Is artificial hydration effective in improving the symptoms and general comfort of patients in the last days of life?


  1. In general, do not provide artificial hydration in patients in the last days of life. Exceptionally, consider it if:
    • There is poor control of symptoms that could be related to dehydration (for example, delirium) and other control measures have failed.
    • The reduction in oral intake causes unrest or emotional concern in the patient and their relatives despite appropriate communication with the care team.

  1. Review medical records to check whether the patient has previously expressed preferences regarding artificial hydration in an advance directive when considering artificial hydration in the last days of life and the patient is unable to decide.
  2. If artificial hydration is indicated:
    • Address the concerns of the patient and their family and inform them about the evidence of the benefits and risks of artificial hydration in the last days of life
    • Consider it a measure to be taken for a limited time (previously agreed with the patient/relatives)
    • Do not use a daily volume of more than 1 l
    • Do not use the enteral route of administration; rather, subcutaneous administration is the route of choice in home care patients or when an IV line is not already in place.
  3. One artificial hydration has been set up:
    • Monitor changes in signs or symptoms of dehydration and any evidence of benefit or harm approximately every 24 h
    • Continue hydration if there are benefits perceived by the patient and/or family
    • Reduce or stop hydration if there are signs of potential harm such as fluid overload or increased respiratory secretions, or if the patient or their family or close friends request its withdrawal.
  4. In cases in which artificial hydration (via the enteral or parenteral route) is already in place before the last days of life:
    • Review the risks and benefits of continuing this type of hydration in the last days of life with the patient and family/close friends
    • Consider whether to continue, reduce or stop artificial hydration as the patient approaches death.



These recommendations have been formulated seeking to promote appropriate clinical management of hydration in the last days of life, based on the evidence of the risks and benefits and taking into account the values and preferences of patients and their families.

Complete clinical question

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