Thickened fluids

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Thickened fluids and thickened drinks are often used for people with dysphagia, a disorder of swallowing function. [1] The thicker consistency makes it less likely that individuals will aspirate while they are drinking. Individuals with difficulty swallowing may find that liquids cause coughing, spluttering, or even aspiration, and that thickening drinks enables them to swallow safely. Patients may be advised to consume thickened liquids after being extubated.

Contents

Liquid thickness may be measured by two methods, with a viscometer or by line spread test.

Thickening amount

There are several levels of consistency/viscosity and these have historically varied by country, although the launch of the International Dysphagia Diet Standardisation Initiative (IDDSI) [2] aims to remove this variation. According to the IDDSI, the thickness of a drink can be tested by measuring the amount that pours out of a 10ml syringe in 10 seconds. [3]

Patients who have a restriction on thin liquids should avoid milk shakes, ice cream, popsicles, and Jell-O, as these melt into thin liquids in the mouth.

Thickening agents

There are multiple commercial thickeners on the market for thickening liquids. Vendors also offer pre-thickened liquids such as water, juice, and milk in individual serving sized cartons. Some commercial thickeners use modified maize starch, which helps support hydration and nutritional levels, while others use xanthan gum.

Medical value

There is no good evidence that thickening liquids reduces pneumonia in dysphagia (swallowing problems) and it may be associated with poorer hydration and with an adverse effect on quality of life. [4] [5] Thicker consistencies may also be associated with pharyngeal residue and perhaps with an increased risk of severe pneumonia if aspirated. [6] [7] Concern has been expressed that patients receiving modified texture diets, such as thickened liquids are not receiving adequate information about the pros and cons and are not as result giving valid informed consent. [8]

Related Research Articles

<span class="mw-page-title-main">Guar gum</span> Vegetable gum from the guar bean, Cyamopsis tetragonoloba

Guar gum, also called guaran, is a galactomannan polysaccharide extracted from guar beans that has thickening and stabilizing properties useful in food, feed, and industrial applications. The guar seeds are mechanically dehusked, hydrated, milled and screened according to application. It is typically produced as a free-flowing, off-white powder.

<span class="mw-page-title-main">Custard</span> Semi-solid cooked mixture of milk and egg

Custard is a variety of culinary preparations based on sweetened milk, cheese, or cream cooked with egg or egg yolk to thicken it, and sometimes also flour, corn starch, or gelatin. Depending on the recipe, custard may vary in consistency from a thin pouring sauce to the thick pastry cream used to fill éclairs. The most common custards are used in custard desserts or dessert sauces and typically include sugar and vanilla; however, savory custards are also found, e.g., in quiche.

Gravy is a sauce made from the juices of meats and vegetables that run naturally during cooking and often thickened with thickeners for added texture. The gravy may be further coloured and flavoured with gravy salt or gravy browning or bouillon cubes. Powders can be used as a substitute for natural meat or vegetable extracts. Canned and instant gravies are also available. Gravy is commonly served with roasts, meatloaf, rice, noodles, fries (chips), mashed potatoes, or biscuits.

<span class="mw-page-title-main">Dysphagia</span> Difficulty in swallowing

Dysphagia is difficulty in swallowing. Although classified under "symptoms and signs" in ICD-10, in some contexts it is classified as a condition in its own right.

<span class="mw-page-title-main">Pulmonary aspiration</span> Entry of materials into the larynx (voice box) and lower respiratory tract

Pulmonary aspiration is the entry of material such as pharyngeal secretions, food or drink, or stomach contents from the oropharynx or gastrointestinal tract, into the larynx and lower respiratory tract, the portions of the respiratory system from the trachea (windpipe) to the lungs. A person may inhale the material, or it may be delivered into the tracheobronchial tree during positive pressure ventilation. When pulmonary aspiration occurs during eating and drinking, the aspirated material is often colloquially referred to as "going down the wrong pipe".

<span class="mw-page-title-main">Upper gastrointestinal series</span> Radiographs used to examine abnormalities of the digestive system excluding the colon

