According to the Journal of Pain and Palliative Care Pharmacology, 25–88% of all hospice patients, caregivers, and hospice staff will observe significant changes in a patient's behaviors. Some of the changes include picking at sheets or Depends, restlessness movements of the arms and legs, confusion, tight clutching at caregiver's hands, and twitching and jerking. These signs are usually categorized as terminal restlessness. Sometimes, the cause is a medical condition that can be treated.

Objective: Although Wernicke encephalopathy has been reported in the oncological literature, it has not previously been reported in postoperative cancer patients.

Methods: In this communication, we report a patient of hepatocellular carcinoma with liver cirrhosis who developed Wernicke encephalopathy in the form of postoperative delirium. Preoperatively, the patient had a very good appetite and had eaten all the food of an 1800 cal/day diet until 1 day before operation. The operation was done without any complications. The patient developed delirium 2 days after the lobectomy of the liver. The level of delirium remained unchanged until administration of thiamine starting on day 7 postoperatively, which resulted in palliation of delirium without brain damage. Laboratory data demonstrated that the serum thiamine level at day 6 postoperatively was below the lower limit of normal. As the mechanism of Wernicke encephalopathy, we thought that decreased ability to store thiamine due to liver cirrhosis led to depletion of thiamine faster than had been expected.

Results and significance of the research: In cancer patients, clinicians must always remain aware of the possibility of Wernicke encephalopathy, especially in patients with liver dysfunction, which decreases the ability to store thiamine in the liver. Early detection and intervention may alleviate the symptoms of delirium and prevent irreversible brain damage.

Meaning In Madness.

Poem: The Old Man

Clinical update: Literature abstracts.

Clinical updates: Literature abstracts.

Clinical update: Literature abstracts.

Prayer for Cicely.

Calendar of events.

Clinical update: Literature abstracts.

Calendar of events.

Calendar of events.

Calendar of events.