Brief Report
Quantifying fluid intake in dysphagic stroke patients: A preliminary comparison of oral and nonoral strategies,☆☆,,★★,

https://doi.org/10.1053/apmr.2001.27379Get rights and content

Abstract

Finestone HM, Foley NC, Woodbury MG, Greene-Finestone L. Quantifying fluid intake in dysphagic stroke patients: a preliminary comparison of oral and nonoral strategies. Arch Phys Med Rehabil 2001;82:1744-6. Objective: To determine whether dysphagic stroke patients receiving oral (thickened-fluid dysphagia) diets or nonoral (enteral feedings supplemented with intravenous fluids) diets met their estimated fluid requirements. Design: Cohort study. Setting: University-affiliated hospital. Participants: Thirteen dysphagic patients with new strokes were studied for 21 days postadmission to hospital. Interventions: Seven patients (group 1) were started on nonoral feeding and later progressed to oral diets and 6 patients (group 2) received oral dysphagia diets only. Main Outcome Measure: Fluid intake. Results: Fluid intake of patients in group 1 significantly declined over the 21 days (mean ± standard deviation, 3158 ± 523mL/d vs 984 ± 486mL/d; p < .0001), representing 134% ± 26% and 43% ± 20% of their fluid requirements, respectively. Mean fluid intake of patients in group 2 was 755 ± 162mL/d, representing 33% ± 5% of requirements. This volume was significantly lower than the fluid intake of patients who received nonoral feeding (p < .0001). Conclusions: Dysphagic stroke patients who received thickened-fluid dysphagia diets failed to meet their fluid requirements whereas patients on enteral feeding and intravenous fluid regimens received ample fluid. © 2001 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation

Section snippets

Methods

The present research was part of a prospective study investigating the energy metabolism of stroke patients. Fifty-five patients admitted to a university-affiliated hospital within 5 days of onset of symptoms of their first ischemic or hemorrhagic stroke were enrolled in the study between August 1996 and October 1997 and studied for 21 days. At admission, 28 patients (50.9%) were determined to be dysphagic on the basis of a bedside swallowing evaluation performed by a speech-language

Group 1: Stroke patients initiated on enteral feeding

In the acute stage, group 1 patients received a mean of 3158mL of fluid daily from all sources, representing 134% of their estimated fluid requirements (table 1).Intravenous therapy began on admission and continued for 7 to 9 days. In the subacute stage, the mean fluid intake of group 1 patients dropped to 984mL/d, representing 43% of their estimated fluid requirements, or approximately one third of previous values (see table 1). These patients remained on thickened fluids from 7 to 25 days

Discussion

The results of the present preliminary study suggest that dysphagic stroke patients receiving thickened-fluid dysphagia diets failed to achieve fluid intakes that meet their estimated fluid requirements, whereas enterally and intravenously fed patients exceeded theirs. Acutely dysphagic patients who were unable to eat orally were started on intravenous fluids immediately after admission and within 12 to 48 hours also received a NG tube for enteral feedings. Patients started on oral dysphagia

Conclusions

Dysphagic stroke patients on thickened-fluid dysphagic diets did not consume sufficient fluid to meet their needs and are at risk for developing dehydration and its consequences. However, enterally fed patients met or exceeded their requirements through the use of supplemental fluids given either enterally or intravenously. The findings of this preliminary study must be confirmed by a prospective study that uses a larger, randomly selected sample.

References (12)

There are more references available in the full text version of this article.

Cited by (89)

  • Fluids, energy intake, and stroke

    2023, Diet and Nutrition in Neurological Disorders
  • Fluid and energy intake in stroke patients during acute hospitalization in a stroke unit

    2019, Journal of Clinical Neuroscience
    Citation Excerpt :

    Main fluid source in patients with dysphagia depended on IVs fluids prescription accounting for 57.2% of total fluids, while water from enteral and parenteral formulas accounted only for 15.6% of the overall fluid intake. Our results are in contrast with previous findings [24], suggesting that in our sample most patients still did not receive enough fluids independently if they were receiving a “nil per os” (NOS) diet or a thickened-fluid diet. In the multivariate analysis oral fluid consumption was associated with risk of dehydration at discharge, while total fluid intake (including enteral and parenteral fluids) did not reach statistical significance.

  • Swallowing Disorders After Stroke

    2018, Stroke Rehabilitation
View all citing articles on Scopus

Supported by the Heart and Stroke Foundation of Ontario (grant no. T-3602).

☆☆

No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit upon the author(s) or upon any organization with which the author(s) is/are associated.

Reprint requests to Hillel M. Finestone, MD, St. Vincent's Hospital, 60 Cambridge St. N, Ottawa, Ont K1R 7A5, Canada, e-mail: [email protected].

★★

Supplier

a. Minitab Inc, 3081 Enterprise Dr, State College, PA 16801-3008.

View full text