Dehydration—The Pharynx is Affected As Well

An 89-year-old man with Parkinson‘s disease was transferred from a retirement home to the hospital because of suspected aspiration pneumonia. He was severely dehydrated and in an akinetic crisis. Oral nutrition had been possible up to this point with pureed food and thickened fluids; for the last two days, however, he had hardly taken any food or drink by mouth. He was unable to swallow for a clinical swallowing test and, temporarily, no nutrition could be given. A fiber-optic endoscopic evaluation of swallowing (FEES) revealed incrustation on the pharyngeal mucosa (part of the epiglottis can also be seen in the lower part of the picture). This image shows that the clinically significant effects of dehydration are not restricted to the visible portion of the tongue. Rather, when pharyngeal eschar (incrustation) is present, the trigger zones of the swallowing reflex are displaced, so that the reflex may be pathologically impaired or absent.