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

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.