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Chanthong P, Siriwattanakul S, Srion C. Comparison of feasibility between hypodermoclysis and intravenous hydration among palliative care patients in Thailand. Int J Palliat Nurs 2022; 28:308-312. [PMID: 35861446 DOI: 10.12968/ijpn.2022.28.7.308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Hypodermoclysis is a method of subcutaneous fluid administration. It has been used to treat palliative patients safely and effectively. However, the use of subcutaneous hydration is often overlooked. AIM This study aimed to compare the feasibility, pain experience and acceptability between subcutaneous and intravenous hydration in a hospital setting. METHODS A prospective, randomised clinical trial was conducted. Patients requiring fluid administration were randomly allocated an intravenous or subcutaneous route. Patients' pain score, satisfaction and acceptance levels were collected. The difficulty score of the needle insertion and acceptance scores from nurses were recorded. FINDINGS A total of 26 patients were enrolled. The difficulty scores and patients' pain scores were significantly lower in the subcutaneous group. The satisfaction and acceptance levels of the patients and nurses were similar in both groups. No systemic side-effects were found in either group. CONCLUSION Hypodermoclysis was acceptable and satisfying to patients and nurses. It was less painful than the intravenous route.
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Affiliation(s)
- Pratamaporn Chanthong
- Palliative Physician, Siriraj Palliative Care Center, Faculty of Medicine Siriraj Hospital, Thailand
| | - Suphawan Siriwattanakul
- Medicine Physician and Rheumatologist, Golden Jubilee Medical Center, Mahidol University, Thailand
| | - Chawalee Srion
- Clinical Nurse Manager, Golden Jubilee Medical Center, Mahidol University, Thailand
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Danielsen MB, Andersen S, Worthington E, Jorgensen MG. Harms and Benefits of Subcutaneous Hydration in Older Patients: Systematic Review and Meta-Analysis. J Am Geriatr Soc 2020; 68:2937-2946. [PMID: 33411351 DOI: 10.1111/jgs.16707] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 05/28/2020] [Accepted: 06/16/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To review all available original publications on the harms and benefits of subcutaneous (SC) hydration in older patients. DESIGN Systematic review and meta-analysis. PARTICIPANTS All studies on SC hydration in older patients without restrictions on design or language. MEASUREMENTS The Medline, Embase, CINAHL, Cochrane Central Register of Controlled Trials, and Web of Science databases and trial registries were searched from inception to November 5, 2019, and two reviewers independently extracted the data and assessed the risk of bias of individual outcomes. RESULTS Thirty-one publications from 29 studies met the eligibility criteria. The data from six randomized controlled trials were used for the meta-analyses. The subgroup analysis including only the studies with the lowest risk of bias showed that SC hydration was associated with fewer adverse effects than intravenous (IV) hydration (risk ratio (RR) = 0.69; 95% confidence interval (CI) = 0.53-0.88; P = .003; n = 4; I2 = 0.0%; 545 infusions in each group). In absolute numbers, patients treated with SC hydration had an incidence rate of 90 adverse effects per 1,000 infusions versus 130 adverse effects per 1,000 infusions (95% CI = 102-169) with IV hydration. Secondary outcomes comparing IV with SC hydration showed that SC was 3.2 minutes faster to set up and markedly reduced the risk of agitation (RR = 0.42; 95% CI = 0.22-0.79; P = .007; I2 = 65%; n = 3); however, SC hydration delivered a lower volume of fluid and was less efficient at reducing serum osmolality (s-osmolality). CONCLUSIONS SC hydration is safer than IV hydration and potentially reduces the risk of agitation, but it is less effective. SC hydration should be available as an alternative to IV hydration when treating older patients for mild-to-moderate dehydration. More high-quality studies are needed in the field to increase the confidence in the estimates.
