Chapter 3: Symptoms and health concerns
Dehydration – What can help
I remember our mom wanting her favourite Chapstick whenever she was awake but not wanting anything else. When the nurse told us that was normal, I think we all felt a sense of relief. The nurse gave us some swabs for Mom’s mouth, and I think we felt better doing something for her.
What the healthcare provider can do
Certain physical clues, such as a dry mouth, can help determine if dehydration is present and how severe it is. Since dry mouth can be caused by many different problems, the healthcare provider may do a physical exam. This might help figure out the cause and help them make decisions about what other tests may be needed.
Blood tests can confirm dehydration and tell the healthcare provider how severe it is. Other tests may be considered, depending on what is suspected.
The healthcare provider may consider several different options:
Helping the person you are caring for take fluids by mouth
Oral rehydration can be effective if fluids can be swallowed and “kept down.” Giving frequent sips of water or a commercial preparation can help maintain hydration.
Fluids can be given through a vein. This is most commonly provided in hospitals if the oral route cannot be used. This option may or may not be available in other places, for example, at home, in a hospice, or personal care home.
Under the skin (subcutaneous)
Using small needles placed under the skin known as subcutaneous tissue. Fluids are absorbed into the rest of the body. This method is called hypodermoclysis. This method can be useful when intravenous infusions cannot be provided and may be more readily available in settings outside of the hospital.
Continue care when fluids are not given
Healthcare providers have noted that people can be very comfortable even if they drink very little fluid. If they experience a dry mouth or the occasional feeling of thirst, this can be managed with small sips of fluid, ice chips, and regular mouth care.
What families can do
Family members are sometimes asked about if they want to keep providing fluids to a person who is dying. This decision can be more difficult if there is no healthcare directive and if the wishes of the patient are unknown.
Click on each suggestion below to read more about giving fluids.
- Offer fluids they enjoy such as juices, flavoured water, Jell-O, Popsicles, or ice chips. Avoid juices high in acid, such as orange juice, as they may irritate the mouth.
- Offer small, frequent sips of fluid rather than a whole cup at once.
- Offer a straw for drinking. A straw may help decrease choking as smaller amounts can be taken.
- Consult with a healthcare provider about thickened fluids as this may help with swallowing.
- What will happen with and without fluids being given?
- What can be done to ensure comfort and relief of the feeling of thirst, no matter which choice is made?
- How complicated and burdensome will it be to treat dehydration? For example, would a transfer from home to hospital be required?
- Will giving fluids will help the problem at hand or achieve the goals of care?
- If you had a note from the person in your pocket directing the decision, what do you think it might say?
- When someone is too weak to swallow, provide mouth care to keep their mouth moist and comfortable.
- Mouth care should be done at least three to four times a day, or even every hour or two if the mouth is very dry. People taking medication under the tongue should have their mouths moistened frequently to help the medication absorb.
Avoid giving fluids to people who are not able to swallow safely.
Avoid forcing someone to drink fluids.