Inadequate fluid intakes in dysphagic acute stroke

doi:10.1054/clnu.2001.0467

Clinical Nutrition

Volume 20, Issue 5, October 2001, Pages 423-428

https://doi.org/10.1054/clnu.2001.0467 Get rights and content

Abstract

Background and Aims: To investigate the fluid intakes of patients with dysphagic acute stroke and to evaluate the effect of disability, the ward speciality and the type of fluid given on oral intake. Methods: Patients were prospectively recruited and randomly assigned to receive powder-thickened fluids or ready prepared pre-thickened fluids. Parenteral, enteral and oral fluid intakes, urine output, clinical sequelae and the frequency of requests for biochemical measures of hydration were recorded for a maximum of fourteen days. Results: 24 patients with dysphagic acute stroke requiring thickened fluids were recruited from a large teaching hospital. Mean thickened fluid intake was 455 ml/d (SEM±70) resulting in the use of an extra 742 ml/d (±132) of supplementary fluids. This did not result in an adequate total intake due to insufficient volumes being given for too short a period. Patients not on specialist stroke units who received pre-thickened fluids drank almost 100% more than those on powder-thickened fluids (P=0.04).Conclusions : Fluid intakes in this patient group are insufficient to achieve requirements. Hospital staff must ensure adequate fluid intakes in patients at risk of dehydration, which should include both an adequate prescription and provision of supplementary fluids. Pre-thickened drinks improve oral fluid intake in patients with dysphagic acute stroke on non-specialist wards.

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Head and neck cancer (HNC) treatment causes dysphagia, which may lead to aspiration pneumonia (AP). Thickened fluids are widely used to prevent aspiration in patients with dysphagia; however, there is little evidence that they can prevent AP. This study aimed to clarify the differences between restriction of oral intake of fluids (R), only thickened fluids (TF), and no restriction of fluids (NR) for AP in patients with dysphagia after HNC treatment.
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The mean patient age was 64 ± 13, 67 ± 11, and 68 ± 10 years, while the Dynamic Imaging Grade of Swallowing Toxicity score 3–4 was 2.8%, 27.5, and 53.3%% water in NR, TF, and R groups, respectively. AP was diagnosed or suspected after starting oral intake in 37 (9.3%), 11 patients (15.9%), and 45 (17.6%) and antibacterial drugs were administered in 11 (2.8%), 7 patients (10.1%), and 25 (9.8%) in NR, TF, and R groups, respectively. R and TF had significant negative impacts on AP.
Fluid restrictions may not reduce the risk of AP or affect the administration of antibacterial drugs. Medical staff should bear in mind that fluid restrictions do not necessarily prevent AP in patients with HNC.
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Data were extracted retrospectively for 31,953 acute stroke patients admitted to six hospitals in Adelaide, South Australia over a 20-year period. Tests of difference compared rates of complications between patients with and without dysphagia. Multiple logistic regression modelling explored variables that significantly predicted each complication.
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A ready-to-eat food called texture-modified chicken rendang (TMCR) was developed for consumption of the elderly with dysphagia in Malaysia. Incorporation of xanthan gum as food thickener in retorted TMCR was evaluated monthly over 6 months’ period for its shelf-life stability and quality. Throughout storage period, both stability and quality of the TMCR samples had reduced significantly, mainly due to lipid and protein oxidation. However, the absence of aerobic and anaerobic bacteria as well as yeast and mould count indicates that TMCR was safe to be consumed. In addition, the TBARs value was found to be within the acceptable limit (under 1.5 mg MDA/kg) indicating low level of rancidity. Overall, the addition of xanthan gum was able to reduce physical and chemical changes imparted from thermal and oxidation processes which affect both quality and stability of the stored samples.

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^f1: (Correspondence to: KW, Research Dietitian, Department of Nutrition and Dietetics, Kings College London, 150 Stamford Street, London, SE1 9NN, UK)

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Regular ArticleInadequate fluid intakes in dysphagic acute stroke

Abstract

Int J Nurs Studies

Arch Phys Med Rehabil

Arch Phys Med Rehab

J Am Diet Assoc

J Am Diet Assoc

Clin Nutr

Clin Nutr

The health of the nation: nutritional guidelines for hospital catering

Fluid balance in elderly patients following acute stroke

Age Ageing

Hydration in acute stroke: where do we go from here?

Clin Effect Nurs

The natural history of dysphagia following a stroke

Dysphagia

Aspiration in acute stroke: A clinical study with videofluoroscopy

QJM

Aspiration and relative risk of medical complications following stroke

Arch Neurol

Dysphagia in acute stroke

BMJ

Influence of raised plasma osmolality on clinical outcome after acute stroke

Stroke

Development and dissemination of an aspiration risk reduction diet

Dysphagia

Factors affecting use of food and commercial agents to thicken liquids for individuals with swallowing disorders

J Am Diet Assoc

Regular Article
Inadequate fluid intakes in dysphagic acute stroke