title: Effects of parenteral hydration in terminally ill cancer patients: a preliminary study.
abstract: OBJECTIVE
  Most patients with cancer develop decreased oral intake and dehydration before death. This study aimed to determine the effect of parenteral hydration on overall symptom control in terminally ill cancer patients with dehydration.
  
  
  METHODS
  Patients with clinical evidence of mild to moderate dehydration and a liquid oral intake less than 1,000 mL/day were randomly assigned to receive either parenteral hydration with 1,000 mL (treatment group) or placebo with 100 mL normal saline administered over 4 hours for 2 days. Patients were evaluated for target symptoms (hallucinations, myoclonus, fatigue, and sedation), global well-being, and overall benefit.
  
  
  RESULTS
  Twenty-seven patients randomly assigned to the treatment group had improvement in 53 (73%) of their 73 target symptoms versus 33 (49%) of 67 target symptoms in the placebo group (n=22; P = .005). Fifteen (83%) of 18 and 15 (83%) of 18 patients had improved myoclonus and sedation after hydration versus eight (47%) of 17 and five (33%) of 15 patients after placebo (P = .035 and P = .005, respectively). There were no significant differences of improvement in hallucinations or fatigue between groups. When blinded to treatment, patients (17 [63%] of 77) and investigators (20 [74%] of 27) perceived hydration as effective compared with placebo in nine (41%) of 22 patients (P = .78) and 12 (54%) of 22 investigators (P = .15), respectively. The intensity of pain and swelling at the injection site were not significantly different between groups.
  
  
  CONCLUSIONS
  Parenteral hydration decreased symptoms of dehydration in terminally ill cancer patients who had decreased fluid intake. Hydration was well tolerated, and a placebo effect was observed. Studies with larger samples and a longer follow-up period are justified.
authors.affiliation: Department of Palliative Care and Rehabilitation Medicine, Unit 8, The University of Texas M.D. Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030, USA. ebruera@mdanderson.org
authors.forename: Eduardo
authors.initials: E
authors.lastname: Bruera
authors.forename: Raul
authors.initials: R
authors.lastname: Sala
authors.forename: Maria Antonieta
authors.initials: MA
authors.lastname: Rico
authors.forename: Jairo
authors.initials: J
authors.lastname: Moyano
authors.forename: Carlos
authors.initials: C
authors.lastname: Centeno
authors.forename: Jie
authors.initials: J
authors.lastname: Willey
authors.forename: J Lynn
authors.initials: JL
authors.lastname: Palmer
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003681:Dehydration / Q000628:therapy*; D004311:Double-Blind Method; D005221:Fatigue; D005260:Female; D005440:Fluid Therapy; D006212:Hallucinations; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications; D010288:Parenteral Nutrition; D010919:Placebos; D011788:Quality of Life; D012720:Severity of Illness Index; D012965:Sodium Chloride; D013727:Terminal Care
chemical_list: D010919:Placebos; D012965:Sodium Chloride