Managing Fluid Retention in Terminal Pancreatic Cancer: The Effect of Discontinuing Intravenous Fluids

Intravenous fluids are often administered to maintain hydration during clinical management of advanced cancer. However, their effectiveness and safety at the terminal phase remain a subject of rigorous debate. The physiological ability to metabolize artificial hydrates is frequently compromised among patients with irreversible cachexia associated with terminal cancer. Consequently, administering excessive fluids to such patients can lead to worsening limb edema and pleural effusion accumulation or ascites. This can increase discomfort and suffering among patients, and significantly reduce their quality of life. An 86-year-old woman was diagnosed with pancreatic head cancer with liver metastases and was initially referred for treatment of a cerebral infarction. She remained hospitalized under palliative symptom management and end-of-life care. She initially received intravenous fluids along with oral intake, but progressive lower limb edema developed and she rapidly gained weight. Following a discussion with the patient and her family, intravenous fluid therapy was discontinued, and care focused on supporting her current oral intake. Consequently, the lower limb edema improved, and the patient was able to remain hospitalized without distressing symptoms such as dyspnea. This case suggests that the clinical benefits of intravenous fluids should be carefully balanced against the risk of exacerbating physical distress when patients with terminal cancer have worsening fluid retention. Our findings align with current palliative care insights, indicating that prioritizing comfort-oriented care can lead to a more peaceful end-of-life experience.