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Thiamine deficiency in the outpatient psychiatric oncology setting: A case series

Published online by Cambridge University Press:  12 October 2020

Rose Zhang ,
Sudhakar Tummala  and
Deepti Chopra Open the ORCID record for Deepti Chopra [Opens in a new window]
Rose Zhang
Affiliation:
PGY4 General Psychiatry Resident, UT Health Science Center of Houston, McGovern Medical School, Houston, TX
Sudhakar Tummala
Affiliation:
Department of Neuro-oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
Deepti Chopra*
Affiliation:
Department of Psychiatry, The University of Texas MD Anderson Cancer Center, Houston, TX
*
Author for correspondence: Deepti Chopra, Department of Psychiatry, 1400 Pressler Street, Houston, TX 77025, USA. E-mail: dachopra@mdanderson.org
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Abstract

Objective

B vitamins are essential for the functioning of the nervous system. Vitamin B1 (thiamine) deficiency is associated with neuropsychiatric syndromes such as Wernicke's encephalopathy (WE), which, if untreated, has an estimated mortality of 17–20%. Although the prevalence of thiamine deficiency in the general population is difficult to estimate, it is being increasingly recognized in oncology, especially in the inpatient setting. We describe three cases of thiamine deficiency (TD) in the outpatient psychiatric oncology setting.

Method

Retrospective chart review of three adult patients, who were seen in the psychiatric oncology clinic and found to have TD on laboratory testing, was done. Patient, disease, and thiamine treatment-related information were obtained, and descriptive statistics were used to analyze the data.

Results

The average age was 59 years, mean body mass index (BMI) was 22.00 ± 4.58 (mean ± SD), and mean thiamine level was 59.10 ± 7.69 that ranged from 45 to 68 nmol/L (normal thiamine level reference: 70–180 nmol/L). None of the patients had brain imaging nor cerebrospinal fluid analysis. Risk factors such as unbalanced nutrition, prior GI surgery, renal disease, and chemotherapy were noted.

Significance of results

TD can have a multifactorial etiology in oncology. Identification of TD in both inpatient and outpatient setting is important. Our report highlights how early identification of TD in the outpatient setting can help prevent further clinical progression.

Keywords

CancerOncologyThiamineVitamin B1
Type
Case Report
Information
Palliative & Supportive Care , Volume 18 , Issue 5 , October 2020 , pp. 609 - 613
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Copyright
Copyright © The Author(s), 2020. Published by Cambridge University Press

