International Journal of Case Reports and Images - IJCRI - Case Reports, Case Series, Case in Images, Clinical Images

   
Case Report
 
A case report on the use of oral thiamine in a palliative care patient in the management of peripheral edema in a community setting in New South Wales, Australia
Tai Vicki
MB. ChB, BAO (NUI), LRCPI&SI, FRACP, FAChPM, FRCP(Glasg), Staff Specialist, Central Coast Palliative Care Services, New South Wales, Australia; Conjoint Fellow, School of Medicine and Public Health, The University of Newcastle, New South Wales, Australia

doi:10.5348/ijcri-201603-CR-10590

Address correspondence to:
Vicki May Ling Tai
Central Coast Palliative Care Service, Killarney Vale
NSW, Australia
NSW 2261

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How to cite this article
Tai VML. A case report on the use of oral thiamine in a palliative care patient in the management of peripheral edema in a community setting in New South Wales, Australia. Int J Case Rep Images 2016;7(1):15–17.


Abstract
Introduction: Thiamine deficiency may present insidiously and has a spectrum of symptoms. Whilst outbreaks occur in developing countries, select communities in developed countries are also susceptible. Body stores of thiamine are low and depleted easily. Initially, deficiency may present with anorexia, malaise, generalized weakness and paresthesias with edema and palpitations. Over time it may progress to frank peripheral neuropathy and cardiac involvement [1]. Palliative care patients are frail, often malnourished with weight loss with catabolic states contributing to deficiency of micronutrients. Symptoms as described are often attributed to underlying disease or treatment received. A previous study found high rates of thiamine deficiency in terminally ill patients admitted to a palliative care unit [2]
Case Report: A 42-year-old Aboriginal Australian male community based palliative care patient with peripheral edema affecting quality of life and access of subcutaneous sites for medications received thiamine supplementation. This resulted in improvement of edema, access of subcutaneous sites for medications and most importantly patient satisfaction and comfort.
Conclusion: Thiamine deficiency should be considered in the frail, malnourished. Presentation may be insidious and symptoms may be overlooked in those who are palliative. Supplementation is inexpensive. Biochemical verification is not always feasible and for practical reasons often supplementation precedes detection. More research needs to be done in this area.

Keywords: Edema, Malnourished, Micronutrient, Palliative, Thiamine deficiency


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Author Contributions
Vicki May Ling Tai – Substantial contributions to conception and design, Acquisition of data, Analysis and interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Guarantor of submission
The corresponding author is the guarantor of submission.
Source of support
None
Conflict of interest
Authors declare no conflict of interest.
Copyright
© 2016 Vicki May Ling Tai. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.



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