[Dysphagia] thickened liquids

[eripley at yahoo.com (Irene Campbell-Taylor)]

Increasingly, physicians are realizing that thickened liquids tend to produce not only dehydration but malnutririon as the recent literature indicates. It is not possible to get enough water on thickened liquids without compromising other intake.  Also, there is NO evidence whatever that thickeners achieve any positive result. Hydration requires adequate intake of water, nit just any fluid : See

ASHA SID 13 Newsletter, Perspectives on Swallowing and Swallowing Disorders, 11(2): 16-19, 2002

Defining Physical Properties of Fluids for Dysphagia Evaluation and Treatment JoAnne Robbins; Wm. S. Middleton ;Mark Nicosia;Jacqueline A. Hind; Gary D. Gill; Roberto Blanco, EZ-EM, Inc;Jed Logemann, Northwestern University.

 
Thickening liquids has been and continues to be one of the most frequently used compensatory interventions in hospitals and long term care facilities, the latter because liquid aspiration is most common in elderly patients (Feinberg, Knebl, Tully, Segall, 1990; La Croix, Lipson, Miles, White, 1989). Nonetheless, there are little (sic) extant data that convincingly demonstrate that drinking thickened liquids has a significant positive effect on health outcomes such as pneumonia, hydration, nutrition, or quality of life. Bolus flow outcomes have long served as surrogate indicators of health outcomes. They include direction (aspiration or penetration), duration (transit times), and clearance (residue). The generally accepted clinical notion that manipulation of thicker (more viscous) substances reduces occurrence of aspiration, or modifies other bolus flow characteristics in dysphagic persons that produce an "improved swallow", has little support other than anecdotal, in the literature. 
And
Whelan K. Inadequate fluid intakes in dysphagic acute stroke. Clin Nutr 2001 Oct;20(5):423-8  Patients not on specialist stroke units who received pre-thickened fluids drank almost 100% more than those on powder-thickened fluids (Note: This was still only approximately 900ml fluid/day.Fluid intakes in this patient group are insufficient to achieve requirements. Hospital staff must ensure adequate fluid intakes in patients at risk of dehydration, which should include both an adequate prescription and provision of supplementary fluids

Finestone HM, Foley NC, Woodbury MG, Greene-Finestone L.. Quantifying fluid intake in dysphagic stroke patients: a preliminary comparison of oral and nonoral strategies. Arch Phys Med Rehabil 82:1744-6. 2001. 
The authors examined thirteen dysphagic patients with acute strokes for 21 days postadmission. Seven patients (group 1) were started on enteral feeding and later progressed to oral diets and 6 patients (group 2) received oral dysphagia diets.  Fluid intake of patients in group 1 significantly declined over the 21 days . Mean fluid intake of patients in group 2 was  approximately 33% of requirements. This volume was significantly lower than the fluid intake of patients who received nonoral feeding. The patients who received thickened-fluid dysphagia diets failed to meet their fluid requirements whereas patients on enteral feeding and intravenous fluid regimens received sufficient fluid. It is not clear how much the intravenous fluid contributed to the overall fluid intake and whether or not fluid intake would have been sufficient without it.

 
This practice requires significant reconsideration, at best.
What is the general consensus out there: Do thickened liquids provide as 
much hydration as regular thin liquids? I work with a doctor who feels that 
anyone on thickened liquids is at risk for dehydration (even if they take adequate 
amounts).
Thank you, Patti Banick, SLP
Maryland
_______________________________________________
Dysphagia mailing list
Dysphagia@b9.com
http://lists.b9.com/mailman/listinfo/dysphagia


Dr I Campbell-Taylor
Clinical Neuroscientist
Exclusive Distributor:
www.interactivetherapy.com