Opioid metabolites are generally eliminated through the kidneys. Patients with renal impairment are at high risk of developing opioid-related neurotoxicities. Dehydration can result in renal impairment (pre-renal failure). The rationale therefore for hydrating patients presenting with opioid-related toxicity is that it facilitates the elimination of these metabolites. Furthermore, dehydration is recognized to cause or aggravate delirium. When hydration is indicated, the oral route is preferred. Where this is not possible or insufficient, hydration can be performed subcutaenously by hypodermoclysis. The decision to hydrate or not to hydrate palliative patients needs to be individualized, taking into consideration various factors such as life expectancy and overall symptom burden.

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Clinical Presentation
Underlying Mechanisms
Assessment of toxicities
Overall management
Opioid rotation
Opioid dose reduction
Addition of other drugs
Hydration
References
Credits