ABSTRACT
There are many facets to the often-complicated and controversial topic of dehydration and rehydration of palliative care populations. At the center of the discussion, irrespective of the setting and circumstances, is the desire to keep patients as comfortable as possible while avoiding unnecessary management or procedures. However, there is no doubt that the definition of “unnecessary” will have great international variation. Clinicians with the responsibility to make these decisions will need to sort through expressions of opinion, information on pathophysiology and biochemical changes, research looking at a variety of outcomes, differing family and cultural expectations, and consensus statements. This diverse information then has to be individually applied to the specific trajectory and circumstances of patients and their families. The need to consider individual circumstances and predictions of life expectancy in evaluating the potential benefits of rehydration is a recurring theme. Although starting from different perspectives, there is some consensus about: available data are inadequate for final conclusions on this issue; careful individual assessment of the relevance of fluid deficit to each clinical situation is essential; and further carefully designed research trials are required.
