[Dysphagia] Re: Fluid intake

[hillivie423 at adelphia.net (hillivie423@adelphia.net)]

 I have asked the same question of nursing homes and residential facilities for people who have severe to profound mental retardation.  No one has seen it used recently, but a few "old timers" report knowing about its use elsewhere.
---- LOBSTERPAM@aol.com wrote: 
> 
> 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
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