Article Text

Download PDFPDF

Hydration and symptoms in the last days of life
  1. Martine E Lokker1,
  2. Agnes van der Heide1,
  3. Wendy H Oldenmenger2,
  4. Carin C D van der Rijt2 and
  5. Lia van Zuylen2
  1. 1Public Health, Erasmus MC, Rotterdam, The Netherlands
  2. 2Medical Oncology, Erasmus Medical Center, Rotterdam, The Netherlands
  1. Correspondence to Dr Agnes van der Heide, Erasmus Medical Center, Rotterdam 3015 GD, The Netherlands; a.vanderheide{at}


Objectives At the end of life oral fluid intake is often reduced. Consensus about the most appropriate management for terminally ill patients with limited oral fluid intake is lacking. The objective of this study is to investigate to what extent the amount of fluid intake, preceding and during the dying phase, is related to the occurrence of death rattle and terminal restlessness.

Methods A multicentre prospective observational study was performed. Data on the occurrence of death rattle and terminal restlessness, fluid intake and opioid use of patients expected to die within a few days or hours were collected.

Results 371 patients were included. Death rattle was reported at least once in 40% (n=149) of patients during the dying phase. Death rattle occurrence was not associated with the amount of fluid intake during the days before dying. Terminal restlessness was reported in 26% of patients (n=96). Terminal restlessness was not associated with a lower amount of fluid intake during the days before dying. Terminal restlessness during the last 24 hours of life was associated with a higher amount of fluid (ie, >250 mL/day) during 48–25 hours before death.

Conclusions Caution with fluid intake to prevent development of death rattle does not seem to be necessary. Our study suggests that a higher amount of fluid intake during 48–25 hours before death may be associated with the occurrence of terminal restlessness during the last 24 hours of life. These results suggest that actively providing dying patients with artificial fluid may not be beneficial.

  • end of life care
  • hydration
  • symptoms
  • death
  • dying

This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See:

View Full Text

Statistics from


  • Contributors All authors have made substantial contributions to the conception of the work, acquisition, data collection, analysis, interpretation of data, drafting the article, and approved the final version to be published.

  • Funding This study was funded by The Netherlands Organization for Health Research and Development (grant number 11510004).

  • Competing interests CCDvdR has received a grant from Kyowa Kirin and consulting fees from Kyowa Kirin, IPSEN Farmaceutica and MunDipharma. MEL, AvdH, WHO and LvZ declared no competing interests.

  • Patient consent for publication Not required.

  • Ethics approval The study was approved by the Medical Ethics Research Committee of the Erasmus MC, University Medical Centre Rotterdam.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement All data relevant to the study are included in the article or uploaded as supplementary information.

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.