braces_for_impact

Hello all,

In a recent discussion my girlfriend and I had, we approached the subject of death. One of the topics was that the human body seems to at times have an affinity to "hold on", that is, to stave off death until a relative is seen, for example.

My girlfriend who is a c. n. a. of course sees death all the time. An example she has given me was of a dying person (from cancer) who managed to hold on without food or water for a month to a month and a half. She considered this very remarkable, where I simply saw a body shutting down thus using less water and producing less fluids so as to survive without fluid much longer than normal. Though I am not accusing my girlfriend of lying by any means, I was wondering...

How long can a healthy human body survive without water?

and

Is a terminal patient surviving such a long stretch of time without fluids possible and explainable medically?

doghouse

I'm not sure the term healthy applies here, but most patients will die within 5-10 days without any fluids.

45 days? With absolutely no fluids of any kind? I would say no.

The minimal insensible water loss is about 800 ml/day (breathing, skin evaporation). Metabolic water production can make up about half of this, so let’s say figures they are losing 400 ml/day. And this doesn’t even account for urine production and other measurable losses. So, over 45 days, the patient loses around 18 liters of fluid. Say the patient is 70 kg (real big for a dying cancer patient). This means the patient has lost 26% of his or her body weight in fluid. 10% is usually fatal.

It just doesn’t make sense.

Craig

A friend's mom died last year of liver (and other) cancer. She was in a coma for essentially three weeks and was not able to eat or drink anything, yet she managed to "live" (using that word only in the most literal sense) for those three weeks. She eventually died from organ failure, not dehydration or starvation. In a comatose state I imagine the body can go for a long time without food/water- in fact that's probably the whole point of a coma, to shut down to a point that survival is lenghtened.

However, there is a pretty clear pattern of people that do manage to "hold on" until after a particular holiday has passed. There is a down turn in deaths right before Christmas (in countries that celebrate it) and then after there is a spike. It appears that people manage to hold out through the holiday and then die afterwards.

This appears in most cultures, right before and after particularly special occasions like holidays, birthdays, anniversaries, etc.

braces_for_impact

My understanding is that this particuar patient was under a 'no resuscitate' order, as such if food or water is turned down it is not forced on the patient (such as an IV or feeding tube).

I don't know 30-45 days seems like an awfully long time to be without fluid, but perhaps it's possible if everything is running minimally?

Perhaps the time has been exagerrated somehow, I find it difficult to believe.

Godless Dave

My mom was an RN in a nursing home for a long time, and claims to have seen people survive without food or water for over 10 days.

Mad Kally

I'm a hospice RN, they can become extrememly dehydated very quickly (which causes other problems with body systems, such as organ failure) But 45 days, no..

I've noticed that when patients are ready to die, they naturally stop eating and drinking fluids. Maybe this could have something to do with it. Trying to get them to drink a little sip of Ensure (nutritional supplement) becomes impossible for many patients at the end. Maybe they are through after they see a loved one or a special occasion arrives, possibly then they literally "shut down".

Godless Dave, the 10 days sounds more reasonable, possibly longer, I've never kept track.

southernhybrid

I concur with nurse colleague Kally. 10 days, yes. 45 days, no way.

BFI, Perhaps your GF did not know the entire situation in the cases she mentioned. Tube feedings and IVs are not withheld just because a person has a DNR order in effect. Nursing homes rarely withhold tube feedings unless a person is actively dying and even then it would probably only be stopped if the person couldn't tolerate it. My guess would be that these dying folks were getting a limited amount of food and hydration. I've seen people last for over a year on a greatly reduced caloric and fluid intake, say 800-1000 calories and 800-1000 or so mls. per 24 hrs.

ps418

You can go a long time without drinking water, as long as you are recieving IV fluids. If someone if incapable of drinking, they will automatically be placed on IV fluids. I agree with the others that 45 days with no fluids whatsoever is very unlikely because, as doghouse points out, you're losing 400-800 ml minimally via evaporation, breathing, etc.

Patrick

Mad Kally

I had a terminal patient who revoked hospice when her cancer went through from her trachea to esophogus. Her family and I cried and I ran to my car to get all my IV equipment. It was a good day. Of couse she was still terminal, but she would have a little more time to be with her family.

I had to turn her over to another nurse who didn't do hospice, but I still stopped by to see her once in a while. That's the only time I recall anyone revoking hospice. She had G-Tube (gastric) placement shortly after. I started the IV as a temporary measure. Her children had not called and had me paged for 2 days after it happened!