The use of hypodermoclysis for rehydration in terminally ill cancer patients
Journal of Pain and Symptom ManagementPublished 1 July 1994Open access
Robin L. Fainsinger, Tara MacEachern, Melvin J. Miller, Éduardo Bruera, Kathy Spachynski, Norma Kuehn
Citations158
SJR quartileQ1
SJR score1.21
SNIP1.42
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TL;DR
It is confirmed that HDC for dehydration is a safe and effective technique and the need for further research to clarify the role of rehydration in assisting symptom control is suggested.
Abstract
The need to treat dehydration in terminally ill patients to minimize symptom distress remains a controversial issue. Hypodermoclysis (HDC) is a simple technique for rehydration that offers many advantages over the intravenous route. In this prospective open study of 100 consecutive patients who died on a palliative care unit, we recorded our indications for, and use of, HDC. Of the 100 patients, 69 received HDC for an average of 14 +/- 18 days during an average admission of 35 +/- 41 days. The 31 patients who did not receive HDC had an average admission of 22 +/- 24 days, and appeared to have different characteristics than the HDC group. HDC was well tolerated in most patients at an average volume of 1203 +/- 505 mL/day. These results confirm that HDC for dehydration is a safe and effective technique and suggest the need for further research to clarify the role of rehydration in assisting symptom control.
Keywords
Medicine
Annals of Internal MedicineHyponatremia: A Prospective Analysis of Its Epidemiology and the Pathogenetic Role of Vasopressin
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In edematous and hypovolemic patients, plasma hormonal responses were compatible with baroreceptor-mediated release of vasopressin, and nonosmotic secretion of arginine vasoppressin is a major pathogenetic factor in this electrolyte disturbance.
Archives of Environmental Health An International JournalRole of Dehydration in Heat Stress-Induced Variations in Mental Performance
386 Citations1988P. M. Gopinathan, G. Pichan +1 more
Variation in mental performance under different levels of heat stress-induced dehydration was recorded in 11 subjects heat acclimatized to the tropicals and indicated significant deterioration in mental functions at 2% or more body dehydration levels.
Life SciencesMorphine-6-glucuronide, a potent mu agonist
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All 6-glucuronide actions were sensitive to the opiate antagonist naloxone and up to 20-fold more potent than morphine following microinjections in the same region.
Journal of Palliative CareSymptom Control during the Last Week of Life on a Palliative Care Unit
362 Citations1991Robin L. Fainsinger, Melvin J. Miller +3 more
Evaluation of patient records and medication changes revealed 6/99 patients with pain and 10/39 patients with delirium requiring increased treatment, probably resulting in sedation in the last days of life.
Journal of Pain and Symptom ManagementCognitive failure in patients with terminal cancer: A prospective study
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It is suggested that CF is extremely prevalent during the last weeks of life and, consequently, informed consent for therapeutic or research procedures or resuscitation may be impossible to obtain reliably at that stage.
2.3 Fluids and Electrolytes
234 Citations2018
British Journal of AnaesthesiaSTUDIES ON MORPHINE DISPOSITION: INFLUENCE OF RENAL FAILURE ON THE KINETICS OF MORPHINE AND ITS METABOLITES
130 Citations1989John W. Sear, C. W. Hand +2 more
M6G has been shown to possess analgesic properties in both man and experimental animals, and therefore the increased AUC for M6G may contribute to the prolonged effect seen with morphine when given to patients with impaired renal function.
Journal of the American Geriatrics SocietyComfort Measures for the Terminally III
121 Citations1985J. Andrew Billings
The decision to administer fluids to a dehydrated dying patient is often discussed primarily as an ethical issue, but sensible therapeutic choices should be based first on a clear appreciation of the clinical manifestations of water and electrolyte disorders and of the potential benefits of treatment.
Journal of Pain and Symptom ManagementSymptom control in terminally ill patients with malignant bowel obstruction (MBO)
118 Citations1994Robin L. Fainsinger, Kathy Spachynski +2 more
Evaluation of 100 consecutive patients who died on the Palliative Care Unit suggests that intensive medical management can provide good symptom control without using intravenous lines and with minimal use of nasogastric tubes.