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Affiliation(s)
- Mathias Brix Danielsen
- Department of Geriatric Medicine, Aalborg University Hospital, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Stig Andersen
- Department of Geriatric Medicine, Aalborg University Hospital, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Elisa Worthington
- Department of Emergency Medicine, Aalborg University Hospital, Aalborg, Denmark
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Makowsky MJ, Bell P, Gramlich L. Subcutaneous Magnesium Sulfate to Correct High-Output Ileostomy-Induced Hypomagnesemia. Case Rep Gastroenterol 2019; 13:280-293. [PMID: 31341460 PMCID: PMC6639584 DOI: 10.1159/000501121] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Accepted: 05/18/2019] [Indexed: 12/30/2022] Open
Abstract
Fluid and magnesium abnormalities are common in patients with high-output stomas. Subcutaneous magnesium administration may be more feasible for long-term management in ambulatory patients, but magnesium sulfate is approved only for intravenous or intramuscular injection. We describe the management of chronic hypomagnesemia and dehydration secondary to a high-output ileostomy following radiation and chemotherapy for anal squamous cell carcinoma with intermittent home-based subcutaneous magnesium infusions in a 61-year-old female with a history of Crohn's disease and multiple bowel resections. Despite aggressive management with intravenous magnesium sulfate and oral magnesium glucoheptonate over 8 months, 49% of her magnesium concentrations were <0.60 mmol/L (mean 0.61 ± 0.09) necessitating 4 emergency, 1 hospital, and 4 infusion clinic visits. After initiation of subcutaneous magnesium sulfate, all magnesium concentrations were >0.60 mmol/L (mean 0.79 ± 0.08 mmol/L over 9 months). The patient tolerated the infusions well, only developing one minor episode of infusion-related cellulitis. A systematic review of the literature identified 14 reports where subcutaneous magnesium sulfatewas effective and treatment for adults or children with hypomagnesemia was safe. Home-based intermittent administration of subcutaneous magnesium may be a helpful and safe intervention to temporarily prevent and treat select patients with recurrent symptomatic hypomagnesemia.
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Affiliation(s)
- Mark J. Makowsky
- Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta, Edmonton, Alberta, Canada
- Department of Family Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Peter Bell
- Department of Family Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Leah Gramlich
- Division of Gastroenterology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
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Caccialanza R, Constans T, Cotogni P, Zaloga GP, Pontes-Arruda A. Subcutaneous Infusion of Fluids for Hydration or Nutrition: A Review. JPEN J Parenter Enteral Nutr 2018; 42:296-307. [PMID: 29443395 DOI: 10.1177/0148607116676593] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Accepted: 10/04/2016] [Indexed: 11/17/2022]
Abstract
Subcutaneous infusion, or hypodermoclysis, is a technique whereby fluids are infused into the subcutaneous space via small-gauge needles that are typically inserted into the thighs, abdomen, back, or arms. In this review, we provide an overview of the technique, summarize findings from studies that have examined the use of subcutaneous infusion of fluids for hydration or nutrition, and describe the indications, advantages, and disadvantages of subcutaneous infusion. Taken together, the available evidence suggests that, when indicated, subcutaneous infusion can be effective for administering fluids for hydration or nutrition, with minimal complications, and has similar effectiveness and safety to the intravenous route. Of note, subcutaneous infusion offers several advantages over intravenous infusion, including ease of application, low cost, and the lack of potential serious complications, particularly infections. Subcutaneous infusion may be particularly suited for patients with mild to moderate dehydration or malnutrition when oral/enteral intake is insufficient; when placement of an intravenous catheter is not possible, tolerated, or desirable; at risk of dehydration when oral intake is not tolerated; as a bridging technique in case of difficult intravenous access or catheter-related bloodstream infection while infection control treatment is being attempted; and in multiple settings (eg, emergency department, hospital, outpatient clinic, nursing home, long-term care, hospice, and home).
