ABSTRACT
A 72-year-old female was admitted with severe calciphylaxis-associated bilateral leg pain on a background of end-stage renal failure on hemodialysis. Palliative care input was requested, and following transfer to our unit she was commenced on low-dose methadone as adjunctive analgesic therapy. A remarkable and sustained analgesic response was observed. Calciphylaxis is associated with severe pain, and careful consideration of analgesic agents and their pharmacokinetics in patients with end-stage renal failure is required.
ABSTRACT
Palliative care patients experience seizures in different stages of their disease and may not tolerate oral medications toward the end of life. Subcutaneous infusions of levetiracetam and sodium valproate are increasingly used off-label. This retrospective analysis (conducted from January 2019 to July 2020 in Australia) reports the effectiveness and adverse effects of levetiracetam and sodium valproate delivered via subcutaneous infusion. The doses ranged from 500 to 3000 mg/d of levetiracetam and 500 to 2500 mg/d of sodium valproate. The concentrations ranged from 20 to 83 mg/mL of levetiracetam and 20 to 50 mg/mL of sodium valproate. Subcutaneous levetiracetam was given for a median duration of 6.5 days, with no seizure recurrences in 75% of patients and no reported adverse effects in any patients. Subcutaneous sodium valproate was given for a median duration of 3.5 days, with no reported seizure recurrences in 83% of patients and one report of a localized skin reaction. This analysis suggests that subcutaneous levetiracetam and sodium valproate can effectively control seizures in palliative care populations, with minimal localized reactions.
Subject(s)
Piracetam , Valproic Acid , Humans , Levetiracetam/therapeutic use , Valproic Acid/adverse effects , Anticonvulsants/adverse effects , Palliative Care , Retrospective Studies , Piracetam/adverse effects , Treatment Outcome , Seizures/chemically induced , Seizures/drug therapyABSTRACT
BACKGROUND: Nausea and vomiting are two interrelated distressing symptoms experienced by patients with malignancies. They are multifactorial in aetiology. CASE PRESENTATION: A middle-aged woman diagnosed with bilateral ovarian malignancy had undergone chemotherapy and was suffering nausea and vomiting, and was responding to basic therapeutic measures. CASE MANAGEMENT: She was resistant to treatment with metoclopramide that was commenced by the oncology team, as for any patient with nausea and vomiting. This report examines a 'mechanistic' approach to nausea management and life-style modifications. CASE OUTCOME: Within 2 days of the evidence-based revision of her management plan, the patient expressed that she had experienced a significant symptomatic relief and an improvement in her general wellbeing. CONCLUSION: The early identification of the most probable causative factors of nausea and vomiting in patients with advanced malignancies will lead to significant improvements in their quality of life and save time and resources.
Subject(s)
Antiemetics , Nausea , Neoplasms , Palliative Care , Vomiting , Antiemetics/therapeutic use , Female , Humans , Middle Aged , Nausea/drug therapy , Nausea/etiology , Neoplasms/complications , Neoplasms/drug therapy , Quality of Life , Vomiting/drug therapy , Vomiting/etiologyABSTRACT
Subcutaneous patient-controlled analgesia (SCPCA) is an underutilized method of pain management in palliative care patients. In a select group of patients, including patients in whom enteral analgesia is ineffective or undeliverable, and in patients with limited access to healthcare due to geographical or other logistic issues, SCPCA can provide an effective and safe alternative.