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Subclinical thiamine deficiency: What is the most appropriate method of diagnosis and treatment?

Published online by Cambridge University Press:  28 September 2020

Hideki Onishi Open the ORCID record for Hideki Onishi [Opens in a new window] ,
Nozomu Uchida Open the ORCID record for Nozomu Uchida [Opens in a new window] ,
Kumi Itami ,
Masakazu Sato ,
Saki Tamura ,
Akira Kurosaki  and
Mayumi Ishida Open the ORCID record for Mayumi Ishida [Opens in a new window]
Hideki Onishi
Affiliation:
Department of Psycho-Oncology, Saitama Medical University International Medical Center, Hidaka, Saitama, Japan
Nozomu Uchida
Affiliation:
Department of General Medicine, Ogano Town Central Hospital, Chichibu-gun, Saitama, Japan
Kumi Itami
Affiliation:
Department of Nursing, Saitama Medical University International Medical Center, Hidaka, Saitama, Japan
Masakazu Sato
Affiliation:
Department of Gynecologic Oncology, Saitama Medical University International Medical Center, Hidaka, Saitama, Japan
Saki Tamura
Affiliation:
Department of Gynecologic Oncology, Saitama Medical University International Medical Center, Hidaka, Saitama, Japan
Akira Kurosaki
Affiliation:
Department of Gynecologic Oncology, Saitama Medical University International Medical Center, Hidaka, Saitama, Japan
Mayumi Ishida*
Affiliation:
Department of Psycho-Oncology, Saitama Medical University International Medical Center, Hidaka, Saitama, Japan
*
Author for correspondence: Mayumi Ishida, Department of Psycho-oncology, Saitama Medical University International Medical Center, 1397-1 Yamane, Hidaka City, Saitama 350-1298, Japan. E-mail: [email protected]
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Abstract

Objectives

The symptoms of thiamine deficiency vary considerably and asymptomatic cases; i.e., subclinical thiamine deficiency (SCTD), are known to exist. However, there is no information available on the treatment of SCTD.

Methods

We report a patient who underwent intravenous thiamine replacement therapy for about a month after being diagnosed with SCTD, but who developed SCTD again about three weeks after finishing the treatment.

Results

The patient was a 64-year-old woman who, after starting treatment for cervical cancer, complained of anxiety and underwent an initial psychiatric examination. The psychiatric diagnosis was an adjustment disorder. Based on the possibility of SCTD complications due to her decreased appetite and weight loss, her serum thiamine concentration was measured and found to be low. Therefore, thiamine was administered intravenously for 29 days. At the end of treatment, thiamine administration was discontinued as there were no apparent neuropsychiatric symptoms or problems with appetite. Twenty-three days later, there were still no problems with appetite or neuropsychiatric symptoms, but a follow-up blood sample revealed that her serum thiamine was again below the normal range.

Significance of results

Currently, there is no information available regarding the diagnosis and treatment of SCTD in cancer patients. In some cases, such as this case, the deficiency recurs without any symptoms indicative of SCTD; therefore, further examination for diagnosis and treatment is necessary.

Keywords

CancerKorsakoff syndromeSubclinical thiamine deficiencyThiamineWernicke encephalopathy
Type
Case Report
Information
Palliative & Supportive Care , Volume 18 , Issue 5 , October 2020 , pp. 614 - 616
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Copyright
Copyright © The Author(s), 2020. Published by Cambridge University Press

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