Overfeeding, overhydration, elderly patients & the LCP – Clinical Medicine article

Article published in the Royal College of Physicians journal Clinical Medicine 2013;13(3):248-251

Overfeeding and overhydration in elderly medical patients – Lessons from the Liverpool Care Pathway.

Eleni Tsiompanou; Caroline Lucas; Mike Stroud

‘If a convalescent while taking nourishment remains weak, it is a sign that the body is being overnourished’ Hippocratic Aphorism – 4th century BC

Abstract 

This paper describes three elderly patients who were admitted to hospital with aspiration pneumonia. They were kept nil by mouth (NBM) for a number of days, while being given intravenous hydration initially and enteral feeding subsequently. During that time they deteriorated and appeared to be dying, so the Liverpool Care Pathway (LCP) for the dying was used to support their care. Artificial nutrition and hydration were stopped. They quickly improved and the LCP was discontinued. Two of the patients deteriorated again on reintroduction of enteral feeding and/or intravenous fluids, only to improve a second time following withdrawal of feeding and fluids. Vulnerable elderly patients should not be made NBM except as a last resort. Clinicians should be alert to the possibility of refeeding syndrome and overhydration as reversible causes of clinical deterioration, particularly in frail elderly patients. Use of the LCP in these patients provided a unique opportunity to witness the positive effects of withdrawal of excessive artificial nutrition and hydration.

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5 thoughts on “Overfeeding, overhydration, elderly patients & the LCP – Clinical Medicine article

  1. Can you not withdraw a patient’s fluids without ‘diagnosing dying’ ? Perhaps they were given inappropriate iv fluids from admission onwards…the lack of clinical depth here does little to suggest placing a vulnerable patient on a terminal pathway can substitute for competent clinical care.

  2. Thank heavens NICE have just issued a draft consultation document on i.v. fluid therapy in adult patients….PLEASE READ IT…the number of avoidable deaths caused by administering the wrong fluids is unacceptable…as is ‘diagnosing imminent death’ because they haven’t been assessed competently in the first place….http://www.nice.org.uk/nicemedia/live/13298/63881/63881.pdf

    • Thank you for your valuable comments.
      Please have a look at my reply on the 24th of July in the BMJ (British Medical Journal) online, where I also mention the NICE guidelines on fluids http://bit.ly/134SV6h

  3. And what of the trauma to the patient and relatives, being told they are ‘imminently dying’ when in fact, they are merely over-hydrated- doesn’t sound like a particularly strenuous MDT was held. Personally, my favourite Hippocratic aphorism is ‘first do no harm’…

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