Most patients reduce their fluid intake or stop drinking before they die.
This distresses the family and it is necessary to explain to the caregivers that this is an expected event and suggest alternate ways for them to give care.
If the patient is still taking some fluids but not eating, salt-containing fluids, such as soups, soda water, sports drinks and red vegetable juices can facilitate rehydration, and help maintain electrolyte balance.
When the patient stops taking fluids, it is necessary to explain to the family that patients with peripheral edema or ascites have excess body water and salt and are not dehydrated.
The most frequent symptoms that dehydrated patients complain of are thirst, dry mouth and fatigue.
The best treatment for these symptoms is frequent and good oral care, ice chips and swabs with water.
Parenteral fluids have not been shown to lengthen life. Parenteral fluids may even shorten life. It may worsen edema and ascites, and increase gastrointestinal and respiratory secretions which may result in breathlessness, pain, nausea and vomiting and increased urination that requires catheter placement.
Ferris FD, Danilychev M, Chapter 23, Last Hours of Living, In: Emanuel LL, Librach SL; Palliative Care – Core Skills and Clinical Competencies; Second Edition, St.Louis, Missouri, Elsevier, 2011, pp. 319 -342.