Practice Lesson of the Week

Life saving treatment for a “palliative care” patient

BMJ 2008; 337 doi: http://dx.doi.org/10.1136/bmj.39563.581377.80 (Published 29 July 2008) Cite this as: BMJ 2008;337:a428
  1. Jane Gibbins, specialist registrar and clinical research fellow,
  2. Gaye Senior Smith, clinical nurse specialist,
  3. Karen Forbes, consultant and macmillan professorial teaching fellow
  1. 1Department of Palliative Medicine, Bristol Haematology and Oncology Centre, Bristol BS2 8ED
  1. Correspondence to: J Gibbins janegibbins{at}hotmail.com
  • Accepted 3 April 2008

A “palliative care” label should not prevent life saving treatment for an illness with reversible cause

The word palliative is used in different ways in different contexts. Lack of clarity about its meaning can lead to confusion about the role of palliative care teams and the appropriateness of active management in a patient’s care.

Case report

A 60 year old woman was diagnosed with a rare haemangioendothelioma of the lung with liver, bone, and lung metastases in April 2004. She was referred to the outpatient clinic run by our specialist hospital palliative care team in December 2006 by her respiratory physician. Although she was extremely independent, she had severe right upper quadrant pain, which was consistent with liver capsular distension secondary to liver metastases. She had tried non-steroidal anti-inflammatory drugs and steroids with no effect. Her pain responded to opioids. Her morphine was increased, and pain was controlled by 550 mg modified release morphine twice daily, with no opioid side effects.

She remained stable with no changes in her medication. In June 2007 she was admitted to hospital with a two week history of severe diarrhoea (10 to 15 times a day) and vomiting. On examination her Glasgow coma score was 12/15, and both her arms and legs were twitching. She was confused, hallucinating, and dehydrated and had a temperature of 36.6°C. She was tachycardic (pulse 130 beats per minute) with a blood pressure of 117/86 mm Hg.

The working diagnosis was acute renal failure secondary to prolonged diarrhoea …

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