Abstract
BackgroundIn the Rehabilitation and Aged Care Services Program at Southern Health in Victoria, saline hypodermoclysis is a relatively common method of rehydration. However, there were questions about the safety and effectiveness of subcutaneous infusion of other fluids and, in particular, dextrose solutions. This review aimed to assess the safety and effectiveness of rehydration of elderly patients with subcutaneous 5% dextrose solutions compared with intravenous 5% dextrose solutions.MethodsWe searched the Cochrane Library, Medline, IDIS, CINAHL, Current Contents, Premedline, Australasian Medical Index, the Joanna Briggs Institute, the US National Guideline Clearinghouse and bibliographies of retrieved articles. Searching was undertaken in July 2003. Studies selected were primary studies (or systematic reviews of primary studies) providing evidence as to the effectiveness and safety of subcutaneous infusion of dextrose solutions for rehydration of elderly patients. We included articles published in English in the last 10 years. Data were extracted by a single researcher.ResultsFrom our search we identified 15 potentially relevant articles. We obtained the full text of these articles to determine their relevance. After application of the inclusion criteria, four articles remained for appraisal including one systematic review, two randomised controlled trials and one cohort study.ConclusionThe four studies appraised all provide evidence that appropriate volumes of subcutaneous dextrose infusions (in the form of half-normal saline-glucose 5%, 40 g/L dextrose and 30 mmol/L NaCl, or 5% dextrose solution and 4 g/L NaCl, or two-thirds 5% glucose and one-third normal saline) can be used effectively for the treatment of dehydration, with similar rates of adverse effects to intravenous infusion. The evidence in this area is limited, and larger randomised controlled trials using validated outcome measures would be useful to confirm these results.
Highlights
In the Rehabilitation and Aged Care Services Program at Southern Health in Victoria, saline hypodermoclysis is a relatively common method of rehydration
A physician from Rehabilitation and Aged Care Services at Southern Health contacted the Centre for Clinical Effectiveness to ask that we investigate the safety and effectiveness of subcutaneous dextrose solutions in dehydrated patients aged over 65 years
Data sources We carried out a comprehensive search of the literature including the Cochrane Library, Medline, IDIS, CINAHL, Current Contents, Premedline, Australasian Medical Index, the Joanna Briggs Institute and the United States National Guideline Clearinghouse (Table 1)
Summary
In the Rehabilitation and Aged Care Services Program at Southern Health in Victoria, saline hypodermoclysis is a relatively common method of rehydration. This review aimed to assess the safety and effectiveness of rehydration of elderly patients with subcutaneous 5% dextrose solutions compared with intravenous 5% dextrose solutions. A physician from Rehabilitation and Aged Care Services at Southern Health contacted the Centre for Clinical Effectiveness to ask that we investigate the safety and effectiveness of subcutaneous dextrose solutions in dehydrated patients aged over 65 years. In the Rehabilitation and Aged Care Services Program saline hypodermoclysis is a relatively common method of rehydration. There were questions about the safety and effectiveness of subcutaneous infusion of other fluids and, in particular, dextrose solutions. We only appraised the systematic review and relevant articles published after (or not included in) the systematic review
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