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Palliative care - fluid, food, and digestion

Constipation - palliative care; End of life - digestion; Hospice - digestion

People who have a very serious illness or who are dying often don't feel like eating. Body systems that manage fluids and food may change at this time. They can slow and fail. Also, medicine that treats pain can cause dry, hard stools that are difficult to pass.

Palliative Care

Palliative care is a holistic approach to care that focuses on treating pain and symptoms and improving quality of life in people with serious illnesses and a limited life span.

When Your Body has Problems Handling Fluids and Food

A person who is very sick or dying may experience:

  • Loss of appetite
  • Trouble chewing, caused by mouth or tooth pain, mouth sores, or a stiff or painful jaw
  • Constipation, which is fewer bowel movements than usual or hard stools
  • Nausea or vomiting

What you can do to Feel Better

These tips may help relieve discomfort due to loss of appetite or problems eating and drinking.

Fluids:

  • Sip water at least every 2 hours while awake.
  • Fluids can be given by mouth, through a feeding tube, an IV (a tube that goes into a vein), or through a needle that goes under the skin (subcutaneous).
  • Keep the mouth moist with ice chips, a sponge, or oral swabs made for this purpose.
  • Talk to someone on the health care team about what happens if there is too much or too little fluid in the body. Decide together whether the person needs more fluids than they are taking in.

Food:

  • Cut food into small pieces.
  • Blend or mash foods so they don't need to be chewed much.
  • Offer food that is soft and smooth, like soup, yogurt, applesauce, or pudding.
  • Offer shakes or smoothies.
  • For nausea, try dry, salty foods and clear liquids.

Digestion:

  • If needed, write down the times the person has bowel movements.
  • Sip water or juice at least every 2 hours while awake.
  • Eat fruit, such as prunes.
  • If possible, walk more.
  • Talk to someone on the health care team about stool softeners or laxatives.

When to Call the Doctor

Call a member of the health care team if nausea, constipation, or pain cannot be managed.

References

Amano K, Baracos VE, Hopkinson JB. Integration of palliative, supportive, and nutritional care to alleviate eating-related distress among advanced cancer patients with cachexia and their family members. Crit Rev Oncol Hematol. 2019;143:117-123. PMID: 31563078 pubmed.ncbi.nlm.nih.gov/31563078/.

Gebauer S. Palliative care. In: Pardo MC, Miller RD, eds. Basics of Anesthesia. 7th ed. Philadelphia, PA: Elsevier; 2018:chap 49.

Rakel RE, Trinh TH. Care of the dying patient. In: Rakel RE, Rakel DP, eds. Textbook of Family Medicine. 9th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 5.

Review Date: 1/12/2020

Reviewed By: David C. Dugdale, III, MD, Professor of Medicine, Division of General Medicine, Department of Medicine, University of Washington School of Medicine, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

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