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Affiliation(s)
- Riccardo Caccialanza
- Servizio di Dietetica e Nutrizione Clinica, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Thierry Constans
- Service de Médecine Gériatrique, Centre Hospitalier Régional Universitaire and Université François Rabelais, Tours, France
| | - Paolo Cotogni
- Anesthesiology and Intensive Care, S. Giovanni Battista Hospital, University of Turin, Turin, Italy
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Fenning SJ, Boyce SR, Wilson P, Stretton F. Subcutaneous magnesium in the advanced cancer setting. BMJ Support Palliat Care 2017. [PMID: 28646082 DOI: 10.1136/bmjspcare-2017-001360] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Hypomagnesaemia can arise from a variety of causes but is particularly prevalent in cancer populations. This case report describes a patient with recurrent symptomatic hypomagnesaemia, on the background of advanced ovarian cancer and a high-output ileostomy, who was successfully managed on a daily continuous subcutaneous infusion of magnesium via a syringe pump. There is limited published information on the subcutaneous administration of magnesium and, to our knowledge, this is the first case to report its routine delivery over 24 hours in a syringe pump. This novel but effective approach for administering magnesium can be delivered in the community and can, therefore, prevent repeated hospital admissions for patients with recurrent symptomatic hypomagnesaemia who would otherwise need intravenous replacement.
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Affiliation(s)
| | | | - Paul Wilson
- Victoria Hospice, Victoria Hospital, Kirkcaldy, UK
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Srebro D, Vučković S, Prostran M. Participation of peripheral TRPV1, TRPV4, TRPA1 and ASIC in a magnesium sulfate-induced local pain model in rat. Neuroscience 2016; 339:1-11. [PMID: 27687800 DOI: 10.1016/j.neuroscience.2016.09.032] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Revised: 08/31/2016] [Accepted: 09/20/2016] [Indexed: 12/22/2022]
Abstract
We previously showed that magnesium sulfate (MS) has systemic antinociceptive and local peripheral pronociceptive effects. The role of transient receptor potential (TRP) channels and acid-sensing ion channels (ASICs) in the mechanism of action of MS has not been investigated in detail. The aim of this study was to explore the participation of TRP channels in the pronociceptive action of MS in rats after its intraplantar injection. The paw withdrawal threshold (PWT) to mechanical stimuli was measured by the electronic von Frey test. Drugs that were tested were either co-administered with an isotonic pH-unadjusted or pH-adjusted solution of MS intraplantarily, or to the contralateral paw to exclude systemic effects. We found that the subcutaneous administration of both pH-adjusted (7.4) and pH-unadjusted (about 6.0) isotonic (6.2% w/v in water) solutions of MS induce the pain at the injection site. The pH-unadjusted MS solution-induced mechanical hyperalgesia decreased in a dose-dependent manner as a consequence of co-injection of capsazepine, a selective TRPV1 antagonist (20, 100 and 500pmol/paw), RN-1734, a selective TRPV4 antagonist (1.55, 3.1 and 6.2μmol/paw), HC-030031, a selective TRPA1 antagonist (5.6, 28.1 and 140nmol/paw), and amiloride hydrochloride, a non-selective ASIC inhibitor (0.83, 2.5 and 7.55μmol/paw). In pH-adjusted MS-induced hyperalgesia, the highest doses of TRPV1, TRPV4 and TRPA1 antagonists displayed effects that were, respectively, either similar, less pronounced or delayed in comparison to the effect induced by administration of the pH-unadjusted MS solution; the ASIC antagonist did not have any effect. These results suggest that the MS-induced local peripheral mechanical hyperalgesia is mediated via modulation of the activity of peripheral TRPV1, TRPV4, TRPA1 and ASICs. Specific local inhibition of TRP channels represents a novel approach to treating local injection-related pain.
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Affiliation(s)
- Dragana Srebro
- Department of Pharmacology, Clinical Pharmacology and Toxicology, Faculty of Medicine, University of Belgrade, Serbia.
| | - Sonja Vučković
- Department of Pharmacology, Clinical Pharmacology and Toxicology, Faculty of Medicine, University of Belgrade, Serbia
| | - Milica Prostran
- Department of Pharmacology, Clinical Pharmacology and Toxicology, Faculty of Medicine, University of Belgrade, Serbia
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Affiliation(s)
- Dileep N Lobo
- Division of Gastrointestinal Surgery, E Floor, West Block, Wolfson Digestive Diseases Centre, Nottingham University Hospitals, Queen's Medical Centre, Nottingham, NG7 2UH, UK.
