Ancu Feng Escobar, MD, and Mario Lopez Saca, MD, are members of the multiprofessional team at the Clinica de Cuidados Paliativos, ‘Soporte y control de sintomas del enfermo avanzado’ in San Salvador, El Salvador. Here, they explain the background to their longer article published in the March/April issue of the European Journal of Palliative Care.
The palliative care unit in San Salvador, where we have worked since 2014, provides care in a private clinic, hospitals and at home. In our longer article, published in this month’s European Journal of Palliative Care, we present three cases of acute hyponatraemia that we decided to treat with home-based subcutaneous infusions.
Hyponatraemia is a frequent condition in palliative care patients and is associated with worsening prognosis and quality of life. 1
Symptoms commonly associated with hyponatraemia are: drowsiness, nausea and vomiting, anorexia, disorientation, confusion, weakness and fatigue. Other symptoms may include memory disturbance, attention deficit, gait disturbance, agitation, hallucinations, convulsions, coma, abdominal pain. 2,3
It is common in conditions such as frailty, cancer, cardiac, hepatic and renal insufficiency and can be caused by polypharmacy.
Cannulation of peripheral veins in home-based palliative patients often presents difficulties – it is painful and uncomfortable and there are few services to support intravenous therapy in the community. There may also be limitations to physically taking patients to hospital, because of the complexity of their general state. They may therefore benefit from the subcutaneous route as an alternative infusion route, to offer better symptom management and quality of life.
Hyponatraemia is also a determining factor in relation to the length of hospital stay. We successfully treated three patients with acute symptomatic hyponatraemia by administering subcutaneous sodium therapy at home. The subcutaneous route has been shown to be effective in re-hydrating the patient using saline and glucose solutions.We have now also seen positive results by using hypertonic solution to adjust electrolyte results via this route.
Subcutaneous hydration showed that it was well tolerated by the patient. Furthermore, it allows for increased patient independence and peace of mind for family members and carers, who can be trained in how it is administered.
It is important to clarify here that in these cases the patients were treated at home in the palliative context of advanced chronic diseases, with the compassionate use of hypodermoclysis therapy to bring about rapid symptomatic improvement. There was no evidence of oedema or other complications at the infusion site and, on the contrary, neurological symptoms improved and patients were able to interact with their family.
Based on our experience, we hope that other homecare teams may feel confident to help more patients with acute symptomatic hyponatraemia, with the aim of developing standardised treatment and protocols. 4
- Joan M. Nelson DNP, ANP-BC Marylou V. Robinson PhD, FNP-C. Hyponatraemia in older adults presenting to the emergency department. International Emergency Nursing 20 (4). 2012. 251-4.
- M A de la Cal Ramirez, et al. Manejo agudo de los trastornoselectrolíticos y del equilibrio acido base. 2° Edicion. Available at: http://www.semesandalucia.es/wp-content/uploads/2016/05/libro-electrolitos-segunda-edicion.pdf (Accessed 15th May 2018).
- M J Hannon et al. The Syndrome of inappropiate antidiuretic hormone: prevalence, causes and consequences. 2010. European Journal of Endocrinology.
- R Gallardo Avilés, F Gamboa Antiñolo. Uso de la vía subcutánea en Cuidados Paliativos, Monografías SECPAL. N°4 Octubre 2013. Available at: http://www.cuidarypaliar.es/wp-content/uploads/2016/09/Uso-de-la-v%C3%ADa-subcut%C3%A1nea-en-cuidados-paliativos.-Monograf%C3%ADas-SECPAL.pdf (Accessed 15th May 2018).
This post relates to the longer article, ‘Symptomatic hyponatraemia in home-based palliative care patients treated with subcutaneous infusions: Case reports’ by José Mario López Saca and Ancu Feng, published in the March/April edition of the European Journal of Palliative Care (EJPC) 2018; 25 (2).
To download the full article free of charge, please login if you already have a subscription, or register here.
Note from the EAPC concerning the European Journal of Palliative Care
We regret to announce that since publication of this post Hayward Medical Communications closed the European Journal of Palliative Care (EJPC) in the summer of 2018.
Since the launch of the journal in 1994, the EAPC and the EJPC forged a strong and mutually effective bond. Together, we provided our members and readers with a wide range of papers, including several seminal EAPC White papers, and the book of abstracts for many EAPC congresses. Our successful collaboration also led to the publication of numerous posts on this blog contributed by many of the EJPC’s authors, providing a background to their longer articles. The diversity and high quality of the content has enriched our blog and we are deeply grateful to past and present authors, and to our colleagues at the EJPC. A tribute from the EAPC was published in the June issue of the journal.
You can view and download more than 120 posts based on EJPC articles in the special category on the EAPC blog for the European Journal of Palliative Care.