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Subclinical thiamine deficiency in patients with abdominal cancer

Published online by Cambridge University Press:  26 December 2017

Hideki Onishi ,
Mayumi Ishida ,
Iori Tanahashi ,
Takao Takahashi ,
Yoshitada Taji ,
Kenji Ikebuchi ,
Daisuke Furuya  and
Tatsuo Akechi
Hideki Onishi*
Affiliation:
Department of Psycho-oncology, Saitama Medical University International Medical Center, Saitama, Japan
Mayumi Ishida
Affiliation:
Department of Psycho-oncology, Saitama Medical University International Medical Center, Saitama, Japan
Iori Tanahashi
Affiliation:
Department of Psycho-oncology, Saitama Medical University International Medical Center, Saitama, Japan
Takao Takahashi
Affiliation:
Palliative Medicine, Saitama Medical University International Medical Center, Saitama, Japan
Yoshitada Taji
Affiliation:
Laboratory Medicine, Saitama Medical University International Medical Center, Saitama, Japan
Kenji Ikebuchi
Affiliation:
Laboratory Medicine, Saitama Medical University International Medical Center, Saitama, Japan
Daisuke Furuya
Affiliation:
General Medicine, Saitama Medical University International Medical Center, Saitama, Japan
Tatsuo Akechi
Affiliation:
Department of Psychiatry and Cognitive-Behavioral Medicine, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
*
Author for Correspondence: Hideki Onishi, Department of Psycho-oncology, Saitama Medical University International Medical Center, 1397-1 Yamane, Hidaka City, Saitama 350-1298, Japan. E-mail: honishi@saitama-med.ac.jp
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Abstract

Objective

Thiamine is an essential coenzyme for oxidative metabolisms; however, it is not synthesized in the human body, and the average thiamine storage capacity is approximately 18 days. Therefore, thiamine deficiency (TD) can occur in any condition of unbalanced nutrition. If TD is left untreated, it causes the neuropsychiatric disorder Wernicke encephalopathy (WE). Although WE is a medical emergency, it is sometimes overlooked because most patients with WE do not exhibit all of the typical symptoms, including delirium, ataxia, and ophthalmoplegia. If all of the typical clinical symptoms of WE are absent, diagnosis of TD or WE becomes more difficult.

Method

From a series of cancer patients, we reported three patients who developed TD without the typical clinical symptoms of WE.

Result

A 69-year-old woman with pancreatic body cancer receiving chemotherapy with paclitaxel and gemcitabine for six months. Her performance status (PS) was 1. A detailed interview revealed that she had appetite loss for six months. Another 69-year-old woman with ovarian cancer received nedaplatin; her PS was 0. A detailed interview revealed that she had appetite loss for three months. A 67-year-old woman with colon cancer receiving ramucirumab in combination with second-line fluorouracil with folinic acid and irinotecan. Her PS was 1. A detailed interview revealed that she had appetite loss for three weeks. None exhibited typical clinical signs of WE, but they developed appetite loss for six months, three months, and three weeks, respectively. The diagnosis of TD was supported by abnormally low serum thiamine levels.

Significance of the results

This report emphasizes the possibility of TD in cancer patients even when patients do not develop typical clinical signs of WE. The presence of appetite loss for more than two weeks may aid in diagnosing TD. Patients receiving chemotherapy may be at greater risk for developing TD.

Keywords

Cancerthiamine deficiencyWernicke's encephalopathydelirium

Information

Type
Case Report
Information
Palliative & Supportive Care , Volume 16 , Special Issue 4: Topics in Bereavement , August 2018 , pp. 497 - 499
Copyright
Copyright © Cambridge University Press 2017 