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Sanda S, Schlingmann KP, Newfield RS. Autosomal dominant hypoparathyroidism with severe hypomagnesemia and hypocalcemia, successfully treated with recombinant PTH and continuous subcutaneous magnesium infusion. J Pediatr Endocrinol Metab 2008; 21:385-91. [PMID: 18556971 DOI: 10.1515/jpem.2008.21.4.385] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
UNLABELLED Activating calcium sensor receptor (CaSR) mutations often present with hypocalcemia and hypomagnesemia. Severe hypocalcemia with this mutation has been reported but severe hypomagnesemia has not been well described. AIM To identify the cause of severe hypocalcemia and hypomagnesemia in a young child, and explore the efficacy of continuous subcutaneous magnesium therapy as a safer alternative to intravenous magnesium. PATIENT A 2-8/12 year-old female with severe hypocalcemia and hypomagnesemia of unknown etiology. METHODS Genetic analysis was performed on the proband and both parents. The proband was treated with human parathyroid hormone (teriparatide) and a continuous infusion of subcutaneous magnesium sulfate initially using a Deltec insulin pump and subsequently a Curlin infusion pump. RESULTS The patient has a known de novo mutation in the CASR gene (A843E). She could not be adequately managed with enteral and intravenous electrolyte replacement even after adding teriparatide. She responded well to adjunctive therapy with continuous subcutaneous magnesium. CONCLUSIONS Severe hypomagnesemia can be part of the phenotype of activating CaSR mutations. Subcutaneous magnesium should be considered in patients with difficult to control hypomagnesemia.
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Affiliation(s)
- Srinath Sanda
- Division of Endocrinology, Department of Pediatrics, UC San Diego School of Medicine, La Jolla, CA, USA.
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Richette P, Ayoub G, Lahalle S, Vicaut E, Badran AM, Joly F, Messing B, Bardin T. Hypomagnesemia associated with chondrocalcinosis: A cross-sectional study. ACTA ACUST UNITED AC 2007; 57:1496-501. [DOI: 10.1002/art.23106] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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Arends J, Bodoky G, Bozzetti F, Fearon K, Muscaritoli M, Selga G, van Bokhorst-de van der Schueren MAE, von Meyenfeldt M, Zürcher G, Fietkau R, Aulbert E, Frick B, Holm M, Kneba M, Mestrom HJ, Zander A. ESPEN Guidelines on Enteral Nutrition: Non-surgical oncology. Clin Nutr 2006; 25:245-59. [PMID: 16697500 DOI: 10.1016/j.clnu.2006.01.020] [Citation(s) in RCA: 386] [Impact Index Per Article: 21.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2006] [Accepted: 01/20/2006] [Indexed: 02/06/2023]
Abstract
Enteral nutrition (EN) by means of oral nutritional supplements (ONS) and tube feeding (TF) offers the possibility of increasing or ensuring nutrient intake in cases where normal food intake is inadequate. These guidelines are intended to give evidence-based recommendations for the use of ONS and TF in cancer patients. They were developed by an interdisciplinary expert group in accordance with officially accepted standards, are based on all relevant publications since 1985 and were discussed and accepted in a consensus conference. Undernutrition and cachexia occur frequently in cancer patients and are indicators of poor prognosis. EN should be started if undernutrition already exists or if food intake is markedly reduced for more than 7-10 days. Standard formulae are recommended for EN. Nutritional needs generally are comparable to non-cancer subjects. In cachectic patients metabolic modulators such as progestins, steroids and possibly eicosapentaenoic acid may help to improve nutritional status. EN is indicated preoperatively for 5-7 days in cancer patients undergoing major abdominal surgery. During radiotherapy of head/neck and gastrointestinal regions dietary counselling and ONS prevent weight loss and interruption of radiotherapy. Routine EN is not indicated during (high-dose) chemotherapy.
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Affiliation(s)
- J Arends
- Department of Medical Oncology, Tumor Biology Center, Albert-Ludwigs-Universität, Freiburg, Germany.
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