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Thiamine deficiency as a cause of anorexia in terminally ill cancer patients: A case of possible gastrointestinal beriberi

Published online by Cambridge University Press:  20 March 2024

Eriko Hayashi*
Affiliation:
Nursing Course, School of Medicine, Yokohama City University, Yokohama, Kanagawa, Japan Department of Nursing, Fujisawa Shounandai Hospital, Fujisawa-shi, Kanagawa, Japan
Tetsuya Matuura
Affiliation:
Department of Palliative Care Unit, Fujisawa Shounandai Hospital, Fujisawa-shi, Kanagawa, Japan
Junko Takano
Affiliation:
Department of Palliative Care Unit, Fujisawa Shounandai Hospital, Fujisawa-shi, Kanagawa, Japan
Kaori Morofushi
Affiliation:
Department of Palliative Care Unit, Fujisawa Shounandai Hospital, Fujisawa-shi, Kanagawa, Japan
Kaori Toriizuka
Affiliation:
Department of Palliative Care Unit, Fujisawa Shounandai Hospital, Fujisawa-shi, Kanagawa, Japan
Hideki Onishi
Affiliation:
Department of Psycho-oncology, Saitama Medical University International Medical Center, Hidaka City, Saitama, Japan
*
Corresponding author: Eriko Hayashi; Email: erieritn@yahoo.co.jp

Abstract

Objectives

Anorexia in cancer patients has a variety of causes and impairs patients’ quality of life. However, there have been few reports of thiamine deficiency (TD) playing a role in anorexia during palliative care. The objective of this report was to describe such a case.

Methods

An 82-year-old woman with advanced cervical cancer was admitted for palliative care because of progressive disease. One month after admission, she developed myoclonus on the left side, difficulty speaking, slurred speech, and drooping of the left corner of the mouth, with no consciousness disturbance. She also developed nausea and complained of decreased dietary intake for more than 2 weeks.

Results

The patient’s thiamine level, which had been measured 2 weeks earlier, was 27 ng/ml, which was below the normal range, and 100 mg of thiamine was administered intravenously. After 2 hours, the patient’s neurological findings resolved, and her dietary intake improved from 30% to 40% of meals to 90% to 100%. Subsequently, the patient did not experience similar symptoms, and her clinical course was stable. Based on the patient’s clinical course, gastrointestinal beriberi was diagnosed.

Significance of results

This case shows that TD may cause anorexia. Many patients who receive palliative care have decreased dietary intake. Consequently, such patients may present with gastrointestinal beriberi, as in the present case. Appropriate diagnosis and treatment may contribute to increasing such patients’ quality of life. It may be necessary to differentiate TD from other conditions as a cause of anorexia in patients receiving palliative care.

Type
Case Report
Copyright
© The Author(s), 2024. Published by Cambridge University Press.

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References

Amano, K, Maeda, I, Morita, T, et al. (2017) C-reactive protein, symptoms and activity of daily living in patients with advanced cancer receiving palliative care. Journal of Cachexia, Sarcopenia and Muscle 8(3), 457465. doi:10.1002/jcsm.12184CrossRefGoogle ScholarPubMed
Attaluri, P, Castillo, A, Edriss, H, et al. (2018) Thiamine deficiency: An important consideration in critically ill patients. The American Journal of the Medical Sciences 356(4), 382390. doi:10.1016/j.amjms.2018.06.015CrossRefGoogle ScholarPubMed
Francis, J, Martin, D and Kapoor, WN (1990) A prospective study of delirium in hospitalized elderly. JAMA 263(8), 10971101. doi:10.1001/jama.1990.03440080075027CrossRefGoogle ScholarPubMed
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 & Psychiatry 49(4), 341345. doi:10.1136/jnnp.49.4.341CrossRefGoogle ScholarPubMed
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 and Supportive Care 13(5), 12411249. doi:10.1017/s1478951514001163CrossRefGoogle Scholar
Ishida, M, Sato, S, Sato, I, et al. (2024) What can cause cancer patients to attempt suicide? Thiamine deficiency mimicking the symptoms of major depressive disorder. Palliative and Supportive Care 22, 205208. doi:10.1017/s1478951523001128CrossRefGoogle ScholarPubMed
Onishi, H, Ishida, M, Tanahashi, I, et al. (2018) Subclinical thiamine deficiency in patients with abdominal cancer. Palliative and Supportive Care 16(4), 497499. doi:10.1017/s1478951517000992CrossRefGoogle ScholarPubMed
Onishi, H, Sato, I, Uchida, N, et al. (2021) High proportion of thiamine deficiency in referred cancer patients with delirium: A retrospective descriptive study. European Journal of Clinical Nutrition 75(10), 14991505. doi:10.1038/s41430-021-00859-9CrossRefGoogle ScholarPubMed
Onishi, H, Uchida, N, Yoshioka, A, et al. (2022) Clinical diagnosis, outcomes and treatment of thiamine deficiency in a tertiary hospital. Clinical Nutrition 41(9), 20522053. doi:10.1016/j.clnu.2022.07.009CrossRefGoogle ScholarPubMed
Sechi, G, Sechi, E, Fois, C, et al. (2016) Advances in clinical determinants and neurological manifestations of B vitamin deficiency in adults. Nutrition Reviews 74(5), 281300. doi:10.1093/nutrit/nuv107CrossRefGoogle ScholarPubMed
Sechi, G and Serra, A (2007) Wernicke’s encephalopathy: New clinical settings and recent advances in diagnosis and management. The Lancet Neurology 6(5), 442455. doi:10.1016/s1474-4422(07)70104-7CrossRefGoogle ScholarPubMed
Seto, N, Ishida, M, Hamano, T, et al. (2022) A case of Wernicke encephalopathy arising in the early stage after the start of hemodialysis. CEN Case Reports 11(3), 314320. doi:10.1007/s13730-021-00669-9CrossRefGoogle ScholarPubMed
Uchida, N, Ishida, M, Yoshioka, A, et al. (2023a) Can depressed cancer patients with a borderline thiamine concentration develop deficiency within a short time period? Palliative and Supportive Care 21(4), 768771. doi:10.1017/S1478951522001808CrossRefGoogle ScholarPubMed
Uchida, N, Ishida, M, Yoshioka, A, et al. (2023b) Investigation of whole blood thiamine concentration in independently ambulatory residents of a provincial town in Japan: A cross-sectional study. Cureus 15(5), . doi:10.7759/cureus.38800Google ScholarPubMed