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Hypodermoclysis: A Cure for Moderate Dehydration



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Am Fam Physician. 1999 May 1;59(9):2617-2620.

The technique of hypodermoclysis, or subcutaneous infusion, was largely abandoned in the 1950s, mainly because complications such as pain, sepsis and shock were often linked to practical errors. Ferry and associates review the advantages and disadvantages of this technique and offer practical guidelines for its use in older patients.

Hypodermoclysis is a simple procedure that may be used in cases of mild or moderate dehydration. It may also be used for the infusion of an amino acid solution for the short-term prevention of malnutrition. Studies have shown that fluids administered subcutaneously are well absorbed; in fact, they are absorbed as well as fluids that are given intravenously. Another advantage of hypodermoclysis is that regulations governing intravenous (IV) line use in a long-term care facility do not pertain to the use of hypodermoclysis. Septicemia and thrombosis are avoided with hypodermoclysis, and the risk of hypervolemia is lower when compared with IV therapy. The patient also has more freedom of movement because of the recommended infusion sites (see accompanying table on page 2620).

Indications and Contraindications of Hypodermoclysis

Indications

Infusion of saline/glucosaline solutions to prevent or to treat mild dehydration

Inadequate oral fluid intake because of age-related reduced thirst with fever and anorexia

Difficulty in swallowing fluids

Uncooperative, agitated, confused or demented patients

Transient or mild hyperthermia

Fluid loss higher than normal because of diarrhea, vomiting or diuretic treatment

Dependence, difficulty with access to fluids and foods

Impossibility of increasing oral fluid intake or instigating tube feeding

Peripheral veins difficult to puncture

Infusion of amino acid solution to limit malnutrition

Insufficient short-term food intake

Enteral nutrition undesirable in view of confusion or digestive contraindications, e.g., vomiting or fecal compaction

Enteral or parenteral nutrition technically impossible

Infusion of saline/glucosaline solutions during end-of-life stage

Maintaining ease of contact with family and caregivers by avoiding dehydration-related confusion

Analgesics and anxiolytics infused subcutaneously with fluids

Contraindications

Emergency situations: collapse, shock, severe electrolytic disturbance or major dehydration (serum Na >150 mmol per L, osmolality >300 mmol per kg, BUN/creatinine ratio >25)

Evident hypocoagulation (whether spontaneous or therapeutic)

Severe heart disorders (relative contraindication)


BUN = blood urea nitrogen.

Adapted with permission from Ferry M, Dardaine V, Constans T. Subcutaneous infusion or hypodermoclysis: a practical approach. J Am Geriatr Soc 1999;47:93–5.

Indications and Contraindications of Hypodermoclysis

View Table

Indications and Contraindications of Hypodermoclysis

Indications

Infusion of saline/glucosaline solutions to prevent or to treat mild dehydration

Inadequate oral fluid intake because of age-related reduced thirst with fever and anorexia

Difficulty in swallowing fluids

Uncooperative, agitated, confused or demented patients

Transient or mild hyperthermia

Fluid loss higher than normal because of diarrhea, vomiting or diuretic treatment

Dependence, difficulty with access to fluids and foods

Impossibility of increasing oral fluid intake or instigating tube feeding

Peripheral veins difficult to puncture

Infusion of amino acid solution to limit malnutrition

Insufficient short-term food intake

Enteral nutrition undesirable in view of confusion or digestive contraindications, e.g., vomiting or fecal compaction

Enteral or parenteral nutrition technically impossible

Infusion of saline/glucosaline solutions during end-of-life stage

Maintaining ease of contact with family and caregivers by avoiding dehydration-related confusion

Analgesics and anxiolytics infused subcutaneously with fluids

Contraindications

Emergency situations: collapse, shock, severe electrolytic disturbance or major dehydration (serum Na >150 mmol per L, osmolality >300 mmol per kg, BUN/creatinine ratio >25)

Evident hypocoagulation (whether spontaneous or therapeutic)

Severe heart disorders (relative contraindication)


BUN = blood urea nitrogen.

Adapted with permission from Ferry M, Dardaine V, Constans T. Subcutaneous infusion or hypodermoclysis: a practical approach. J Am Geriatr Soc 1999;47:93–5.

The disadvantages of this therapy are that no more than 1.5 L of fluid may be administered at a single perfusion site, and there is a brief delay before the fluid reaches the intravascular space. One side effect that was reported occasionally several decades ago was vascular collapse, related to the infusion of large quantities of solutions without electrolytes. This effect is prevented by adding 2 to 4 g of sodium chloride to the glucose solution (either 2.5 percent or 5 percent). Another possible solution is isotonic saline (sodium chloride, 0.9 percent). Potassium is not essential but may be added to either of these solutions.

Hypodermoclysis is accomplished with the use of a 21- to 25-gauge butterfly needle attached to the fluid via a single tube with a flow visualization chamber. After strict local asepsis, the needle is introduced at a 45-degree angle into the tissue beneath the skin of the thigh (anterior, lateral or medial aspect), the abdominal wall, the subclavicular regions of the thorax or the back (interor subscapular areas). The fluid may be infused as fast as 125 mL per hour (for up to eight hours) or even up to 250 mL per hour (for up to four hours). The infusion site must be changed after administration of 1.5 L of fluid. Although infusion of an amino acid solution may be effective when nutritional status must be supported, this technique does not replace tube feedings or parenteral nutrition regimens.

The authors conclude that hypodermoclysis is a simple and effective method of treating mild to moderate dehydration in elderly patients. Since hospitalization may be avoided with the use of this technique, the patient may also benefit psychologically and financially.

Ferry M, et al. Subcutaneous infusion or hypodermoclysis: a practical approach. J Am Geriatr Soc. January 1999;47:93–5.



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