A man in his 60s, who was diagnosed as having postoperative recurrent gastric cancer with lymph node and spinal metastases, was admitted to our palliative care unit (PCU). He was unable to receive further aggressive chemotherapy for cancer because of bilateral hydronephrosis and chronic renal failure. He had chronic urethral infection and hence required continuous antibiotic administration. Although his infection was well controlled with antibiotics, his oral intake gradually declined. Seventeen days after admission, he developed systemic hemorrhage, including hematuria and oral bleeding. Coagulation tests revealed that the patient had markedly prolonged prothrombin time (PT) and activated partial thromboplastin time (APTT) but no thrombocytopenia, fibrinogen consumption, or increased fibrin/fibrinogen degradation products (FDP) level. Serum level of protein induced by vitamin K absence or antagonist II (PIVKA-II) was markedly high, and vitamin K level was below the lower limit of the reference range. After he was administered intravenous vitamin K, his symptoms markedly improved. Many patients with advanced cancers tend to have malnutrition, anorexia, and chronic infection that require antibiotic administration. Prophylactic administration of vitamin K might be sometimes necessary for preventing catastrophic hemorrhage.

To investigate whether magnesium abnormalities are associated with the administration of magnesium-containing laxatives in a palliative care setting, we measured the serum magnesium levels in 48 patients with advanced cancer at our palliative care unit (PCU). The mean magnesium concentration in all patients was 2.09 mg/dl (confidence interval [CI], 1.38-3.62). Patients receiving magnesium-containing laxatives (n=38) showed significantly higher serum magnesium concentrations than patients without laxatives (n=10) (2.17 mg/dl vs 1.8 mg/dl, p=0.006). Although 10 patients had serum magnesium abnormalities (hypomagnesemia, 8 and hypermagnesemia, 2), we did not observe clinical manifestation associated with magnesium abnormalities. Interestingly, neither the duration nor the dose of laxatives correlated with serum magnesium concentration. Overall, patients at the PCU tend to have magnesium abnormalities and their symptoms may be analogous to those of advanced cancer patients; in particular, terminal patients with such symptoms might be considered to have magnesium abnormalities.