Antineoplastics
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Reactions 688 - 14 Feb 1998 S Antineoplastics Encephalopathy and hyperammonaemia: case report A 16-year-old boy, who developed acute idiopathic hyperammonaemia and encephalopathy after high-dose antineoplastic treatment for acute lymphoblastic leukaemia, was successfully treated with ammonia-trapping agents. The patient received pulse induction therapy with vincristine 1.5 mg/m 2 , cyclophosphamide 300 mg/m 2 , cytarabine 3380 mg/m 2 , prednisone 40 mg/m 2 and asparaginase 10 000 IU/m 2 . He developed abdominal pain and asparaginase-induced pancreatitis was diagnosed, which was treated with parenteral nutrition, bowel rest, analgesics and antibacterials. On hospital day 8, the boy received intrathecal cytarabine 30mg, hydrocortisone 15mg and methotrexate 15mg. Two days later, he became lethargic, irritable and began to behave inappropriately. On hospital day 11, his serum ammonia level was 322 µm/L (normal 11–35), his serum AST level was 38 IU/L, his serum ALT level was 70 IU/L and his prothrombin time was 12.6 sec. The patient was treated with sodium phenylacetate and sodium benzoate 2.5g every 6 hours via a nasogastric tube and amino acids were excluded from his total parenteral nutrition. His serum ammonia level decreased abruptly and his mental status improved. The treatment was tapered from hospital days 17–19 and the boy tolerated subsequent antineoplastic therapy with no further episodes of hyperammonaemia. Author comment: ‘Because of the high fatality rate associated with this syndrome, early recognition and institution of specific ammonia-lowering agents is imperative. A review of previous cases and our own experience suggests that early treatment before the ammonia level reaches 350 µmol/L may improve the prognosis.’ del Rosario M, et al. Hyperammonemic encephalopathy after chemotherapy: survival after treatment with sodium benzoate and sodium phenylacetate. Journal of Clinical Gastroenterology 25: 682-684, Dec 1997 - USA 800634710 1 Reactions 14 Feb 1998 No. 688 0114-9954/10/0688-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved
Transcript of Antineoplastics
Reactions 688 - 14 Feb 1998
SAntineoplastics
Encephalopathy and hyperammonaemia: casereport
A 16-year-old boy, who developed acute idiopathichyperammonaemia and encephalopathy after high-doseantineoplastic treatment for acute lymphoblastic leukaemia,was successfully treated with ammonia-trapping agents.
The patient received pulse induction therapy with vincristine1.5 mg/m2, cyclophosphamide 300 mg/m2, cytarabine 3380mg/m2, prednisone 40 mg/m2 and asparaginase 10 000 IU/m2.He developed abdominal pain and asparaginase-inducedpancreatitis was diagnosed, which was treated with parenteralnutrition, bowel rest, analgesics and antibacterials.
On hospital day 8, the boy received intrathecal cytarabine30mg, hydrocortisone 15mg and methotrexate 15mg. Twodays later, he became lethargic, irritable and began to behaveinappropriately. On hospital day 11, his serum ammonia levelwas 322 µm/L (normal 11–35), his serum AST level was 38IU/L, his serum ALT level was 70 IU/L and his prothrombintime was 12.6 sec.
The patient was treated with sodium phenylacetate andsodium benzoate 2.5g every 6 hours via a nasogastric tube andamino acids were excluded from his total parenteral nutrition.His serum ammonia level decreased abruptly and his mentalstatus improved. The treatment was tapered from hospitaldays 17–19 and the boy tolerated subsequent antineoplastictherapy with no further episodes of hyperammonaemia.
Author comment: ‘Because of the high fatality rateassociated with this syndrome, early recognition and institutionof specific ammonia-lowering agents is imperative. A review ofprevious cases and our own experience suggests that earlytreatment before the ammonia level reaches 350 µmol/L mayimprove the prognosis.’del Rosario M, et al. Hyperammonemic encephalopathy after chemotherapy:survival after treatment with sodium benzoate and sodium phenylacetate. Journalof Clinical Gastroenterology 25: 682-684, Dec 1997 - USA 800634710
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Reactions 14 Feb 1998 No. 6880114-9954/10/0688-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved