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References

Aksoy, M, Basu, TK, Brient, J, et al. (1980) Thiamin status of patients treated with drug combinations containing 5-fluorouracil. European Journal of Cancer 16(8), 1041–1045.Google Scholar
American Psychiatric Association (2013) Diagnostic and Statistical Manual of Mental Disorders, 5th ed. Washington DC: American Psychiatric Publishing.Google Scholar
Basu, TK, Aksoy, M, and Dickerson, JW (1979) Effects of 5-fluorouracil on the thiamin status of adult female rats. Chemotherapy 25(2), 70–76.Google Scholar
Cassidy, J, Clarke, S, Diaz-Rubio, E, et al. (2008) Randomized phase III study of capecitabine plus oxaliplatin compared with fluorouracil/folinic acid plus oxaliplatin as first-line therapy for metastatic colorectal cancer. Journal of Clinical Oncology 26(12), 2006–2012.Google Scholar
Guerrini, I, Thomson, AD, and Gurling, HM. (2009) Molecular genetics of alcohol-related brain damage. Alcohol and Alcoholism 44(2), 166–170.Google Scholar
Harper, CG, Giles, M, and Finlay-Jones, R (1986) Clinical signs in the Wernicke-Korsakoff complex: A retrospective analysis of 131 cases diagnosed at necropsy. Journal of Neurology, Neurosurgery, and Psychiatry 49(4), 341–345.Google Scholar
Isenberg-Grzeda, E, Alici, Y, Hatzoglou, V, et al. (2016) Nonalcoholic thiamine-related encephalopathy (Wernicke-Korsakoff syndrome) among inpatients with cancer: A series of 18 cases. Psychosomatics 57(1), 71–81.Google Scholar
Isenberg-Grzeda, E, Hsu, AJ, Hatzoglou, V, et al. (2015) Palliative treatment of thiamine-related encephalopathy (Wernicke's encephalopathy) in cancer: A case series and review of the literature. Palliative & Supportive Care 13(5), 1–9.Google Scholar
Isenberg-Grzeda, E, Shen, MJ, Alici, Y, et al. (2017) High rate of thiamine deficiency among inpatients with cancer referred for psychiatric consultation: Results of a single site prevalence study. Psychooncology 26(9):1384–1389.Google Scholar
MacLean, LD, Rhode, BM, and Shizgal, HM. (1983) Nutrition following gastric operations for morbid obesity. Annals of Surgery 198(3), 347–355.Google Scholar
Oken, MM, Creech, RH, Tormey, DC, et al. (1982). Toxicity and response criteria of the Eastern Cooperative Oncology Group. American Journal of Clinical Oncology 5(6), 649–655.Google Scholar
Onishi, H, Ishida, M, Tanahashi, I, et al. (2017) Wernicke encephalopathy without delirium in patients with cancer. Palliative & Supportive Care 1–4.Google Scholar
Onishi, H, Ishida, M, Toyama, H, et al. (2016) Early detection and successful treatment of Wernicke encephalopathy in a patient with advanced carcinoma of the external genitalia during chemotherapy. Palliative & Supportive Care 14(3), 302–306.Google Scholar
Sechi, G, Batzu, L, Agro, L, et al. (2016a) Cancer-related Wernicke-Korsakoff syndrome. Lancet Oncology 17(6), e221–e222.Google Scholar
Sechi, G, Sechi, E, Fois, C, et al. (2016b) Advances in clinical determinants and neurological manifestations of B vitamin deficiency in adults. Nutrition Reviews 74(5), 281–300.Google Scholar
Sechi, G and Serra, A (2007) Wernicke's encephalopathy: New clinical settings and recent advances in diagnosis and management. Lancet Oncology 6(5), 442–455.Google Scholar
Shipton, MJ and Thachil, J (2015). Vitamin B12 deficiency - A 21st century perspective. Clinical Medicine (London, England) 15(2), 145–150.Google Scholar
Tabernero, J, Yoshino, T, Cohn, AL, et al. (2015) Ramucirumab versus placebo in combination with second-line FOLFIRI in patients with metastatic colorectal carcinoma that progressed during or after first-line therapy with bevacizumab, oxaliplatin, and a fluoropyrimidine (RAISE): A randomised, double-blind, multicentre, phase 3 study. Lancet Oncology 16(5), 499–508.Google Scholar
Thomson, AD, Marshall, EJ, and Guerrini, I (2010) Biomarkers for detecting thiamine deficiency--improving confidence and taking a comprehensive history are also important. Alcohol and Alcoholism 45(2), 213.Google Scholar
Victor, M, Adams, RD, and Collins, GH (1971) The Wernicke-Korsakoff syndrome. A clinical and pathological study of 245 patients, 82 with post-mortem examinations. Contemporary Neurology Series 7, 1–206.Google Scholar