ABSTRACT
The controversial topic of dehydration and rehydration of palliative care patients is complicated and has many different aspects to consider. Regardless of the setting and circumstances, the common ground in the discussion is the desire to keep patients as comfortable as possible and avoid futile management and procedures. Differences of opinion start to emerge when considering what may be futile in the provision of hydration at the end of life. A central concern is that fluid deficit could be a reversible component of agitated delirium, which may be missed if we focus exclusively on sedative pharmacological solutions to this common and distressing symptom. Hypodermoclysis is a well-documented and safe method for parenteral hydration and can be easily administered with minimal side effects. We need to consider the following: if palliative care patients are not provided with parenteral hydration, medications such as opioids should be gradually decreased to avoid accumulation and problematic and unnecessary side effects; and the individual circumstances, anticipated prognosis and trajectory of the patient's illness in evaluating the potential benefits of parenteral hydration in end-of-life care.
