[Dysphagia] Re: Fluid intake

[LOBSTERPAM at aol.com (LOBSTERPAM@aol.com)]

In a message dated 10/1/05 15:49:43, eripley@yahoo.com writes:

<< Clinicians, acute and LTC should be promoting hypodermoclysis for as long 
a period as is required to maintain adequate water volumes.  >>

There is much information available about the benefits of this method of 
hydration for patients who cannot take sufficient water orally  - see below for 
two abstracts easily found on Medline.  My question has to do more with U.S. 
medical practice.  I have worked in health care settings (acute and SNF) in the 
U.S. for 18 years (admittedly only per diem the last few), and I have never 
seen the method used in any facility where I worked.  I would be interested in 
knowing if anyone on the list in the U.S. knows of its use in their facilities.

Barua P, Bhowmick BK. Hypodermoclysis--a victim of historical prejudice. Age 
Ageing. 2005 May;34(3):215-7.

Hypodermoclysis (HDC) had fallen into disrepute after adverse clinical 
incidents that were obviously the result of improper use of an ingenious technique. 
HDC has clear advantages over alternative parenteral routes. It has stood the 
rigour of scientific scrutiny but failed to regain its past glory. This is 
possibly because of our ignorance and inability to detach ourselves from an 
age-old prejudice. This is an attempt to demystify some of the myths that surround 
it. The hope is that older people are not denied an element of health care 
that they are perhaps most well suited to.

Arinzon Z, Feldman J, Fidelman Z, Gepstein R, Berner YN Hypodermoclysis 
(subcutaneous infusion) effective mode of treatment of dehydration in long-term 
care patients. Arch Gerontol Geriatr. 2004 Mar-Apr;38(2):167-73.

Dehydration is associated with morbidity and mortality in frail elderly 
patients. Intravenous fluid administration in these patients is sometimes hard, 
especially in agitated patients. The purpose of this study was to review of 57 
long-termed care patients received hypodermoclysis infusion on 118 different 
occasions during the 9 months. Data collection included: demographic data, 
functional and mental status, indication hypodermoclysis, duration of the infusion, 
type of solution, laboratory data, adverse effects, and outcome. The main 
reasons for initiation of the hypodermoclysis were either dehydration (64%) or 
febrile illness (21%). The average duration of infusions was 15.9 days and 
average daily volume was 1161 ml per day. After hydration by hypodermoclysis, in 77% 
of the patients, clinical improvement occurred manifested as general 
improvement (88%), cognitive status improvement (84%), and improved oral intake (81%). 
During the course of the study, failure of the treatment was observed in 12% 
of the patients, mortality of 11% was observed. Nobody developed signs of 
fluid overload. Local complications were reported in 12% of patients: local 
swelling (6/57), complain of local pain at site (3/57) and local inflammation 
(2/57). Hypodermoclysis is a safe, effective and suitable alternative to intravenous 
re-hydration in long-term care patients.

Pam Smith