV hydration regimens which ranged from 500 mL to 3000 mL. Little relationship was found between level of thirst and the amount of IV 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. Since the pilot study's sample was small, definitive conclusions could not be drawn. However, our results highlight the need for future research in this area.

Determinants of the sensation of thirst in terminally ill cancer patients

“…Thus, sensation of thirst is one of the most common symptoms in cancer patients in the late stage. The association between severity of the sensation of thirst and dehydration has been examined in a few studies in palliative care settings [5,13,23,24]. In Ellershaw's report on 23 hospice inpatients, biochemical dehydration defined by the levels of BUN, creatinine, sodium and osmolality was not associated with the symptom [13].…”

“…On the other hand, existing evidence about the role of dehydration in sensation of thirst in terminal patients is at most preliminary, despite recent aggressive discussion in the palliative care literature [3,4,11,18,21,25]. Whereas several empirical studies have demonstrated that biochemical dehydration is not correlated with the symptom [5,13,23,24], these studies have considerable methodological limitations [31]. In Ellershaw's study, the inclusion and exclusion criteria were not described in sufficient detail and the validity of their definition on "biochemical dehydration" had not been established [13].…”

Delirium and dehydration: some fluid for thought?

“…Similarly, difficulties arise in estimating fluid loss in the case of incontinence of urine or feces. Many studies in patients with advanced cancer and in the elderly have failed to show an association between thirst and biochemical markers of fluid deficit or dehydration [18,32,45,76]. Recently, Morita et al reported an association between sensation of thirst and atrial natriuretic peptide levels as an index of hydration status [75].…”

Effects of educational intervention on nurses’ knowledge, attitudes, and behavioral intentions toward supplying artificial nutrition and hydration to terminal cancer patients

“…Chiu's study showed that ANH has no significant influence on survival [7]. However, an increasing number of literature reviews have suggested that ANH is a futile treatment and even brings more harm than good to terminal cancer patients, such as inducing anasarca or pulmonary edema [4,6,18,20,23,25]. Zerwekh, a PCU nurse, first realized this in 1983 and published a paper on the disadvantages of ANH and the possible advantages of dehydration in terminally ill patients based on her clinical experience [33].…”