ABSTRACT
Alkaline phosphatase (ALP) has been measured using a Japan-specific method in Japan. However, the Japan Society of Clinical Chemistry (JSCC) has decided to change to an international standardized method of International Federation of Clinical Chemistry and Laboratory Medicine (IFCC) by the end of fiscal year 2020. The Prognosis in Palliative care Study predictor (PiPS) models were the prognosis predictor methods developed in the UK. The ALP value is included in the test items of PiPS-B of the PiPS models. The international standardization method was not used in previous reports about PiPS in Japan. In this study, we investigated the effect of changing measurement methods of ALP levels on the prognostic value of PiPS using IFCC conversion values. We performed prognostic prediction by PiPS models in 239 consecutive patients admitted to our palliative care unit from March 2019 to March 2021. In 98 PiPS-B calculated patients, the prognosis was recalculated by replacing ALP values with the JSCC recommended conversion values. 5 of 98 patients whose prognosis was “weeks” changed to “months+”. It was suggested that a change in the method of ALP measurement from JSCC to IFCC method may change the “weeks” prognosis prediction by PiPS to a “months+”.
ABSTRACT
This retrospective study investigated the incidence of subcutaneous induration induced by hydromorphone citrate (HM) and haloperidol (HPD). From September 2018 to December 2019, 75 consecutive patients admitted to our palliative care unit were enrolled. A total of 177 subcutaneous injection sight reactions were assessed from the study initiation to data collection. Patients were then classified into three groups: group A, administered HM + normal saline (NS); group B, administered HM + HPD + NS; and group C, administered HM + HPD + 5% glucose water (Glu). Subcutaneous indurations were observed 29 times at the median of 71.0 (27–151) h. The incidence rates of subcutaneous induration were 4.7% (4/86), 39.1% (18/46), and 15.6% (7/45) in groups A, B, and C, respectively. A significant difference in this rate was observed between groups A and B and between groups B and C. The incidence rates of subcutaneous induration were low in the HM + NS group, but it rose by the addition of haloperidol significantly. Changing from NS to Glu as dilution liquid for HM + HPD decreased subcutaneous induration incidence.
ABSTRACT
We report that the discontinuation of haloperidol during subcutaneous infusion therapy with hydromorphone citrate led to the improvement of subcutaneous induration. A 70-year-old female was admitted to our palliative care unit with neck pain. She had neck lymph node metastasis from carcinoma of unknown origin. As subcutaneous infusion of hydromorphone citrate caused nausea, we administered haloperidol with hydromorphone citrate in normal saline. The infusion sites after 4, 9, and 11 days were changed because of subcutaneous induration, which we considered to be caused by haloperidol. After discontinuation of haloperidol, induration at the infusion site was not observed.
ABSTRACT
We report that switching from high concentration morphine citrate to high concentration hydromorphone citrate was effective at reducing the frequency of subcutaneous induration due to subcutaneous infusion and relieving pain. A 66-year-old male was admitted to our palliative care unit with neck pain. He was suffering from neck lymph node metastasis from a carcinoma of unknown origin. We administered a subcutaneous infusion of high concentration morphine citrate (40 mg/ml); however, the infusion site had to be changed about every 3 days because subcutaneous induration occurred and pain-relieving effect of the drug was attenuated. After switching to high concentration hydromorphone citrate (10 mg/ml) diluted to 40%, we no longer needed to change the infusion site due to the drug’s osmolality and the fact that it was a weak irritant and its pH was normalized by its dilution with normal saline. It is worth switching from high concentration morphine citrate to high concentration hydromorphone citrate in terminally ill cancer patients who need subcutaneous infusions of high dose opioids.