Hostname: page-component-78c5997874-m6dg7 Total loading time: 0 Render date: 2024-11-19T16:08:05.909Z Has data issue: false hasContentIssue false
  • English
  • Français

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]
Get access Rights & Permissions [Opens in a new window]

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
Check for updates
Copyright
Copyright © The Author(s), 2020. Published by Cambridge University Press

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

REFERENCES

American Psychiatric Association (2013) Diagnostic and Statistical Manual of Mental Disorders, 5th ed. Washington, DC: American Psychiatric Publishing.Google Scholar
Day, E, Bentham, PW, Callaghan, R, et al. (2013) Thiamine for prevention and treatment of Wernicke-Korsakoff Syndrome in people who abuse alcohol. Cochrane Database of Systematic Reviews 2013(7), Cd004033.Google Scholar
Galvin, R, Brathen, G, Ivashynka, A, et al. (2010) EFNS guidelines for diagnosis, therapy and prevention of Wernicke encephalopathy. European Journal of Neurology 17(12), 1408–1418.CrossRefGoogle ScholarPubMed
Green, JA, Kirwan, JJ, Tierney, J, et al. (2005) Concomitant chemotherapy and radiation therapy for cancer of the uterine cervix. Cochrane Database of Systematic Reviews (3), CD002225. doi:10.1002/14651858.CD002225.pub2.Google 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, and Psychiatry 49(4), 341–345.CrossRefGoogle ScholarPubMed
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 ScholarPubMed
MacLean, LD, Rhode, BM and Shizgal, HM (1983) Nutrition following gastric operations for morbid obesity. Annals of Surgical 198(3), 347–355.CrossRefGoogle ScholarPubMed
Onishi, H, Ishida, M, Tanahashi, I, et al. (2017) Subclinical thiamine deficiency in patients with abdominal cancer. Palliative & Supportive Care 16(4), 497–499.CrossRefGoogle ScholarPubMed
Onishi, H, Ishida, M, Uchida, N, et al. (2019) Subclinical thiamine deficiency identified by preoperative evaluation in an ovarian cancer patient: Diagnosis and the need for preoperative thiamine measurement. Palliative & Supportive Care 17(5), 609–610.CrossRefGoogle Scholar
Onishi, H, Okabe, T, Uchida, N, et al. (2020) Thiamine deficiency in a patient with recurrent renal cell carcinoma who developed weight loss with normal appetite and loss of energy soon after nivolumab treatment. Palliative & Supportive Care 18(2), 241–243.CrossRefGoogle Scholar
Rose, PG, Ali, S, Watkins, E, et al. (2007) Long-term follow-up of a randomized trial comparing concurrent single agent cisplatin, cisplatin-based combination chemotherapy, or hydroxyurea during pelvic irradiation for locally advanced cervical cancer: A Gynecologic Oncology Group Study. Journal of Clinical Oncology 25(19), 2804–2810.CrossRefGoogle ScholarPubMed
Sechi, G (2020) Concerning “Genetic defects of thiamine transport and metabolism: a review of clinical phenotypes, genetics and functional studies” by Marcé-Grau et al. Journal of Inherited Metabolic Disease 43(2), 159–160.CrossRefGoogle ScholarPubMed
Sechi, G and Serra, A (2007) Wernicke's encephalopathy: new clinical settings and recent advances in diagnosis and management. Lancet Neurology 6(5), 442–455.CrossRefGoogle ScholarPubMed
Sechi, G, Batzu, L, Agro, L, et al. (2016a) Cancer-related Wernicke-Korsakoff syndrome. The Lancet Oncology 17(6), e221–e222.CrossRefGoogle 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.CrossRefGoogle Scholar
Thomson, AD, Cook, CC, Touquet, R, et al. (2002) The Royal College of Physicians report on alcohol: guidelines for managing Wernicke's encephalopathy in the Accident and Emergency Department. Alcohol Alcohol 37(6), 513–521.CrossRefGoogle ScholarPubMed
Toita, T, Kitagawa, R, Hamano, T, et al. (2012) Phase II study of concurrent chemoradiotherapy with high-dose-rate intracavitary brachytherapy in patients with locally advanced uterine cervical cancer: efficacy and toxicity of a low cumulative radiation dose schedule. Gynecologic Oncology 126(2), 211–216.CrossRefGoogle ScholarPubMed