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SC Absorption Failure in Oedema — SCE Palliative Medicine MCQ

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ModerateEnd of Life CareSC Absorption Failure in OedemaSCE Palliative Medicine

A dying patient’s syringe driver is running well, but the patient has become anuric with profound oedema. The CSCI site is swollen with poor drug absorption. What alternative route should be considered?

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Correct answer: A — Use intravenous administration if central access exists, or consider sublingual/buccal routes

In cases of anasarca, subcutaneous absorption is unreliable; dose escalation or increasing infusion rate does not correct the underlying impaired tissue perfusion. UK SmPCs advise that the subcutaneous route is unsuitable in oedematous patients. NICE recommends avoiding intramuscular injections and using intravenous when subcutaneous fails. Scottish Palliative Care Guidelines support mucosal routes—sublingual or buccal—for injectable formulations when subcutaneous routes are ineffective. Oral and topical routes are also unreliable in this context, making IV or mucosal routes the only defensible alternative.

Reference: Morphine Sulfate SmPC (subcutaneous route unsuitable in oedema), Scottish Palliative Care Guidelines 'Alternatives to syringe‑pump/subcutaneous route', NICE NG31 last days of life guidance