[Dysphagia] thickened liquids

[smhjr at surfbest.net (smhjr@surfbest.net)]

Speaking to the results of the first article. Patients drink more of
the pre-thickened vs the powder thickened because they taste better.
It takes 50% less thickening agent to create a pre-thickened juice
(the manufacturing process allows you to achieve the same results
with much less thickening agent). 

So our patients want the things to taste good just like we do. I
always require my students to taste all altered liquids so they
realize what they are requiring their subjects to drink. If you
wouldn't drink the stuff why would your patients?

---- Original Message ----
From: eripley@yahoo.com
To: Plbanick@aol.com, dysphagia@b9.com
Subject: Re: [Dysphagia] thickened liquids
Date: Tue, 25 Jan 2005 06:15:59 -0800 (PST)

>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 li!
> terature. 
>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
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>
>Dr I Campbell-Taylor
>Clinical Neuroscientist
>Exclusive Distributor:
>www.interactivetherapy.com
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