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References

REFERENCES

Aksoy, M, Basu, TK, Brient, J, et al. (1980) Thiamin status of patients treated with drug combinations containing 5-fluorouracil. European Journal of Cancer 16, 1041–1045.CrossRefGoogle ScholarPubMed
Antunez, E, Estruch, R, Cardenal, C, et al. (1998) Usefulness of CT and MR imaging in the diagnosis of acute Wernicke's encephalopathy. American Journal of Roentgenology 171, 1131–1137.CrossRefGoogle Scholar
Boros, LG, Brandes, JL, Lee, WN, et al. (1998) Thiamine supplementation to cancer patients: A double edged sword. Anticancer Research 18, 595–602.Google ScholarPubMed
Caine, D, Halliday, GM, Kril, JJ, et al. (1997) Operational criteria for the classification of chronic alcoholics: Identification of Wernicke's encephalopathy. Journal of Neurology, Neurosurgery, and Psychiatry 62, 51–60.CrossRefGoogle ScholarPubMed
Cefalo, MG, De Ioris, MA, Cacchione, A, et al. (2014) Wernicke encephalopathy in pediatric neuro-oncology: Presentation of 2 cases and review of literature. Journal of Child Neurology 29, Np181-5.Google ScholarPubMed
Dantzer, R, O'Connor, CJ, Freund, GG, et al. (2008) From inflammation to sickness and depression: When the immune system subjugates the brain. Nature Reviews Neuroscience 9, 46–56.CrossRefGoogle ScholarPubMed
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, Cd004033.Google Scholar
Galvin, R, Bråthen, G, Ivashynka, A, et al. (2010) EFNS guidelines for diagnosis, therapy and prevention of Wernicke encephalopathy. European Journal of Neurology 17, 1408–1418.CrossRefGoogle 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, 341–345.CrossRefGoogle ScholarPubMed
Isenberg-Grzeda, E, Alici, Y, Hatzoglou, V, et al. (2016a) Nonalcoholic thiamine-related encephalopathy (Wernicke-Korsakoff syndrome) among inpatients with cancer: A series of 18 cases. Psychosomatics 57, 71–81.CrossRefGoogle Scholar
Isenberg-Grzeda, E, Rahane, S, DeRosa, AP, et al. (2016b) Wernicke-Korsakoff syndrome in patients with cancer: A systematic review. Lancet Oncology 17, e142–e148.CrossRefGoogle Scholar
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. Psycho-Oncology 26, 1384–1389.CrossRefGoogle ScholarPubMed
Kuo, SH, Debnam, JM, Fuller, GN, et al. (2009) Wernicke's encephalopathy: An underrecognized and reversible cause of confusional state in cancer patients. Oncology 76, 10–18.CrossRefGoogle ScholarPubMed
Kwon, KA, Kwon, HC, Kim, MC, et al. (2010) A case of 5-fluorouracil induced encephalopathy. Cancer Research and Treatment 42, 118–120.CrossRefGoogle ScholarPubMed
Mitchell, AJ, Chan, M, Bhatti, H, et al. (2011) Prevalence of depression, anxiety, and adjustment disorder in oncological, haematological, and palliative-care settings: A meta-analysis of 94 interview-based studies. Lancet Oncology 12, 160–174.CrossRefGoogle ScholarPubMed
Nakamura, ZM, Tatreau, JR, Rosenstein, DL, et al. (2018) Clinical characteristics and outcomes associated with high-dose intravenous thiamine administration in patients with encephalopathy. Psychosomatics 59, 379–387.CrossRefGoogle ScholarPubMed
Nielsen, MJ, Rasmussen, MR, Andersen, CB, et al. (2012) Vitamin B12 transport from food to the body's cells – A sophisticated, multistep pathway. Nature Reviews Gastroenterology & Hepatology 9, 345–354.CrossRefGoogle Scholar
Onishi, H, Ishida, M, Kagamu, H, et al. (2018a) Wernicke encephalopathy in a lung cancer patient during treatment with nivolumab. Palliative and Supportive Care 17(2), 245–247.CrossRefGoogle Scholar
Onishi, H, Ishida, M, Takahashi, T, et al. (2018b) Wernicke encephalopathy without delirium that appeared as agitation in a patient with lung cancer. Palliative and Supportive Care 16, 800–802.CrossRefGoogle Scholar
Onishi, H, Ishida, M, Tanahashi, I, et al. (2018c) Early detection and successful treatment of Wernicke's encephalopathy in outpatients without the complete classic triad of symptoms who attended a psycho-oncology clinic. Palliative and Supportive Care 16, 633–636.CrossRefGoogle Scholar
Onishi, H, Ishida, M, Tanahashi, I, et al. (2018d) Subclinical thiamine deficiency in patients with abdominal cancer. Palliative and Supportive Care 16, 497–499.CrossRefGoogle Scholar
Onishi, H, Ishida, M, Tanahashi, I, et al. (2018e) Wernicke encephalopathy without delirium in patients with cancer. Palliative and Supportive Care 16, 118–121.CrossRefGoogle Scholar
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 and Supportive Care 17, 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 and Supportive Care 18, 241–243.CrossRefGoogle Scholar
Pelgrims, J, De Vos, F, Van den Brande, J, et al. (2000) Methylene blue in the treatment and prevention of ifosfamide-induced encephalopathy: Report of 12 cases and a review of the literature. British Journal of Cancer 82, 291–294.CrossRefGoogle Scholar
Pirzada, NA, Ali, II and Dafer, RM (2000) Fluorouracil-induced neurotoxicity. Annals of Pharmacotherapy 34, 35–38.CrossRefGoogle ScholarPubMed
Restivo, A, Carta, MG, Farci, AMG, et al. (2016) Risk of thiamine deficiency and Wernicke's encephalopathy after gastrointestinal surgery for cancer. Supportive Care in Cancer 24, 77–82.CrossRefGoogle ScholarPubMed
Sanvisens, A, Zuluaga, P, Fuster, D, et al. (2017) Long-term mortality of patients with an alcohol-related Wernicke-Korsakoff syndrome. Alcohol and Alcoholism 52, 466–471.CrossRefGoogle ScholarPubMed
Sechi, G and Serra, A (2007) Wernicke's encephalopathy: New clinical settings and recent advances in diagnosis and management. Lancet Neurology 6, 442–455.CrossRefGoogle ScholarPubMed
Thomson, AD and Marshall, EJ (2006) The natural history and pathophysiology of Wernicke's encephalopathy and Korsakoff's psychosis. Alcohol and Alcoholism 41, 151–158.CrossRefGoogle ScholarPubMed
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 and Alcoholism 37, 513–521.CrossRefGoogle ScholarPubMed
Zuccoli, G, Santa Cruz, D, Bertolini, M, et al. (2009) MR imaging findings in 56 patients with Wernicke encephalopathy: Nonalcoholics may differ from alcoholics. American Journal of Neuroradiology 30, 171–176.CrossRefGoogle ScholarPubMed