Journal of Pain and Symptom ManagementChronic nausea and morphine-6-glucuronide
118 Citations1991Neil A. Hagen, Kathleen M. Foley +3 more
There is suggestive evidence that morphine-6-glucuronide can produce clinically significant effects in patients with mild renal insufficiency, and a patient who experienced chronic nausea and an episode of confusion while treated with a small, stable dose of oral morphine in the setting of mild renal Insufficiency is described.
The LancetEXPLANATION FOR POTENCY OF REPEATED ORAL DOSES OF MORPHINE?
115 Citations1987G.W. Hanks, G. Wynne Aherne +3 more
Morphine given by injection is the standard by which all other strong analgesics are measured, but when given orally in single doses it is a poor analgesic, but with repeated oral administration it becomes very effective.
European Journal of Clinical PharmacologyPlasma levels of morphine and morphine glucuronides in the treatment of cancer pain: relationship to renal function and route of administration
115 Citations1990Gregory M. Peterson, Ctc Randall +1 more
The results of this study confirm that accumulation of the pharmacologically active M6G is related to renal function, which probably explains the observation that morphine dosage requirements are generally reduced in patients with renal impairment.
The American Journal of MedicineHyponatremia in hospitalized patients with the acquired immunodeficiency syndrome (AIDS) and the AIDS-Related complex
107 Citations1993Winson W. Tang, Elaine M. Kaptein +2 more
Hyponatremia is a common electrolyte disorder in patients hospitalized with AIDS or ARC and is frequently associated with gastrointestinal losses or SIADH as well as increased morbidity and mortality.
The Medical Journal of AustraliaTerminal restlessness — its management and the role of midazolam
100 Citations1991Alexandra L Burke, Pamela L Diamond +3 more
The clinical picture of the syndrome of terminal restlessness in dying patients and the role and mode of administration of midazolam are described.
Journal of Pain and Symptom ManagementNutrition in cancer patients: an update and review of our experience
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Journal of Pain and Symptom ManagementSkin problems in advanced and terminal cancer patients
62 Citations1991Franco De Conno, Vittorio Ventafridda +1 more
The little currently known about the epidemiology and physiopathology of such lesions in the advanced phase of cancer is presented, and approaches to management are suggested.
BMJHypernatraemic dehydration in patients in a large hospital for the mentally handicapped.
58 Citations1989N. J. Macdonald, Kennedy N. McConnell +2 more
Hypernatraemic dehydration, subclinical underhydration, and undernutrition were common in a large hospital for the mentally and physically handicapped and after the initiation of the preventive programme only one patient was admitted with hypernatraemia dehydration in each of the years 1987 and 1988.
Journal of Palliative CareHypodermoclysis in Dehydrated Elderly Patients: Local Effects with and without Hyaluronidase
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PubMedHypodermoclysis (HDC) for symptom control vs. the Edmonton Injector (EI).
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The rationale for using HDC mainly for rehydration and the El when subcutaneous narcotics are needed is explored, and the controversy surrounding the treatment of dehydration in the terminally ill is examined.
American Journal of Industrial MedicineDehydration and serum electrolyte changes in south african gold miners with heat disorders
29 Citations1990Stuart Bs Msc Shearer Afom
Hydration and serum electrolyte changes in 55 black underground gold miners who presented with heat disorders were made, and the findings overall were those of dehydration and salt depletion.
Journal of Pain and Symptom ManagementDehydration in dying patients: Study with physicians in French-speaking Switzerland
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It can be concluded that two thirds of the physicians who responded think that artificial hydration is not the best way to respond to dehydration in dying patients, and the choice depends partly on the assessment of the suffering and thirst resulting from terminal dehydration.
PubMedHypodermoclysis in the Care of Older Adults: An old solution for new problems?
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Subcutaneous infusion (hypodermoclysis) is a simple, safe, and effective technique used to administer fluids into the subcutaneous tissues.
PubMed CentralHypodermoclysis in the Care of Older Adults: An old solution for new problems?
9 Citations1992Molloy, D. William, Cunje, Alwin
BMJ"Thirst strike": hypernatraemia and acute prerenal failure in a prisoner who refused to drink.
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This degree of imprecision in determining the rate of growth, at any age, means that in practice the calculation of a single velocity, even over 12 months, is of limited clinical use.