title: Association between parenteral fluids and symptoms in hospital end-of-life care: an observational study of 280 patients.
abstract: OBJECTIVE
  To investigate whether dying patients receiving parenteral fluids (PF) suffer from more or less symptoms than patients who do not receive PF. Today's evidence on how PF affects palliative patients' symptoms is very scarce. Nevertheless, 40% of the patients who die expectedly in Swedish hospitals receive PF during their last 24 h of life.
  
  
  METHODS
  A historical cohort study of medical records was performed. Of the 530 patients who were reported to have died expectedly at hospital in Västerbotten county (Sweden) between 1 January 2011 and 30 June 2012, 140 cases who had received PF and 140 controls who had not received PF were identified by stratified randomisation and matched by age, sex and main disease. The groups were compared regarding documented presence of dyspnoea, respiratory secretions, anxiety, nausea and confusion during the last 24 h and the last week of life.
  
  
  RESULTS
  The prevalence of documented dyspnoea in the PF groups was higher than in the non-PF groups (51% vs 22% last 24 h, p<0.0001; 70% vs 45% last 7 days, p<0.001). The proportions of patients suffering from dyspnoea increased with larger administered volume. Although our main hypothesis--that the prevalence of respiratory secretions would be higher in the PF group--was not confirmed, we found a tendency in that direction (63% vs 50% last week, p=0.072). No clinically significant differences in anxiety, nausea or confusion were found.
  
  
  CONCLUSIONS
  There is an association between PF administration and increased frequency of documented dyspnoea for terminally ill patients in their last week of life.
authors.affiliation: Department of Radiation Sciences, Umeå University, Umeå, Sweden.
authors.forename: Anna
authors.initials: A
authors.lastname: Fritzson
authors.affiliation: Department of Radiation Sciences, Umeå University, Umeå, Sweden.
authors.forename: Björn
authors.initials: B
authors.lastname: Tavelin
authors.affiliation: Department of Radiation Sciences, Unit of Clinical Research Center-Östersund, Umeå University, Umeå, Sweden.
authors.forename: Bertil
authors.initials: B
authors.lastname: Axelsson
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D004417:Dyspnea / Q000453:epidemiology; D005260:Female; D006761:Hospitals; D006801:Humans; D007263:Infusions, Parenteral / Q000009:adverse effects*; D008297:Male; D013727:Terminal Care
keywords: Fluid Therapy; Nutrition Therapy; Palliative Care; Symptom