When to give fluids and when not to

TW- Discussion of drowning. discussion and description of the dying process

Intention- To raise awareness of the bodies natural dying process, to alleviate concerns around dehydration at the end of life and to aid in ensuring the dying person can have a peaceful, comfortable transition.

Dying can look scary to those who have never witnessed death before. Especially the active dying phase (the weeks, days and hours before death where the body is actively shutting down). There are many things that a dying body might go through which appears to be uncomfortable to witnesses and can even cause distress to the witness. Here, I hope to bring some sense of comfort around what natural dying looks like.

Let’s begin by talking about some of the things that one might witness when a family, patient or loved one is in the active dying phase. During the active dying phase, one might see a wide, gaping mouth, dry mouth and lips, Cheyne stokes breathing or other abnormal breathing, changes in heart rate, temperature and blood pressure,  a lack of or complete loss of consciousness and some grabbing at the air. These are all very normal things to see in someone who is actively dying and do not indicate any kind of discomfort or distress.

If a person in their end of life is awake and requesting food or fluids, you absolutely SHOULD provide these things to the person. My personal opinion is, at that stage, they should have anything they ask for. What I am going to discuss next exclusively applies to people who are in the “active dying” stage. That means, they are no longer fully conscious, they are unable to receive food or fluid by mouth and their body is actively shutting down and going through the dying process.

At this stage of the process, the dying person should be or appear to be dehydrated. I know this sounds counter-intuitive but we must trust that the body knows how to survive birth and it knows how to die. We should not interfere with the bodies natural process at this stage. There is a reason the person is no longer able or willing to take fluids by mouth. The body is saying no thank you.

What happens if we give IV fluids? If we provide IV fluids at this stage, those fluids will not remain intravascular. The heart is no longer capable of pumping that extra fluid around. What happens is that the fluid given via IV seeps out into what is called “third spacing”. This causes oedema (swelling). This swelling usually starts in the legs and, like a flooded field, will continue to back up until it reaches the lungs. At this point, the person enters respiratory distress. Essentially, over time, IV fluids will do nothing for an actively dying person other than cause them to drown.

A dry dying body is a comfortable dying body. When an actively dying person becomes dry or dehydrated, their body will enter ketosis. Outside of popular diet trends, ketosis is beneficial for the dying body for a number of reasons.

  • Ketosis dulls nerve pain and, for obvious reasons, this is desirable for an actively dying person.
  • Ketosis suppresses hunger. The actively dying body is no longer able to digest food, so a dying person will become “nil by mouth” in the actively dying phase. Due to this, it’s clear to understand the benefits of no longer feeling hungry.
  • Ketosis can also elevate feelings of euphoria. Enabling the dying person to transition with peace and comfort.

What should we be doing as caregivers at this end stage? We absolutely can apply lip balm or Vaseline to the lip area to prevent cracking. If someone is alert and asking for a sip of water, we absolutely can give this, but unless they ask for it, we shouldn’t give it. If a dying person is alert and complaining of a dry mouth but not asking for a drink (or is unable to swallow), we can use a damp (not wet) mouth swab to apply some relief.

Other than that, our job is bedside vigil and simply bearing witness to this very sacred right of passage.

Simply be there to walk the person home at the end of their life journey.

Below is a link to a video from “Hospice Nurse Julie”, an experienced ICU RN tuned Hospice nurse. She has channels on several social media outlets where she provides lots of education around the death and dying process.

https://fb.watch/k7bCs5BHhf/

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