[Dysphagia] Hypodermoclysis

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

  I am on record since 1987 (JAGS) as opposing the notion of enteral feeding in the chronically ill elderly. I am also on record as opposing the use of thickeners since they contribute not only to dehydration but also malnutrition. The article you cite has been presented many times in this forum. As to its disadvantages, the abstract reads, in part:
  ?Hypodermoclysis, the subcutaneous infusion of fluids, is a useful and easy hydration technique suitable for mildly to moderately dehydrated adult patients, especially the elderly. The method is considered safe and does not pose any serious complications. The most frequent adverse effect is mild subcutaneous edema that can be treated by local massage or systemic diuretics. Approximately 3 L can be given in a 24-hour period at two separate sites.?
  The disadvantages, as it goes on to describe, are minor. It is not useful for the acutely, severely dehydrated person but that?s not the patient we are discussing.  The typical NH patient is chronically, moderately and sometimes severely dehydrated due to a reduction of thirst, lack of provision of water, or inability to drink with comfort. This is the condition from admission and usually only gets worse. Of course, if they can and will drink water, they should. This, unfortunately, can be difficult to attain for a variety of reasons.
  I can only assume that you have never used ?clysis. Do I call this quality of life? I certainly do when it allows an older person to stay at home rather than go into a nursing home. I do when we can hydrate a patient by infusing adequate fluid overnight 2 or 3 times a week and the patient doesn?t even know it?s there. I do when it allows us to discharge an older person to home with a home carer providing the ?clysis ? or, sometimes the patient herself as the article describes. It is used in the community in many countries and has been for decades. Perhaps greater experience with it will deal with the extraordinary opposition to its use and misunderstanding of its application.


Dr I Campbell-Taylor
Clinical Neuroscientist
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