Use of opioids in patients with cancer with hepatic impairment-a systematic review.

Purpose: Opioids are recommended for moderate-to-severe cancer pain; however, in patients with cancer, impaired hepatic function can affect opioid metabolism. The aim of this systematic review was to evaluate the evidence for the use of opioids in patients with cancer with hepatic impairment.

Methods: A systematic review was conducted and the following databases searched: AMED (-2021), MEDLINE (-2021), EMBASECLASSIC + EMBASE (-2021) and Cochrane Central Register of Controlled Trials (-2021).

Lessons of the month: Pyroglutamic acidosis: long-term paracetamol and a high anion gap.

An 84-year-old woman presented with confusion and Kussmaul respiration. She had a history of urosepsis, renal impairment and osteoarthrosis. The venous blood gas showed a marked metabolic acidosis with a high anion gap.