An upper gastrointestinal series, also called a barium swallow, barium study, or barium meal, is a series of radiographs used to examine the gastrointestinal tract for abnormalities. A contrast medium, usually a radiocontrast agent such as barium sulfate mixed with water, is ingested or instilled into the gastrointestinal tract, and X-rays are used to create radiographs of the regions of interest. The barium enhances the visibility of the relevant parts of the gastrointestinal tract by coating the inside wall of the tract and appearing white on the film. This in combination with other plain radiographs allows for the imaging of parts of the upper gastrointestinal tract such as the pharynx, larynx, esophagus, stomach, and small intestine such that the inside wall lining, size, shape, contour, and patency are visible to the examiner. With fluoroscopy, it is also possible to visualize the functional movement of examined organs such as swallowing, peristalsis, or sphincter closure. Depending on the organs to be examined, barium radiographs can be classified into "barium swallow", "barium meal", "barium follow-through", and "enteroclysis". To further enhance the quality of images, air or gas is sometimes introduced into the gastrointestinal tract in addition to barium, and this procedure is called double-contrast imaging. In this case the gas is referred to as the negative contrast medium. Traditionally the images produced with barium contrast are made with plain-film radiography, but computed tomography is also used in combination with barium contrast, in which case the procedure is called "CT enterography".

<span class="mw-page-title-main">Xanthan gum</span> Polysaccharide gum used as a food additive and thickener

Xanthan gum is a polysaccharide with many industrial uses, including as a common food additive. It is an effective thickening agent and stabilizer that prevents ingredients from separating. It can be produced from simple sugars by fermentation and derives its name from the species of bacteria used, Xanthomonas campestris.

<span class="mw-page-title-main">Feeding tube</span> Medical device used to provide nutrition to people

A feeding tube is a medical device used to provide nutrition to people who cannot obtain nutrition by mouth, are unable to swallow safely, or need nutritional supplementation. The state of being fed by a feeding tube is called gavage, enteral feeding or tube feeding. Placement may be temporary for the treatment of acute conditions or lifelong in the case of chronic disabilities. A variety of feeding tubes are used in medical practice. They are usually made of polyurethane or silicone. The outer diameter of a feeding tube is measured in French units. They are classified by the site of insertion and intended use.

<span class="mw-page-title-main">Megaesophagus</span> Medical condition

Megaesophagus, also known as esophageal dilatation, is a disorder of the esophagus in humans and other mammals, whereby the esophagus becomes abnormally enlarged. Megaesophagus may be caused by any disease which causes the muscles of the esophagus to fail to properly propel food and liquid from the mouth into the stomach. Food can become lodged in the flaccid esophagus, where it may decay, be regurgitated, or maybe inhaled into the lungs.

<span class="mw-page-title-main">Aspiration pneumonia</span> Medical condition

Aspiration pneumonia is a type of lung infection that is due to a relatively large amount of material from the stomach or mouth entering the lungs. Signs and symptoms often include fever and cough of relatively rapid onset. Complications may include lung abscess, acute respiratory distress syndrome, empyema, and parapneumonic effusion. Some include chemical induced inflammation of the lungs as a subtype, which occurs from acidic but non-infectious stomach contents entering the lungs.

<span class="mw-page-title-main">Bone marrow examination</span> Form of pathologic analysis

Bone marrow examination refers to the pathologic analysis of samples of bone marrow obtained by bone marrow biopsy and bone marrow aspiration. Bone marrow examination is used in the diagnosis of a number of conditions, including leukemia, multiple myeloma, lymphoma, anemia, and pancytopenia. The bone marrow produces the cellular elements of the blood, including platelets, red blood cells and white blood cells. While much information can be gleaned by testing the blood itself, it is sometimes necessary to examine the source of the blood cells in the bone marrow to obtain more information on hematopoiesis; this is the role of bone marrow aspiration and biopsy.

<span class="mw-page-title-main">Thickening agent</span> Increases the viscosity of a liquid without altering its other properties

A thickening agent or thickener is a substance which can increase the viscosity of a liquid without substantially changing its other properties. Edible thickeners are commonly used to thicken sauces, soups, and puddings without altering their taste; thickeners are also used in paints, inks, explosives, and cosmetics.

Nothing by mouth is an American medical instruction meaning to withhold food and fluids. It is also known as nil per os, a Latin phrase that translates to English as "nothing through the mouth". Nil by mouth is the term used in the UK (NBM), nihil/non/nulla per os, or complete bowel rest. A liquid-only diet may also be referred to as bowel rest.

<span class="mw-page-title-main">Oropharyngeal dysphagia</span> Difficulty controlling the mouth or throat for swallowing

Oropharyngeal dysphagia is the inability to empty material from the oropharynx into the esophagus as a result of malfunction near the esophagus. Oropharyngeal dysphagia manifests differently depending on the underlying pathology and the nature of the symptoms. Patients with dysphagia can experience feelings of food sticking to their throats, coughing and choking, weight loss, recurring chest infections, or regurgitation. Depending on the underlying cause, age, and environment, dysphagia prevalence varies. In research including the general population, the estimated frequency of oropharyngeal dysphagia has ranged from 2 to 16 percent.

Baby-led weaning is an approach to adding complementary foods to a baby's diet of breast milk or formula. BLW facilitates oral motor development and strongly focuses on the family meal, while maintaining eating as a positive, interactive experience. Baby-led weaning allows babies to control their solid food consumption by "self-feeding" from the start of their experience with food.

A mechanical soft diet or edentulous diet, or soft food(s) diet, is a diet that involves only foods that are physically soft, with the goal of reducing or eliminating the need to chew the food. It is recommended for people who have difficulty chewing food, including people with some types of dysphagia, the loss of many or all teeth, pain from recently adjusted dental braces, or surgery involving the jaw, mouth, or gastrointestinal tract.

<span class="mw-page-title-main">Smoothie</span> Drink made from fruit or vegetables

A smoothie is a beverage made by puréeing ingredients in a blender. A smoothie commonly has a liquid base, such as fruit juice or milk, yogurt or ice cream. Other ingredients may be added, including fruits, vegetables, non-dairy milk, crushed ice, whey powder or nutritional supplements.

<span class="mw-page-title-main">Barium sulfate suspension</span> Contrast agent used during X-rays

Barium sulfate suspension, often simply called barium, is a contrast agent used during X-rays. Specifically it is used to improve visualization of the gastrointestinal tract on plain X-ray or computed tomography. It is taken by mouth or used rectally.

<span class="mw-page-title-main">Aphagia</span> Medical condition

Aphagia is the inability or refusal to swallow. The word is derived from the Ancient Greek prefix α, meaning "not" or "without," and the suffix φαγία, derived from the verb φαγεῖν, meaning "to eat." It is related to dysphagia which is difficulty swallowing, and odynophagia, painful swallowing. Aphagia may be temporary or long term, depending on the affected organ. It is an extreme, life-threatening case of dysphagia. Depending on the cause, untreated dysphagia may develop into aphagia.

Catriona Margaret Steele is a Canadian clinician-scientist. She is a Full professor in the department of speech-language pathology at the University of Toronto and a senior scientist at the Toronto Rehabilitation Institute in the University Health Network.

References

  1. ↑ Clavé P, Shaker R (May 2015). "Dysphagia: current reality and scope of the problem". Nature Reviews. Gastroenterology & Hepatology. 12 (5): 259–70. doi:10.1038/nrgastro.2015.49. PMID   25850008. S2CID   9123787.
  2. ↑ "IDDSI – Home". iddsi.org. Retrieved 15 January 2024.
  3. ↑ "IDDSI flow test" (PDF) (PPT). IDDSI.
  4. ↑ O'Keeffe ST (July 2018). "Use of modified diets to prevent aspiration in oropharyngeal dysphagia: is current practice justified?". BMC Geriatrics. 18 (1): 167. doi: 10.1186/s12877-018-0839-7 . PMC   6053717 . PMID   30029632.
  5. ↑ Makhnevich, Alexander; Perrin, Alexandra; Talukder, Dristi; Liu, Yan; Izard, Stephanie; Chiuzan, Codruta; D'Angelo, Stefani; Affoo, Rebecca; Rogus-Pulia, Nicole; Sinvani, Liron (1 July 2024). "Thick Liquids and Clinical Outcomes in Hospitalized Patients With Alzheimer Disease and Related Dementias and Dysphagia". JAMA Internal Medicine. 184 (7): 778–785. doi:10.1001/jamainternmed.2024.0736. ISSN   2168-6114. PMC  11074929. PMID   38709510.
  6. ↑ Steele CM, Alsanei WA, Ayanikalath S, Barbon CE, Chen J, Cichero JA, Coutts K, Dantas RO, Duivestein J, Giosa L, Hanson B, Lam P, Lecko C, Leigh C, Nagy A, Namasivayam AM, Nascimento WV, Odendaal I, Smith CH, Wang H (February 2015). "The influence of food texture and liquid consistency modification on swallowing physiology and function: a systematic review". Dysphagia. 30 (1): 2–26. doi:10.1007/s00455-014-9578-x. PMC   4342510 . PMID   25343878.
  7. ↑ Robbins J (April 2008). "Comparison of 2 Interventions for Liquid Aspiration on Pneumonia Incidence". Annals of Internal Medicine. 148 (7): 509–18. doi:10.7326/0003-4819-148-7-200804010-00007. PMC   2364726 . PMID   18378947.
  8. ↑ O’Keeffe, S.T., Leslie, P., Lazenby-Paterson, T. et al. Informed or misinformed consent and use of modified texture diets in dysphagia. BMC Med Ethics 24, 7 (2023). https://doi.org/10.1186/s12910-023-00885-1
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