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 an individual will aspirate while they are drinking. Individuals with difficulty swallowing may find liquids cause coughing, spluttering or even aspiration and thickening drinks enables them to swallow safely. Patients may be advised to consume thickened liquids after being extubated. Liquid thickness may be measured by two methods, with a viscometer or by line spread test.

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.
0 – Thin liquids: Unthickened, such as water or juice. Common thin liquids include coffee, tea, clear broth, clear juice, skim milk, 2% milk, and whole milk.
1 – Slightly thick
2 – Mildly thick
3 – Moderately thick
4 – Extremely thick – drinks of this stage should require a spoon to drink.

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.

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.

There is no good evidence that thickening liquids reduces pneumonia in dysphagia and it may be associated with poorer hydration and with an adverse effect on quality of life.[4] Thicker consistencies may also be associated with pharyngeal residue and perhaps with an increased risk of severe pneumonia if aspirated.[5] [6]

References[edit]

  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.
  2. ^ International Dysphagia Diet Standardisation Initiative
  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. ^ 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.
  6. ^ Robbins J (April 2008). "Comparison of 2 Interventions for Liquid Aspiration on Pneumonia Incidence". Annals of Internal Medicine. 148 (7): 509. doi:10.7326/0003-4819-148-7-200804010-00007.