Antineoplastics
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Reactions 1417 - 1 Sep 2012 S Antineoplastics Hyperammonaemic encephalopathy: 2 case reports Two patients developed hyperammonaemic encephalopathy following antineoplastic treatment for colorectal cancer. A 69-year-old man received chemotherapy with oxaliplatin 100 mg/m 2 on day 1 [route not stated] and oral gimeracil/oteracil/tegafur [S-1] 200 mg/body on days 1–14. After completion of the third course, he reported general fatigue and a tremor in his fingers. Neurological findings were suspicious of an excited state of the brainstem reticular formation and he was diagnosed with hepatic encephalopathy. Blood test results showed a high ammonia concentration. He received a branched-chain amino acid (BCAA) preparation and his symptoms and hyperammonaemia improved. His chemotherapy was stopped. A 60-year-old woman received modified FOLFOX6 chemotherapy comprising oxaliplatin 85 mg/m 2 on day 1 [route not stated], folinic acid [leucovorin; route not stated] 200 mg/m 2 on day 1, a rapid IV infusion of fluorouracil 400 mg/m 2 on day 1, and a continuous IV infusion of fluorouracil 2400 mg/m 2 for 48 hours. She reported nausea on day 2 of her first course and received an antiemetic drug. However, there was no improvement and administration was discontinued when she fell into a confused state. Her symptoms improved completely by the next day and her impaired consciousness was diagnosed as being a psychogenic reaction. Two weeks later, she underwent a second course of mFOLFOX6 chemotherapy with another antiemetic agent. Her nausea was self-manageable but her consciousness level decreased immediately after finishing the course and she fell into a coma. Tests revealed a high blood ammonia concentration and she was diagnosed with hepatic encephalopathy cause by hyperammonaemia. She received a BCAA preparation and her symptoms dramatically improved by the next day as well as her hyperammonaemia. She subsequently underwent chemotherapy with panitumumab and irinotecan with no sign of neurological adverse events. Author comment: We report two patients having hyperammonemic encephalopathy while being treated with chemotherapy for colorectal cancer. Aihara A, et al. Two cases of hyperammonemic patients treated by chemotherapy for colorectal cancer. Gan to Kagaku Ryoho 39: 839-42, No. 5, May 2012 [Japanese; summarised from a translation] - Japan 803076390 1 Reactions 1 Sep 2012 No. 1417 0114-9954/10/1417-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved
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Transcript of Antineoplastics
Reactions 1417 - 1 Sep 2012
SAntineoplastics
Hyperammonaemic encephalopathy: 2 casereports
Two patients developed hyperammonaemicencephalopathy following antineoplastic treatment forcolorectal cancer.
A 69-year-old man received chemotherapy withoxaliplatin 100 mg/m2 on day 1 [route not stated] and oralgimeracil/oteracil/tegafur [S-1] 200 mg/body on days 1–14.After completion of the third course, he reported generalfatigue and a tremor in his fingers. Neurological findingswere suspicious of an excited state of the brainstemreticular formation and he was diagnosed with hepaticencephalopathy. Blood test results showed a highammonia concentration. He received a branched-chainamino acid (BCAA) preparation and his symptoms andhyperammonaemia improved. His chemotherapy wasstopped.
A 60-year-old woman received modified FOLFOX6chemotherapy comprising oxaliplatin 85 mg/m2 on day 1[route not stated], folinic acid [leucovorin; route not stated]200 mg/m2 on day 1, a rapid IV infusion of fluorouracil400 mg/m2 on day 1, and a continuous IV infusion offluorouracil 2400 mg/m2 for 48 hours. She reported nauseaon day 2 of her first course and received an antiemetic drug.However, there was no improvement and administrationwas discontinued when she fell into a confused state. Hersymptoms improved completely by the next day and herimpaired consciousness was diagnosed as being apsychogenic reaction. Two weeks later, she underwent asecond course of mFOLFOX6 chemotherapy with anotherantiemetic agent. Her nausea was self-manageable but herconsciousness level decreased immediately after finishingthe course and she fell into a coma. Tests revealed a highblood ammonia concentration and she was diagnosed withhepatic encephalopathy cause by hyperammonaemia. Shereceived a BCAA preparation and her symptomsdramatically improved by the next day as well as herhyperammonaemia. She subsequently underwentchemotherapy with panitumumab and irinotecan with nosign of neurological adverse events.
Author comment: We report two patients havinghyperammonemic encephalopathy while being treated withchemotherapy for colorectal cancer.Aihara A, et al. Two cases of hyperammonemic patients treated by chemotherapyfor colorectal cancer. Gan to Kagaku Ryoho 39: 839-42, No. 5, May 2012[Japanese; summarised from a translation] - Japan 803076390
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Reactions 1 Sep 2012 No. 14170114-9954/10/1417-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved
