Hyperammonemia Secondary to 5-Fluorouracil.

Ashley Scott, Sreenivas V Rao, Mary Lou Affronti
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Abstract

5-fluorouracil (5-FU) is one of the most common adjuvant antineoplastic agents used in the treatment of localized and metastatic colon cancer. Frequent side effects of 5-FU include myelosuppression, mucositis, nausea, vomiting, and diarrhea. However, hyperammonemic encephalopathy is a rare neurologic toxicity that can occur after 5-FU chemotherapy administration. Patients with 5-FU-induced hyperammonemic encephalopathy often exhibit symptoms of altered mental status with no radiologic abnormalities or laboratory abnormalities except for significantly elevated ammonia levels with occasional lactic acidosis and respiratory alkalosis. We report a case of a patient with stage IV colon adenocarcinoma who experienced altered state of consciousness due to hyperammonemia during the administration of palliative chemotherapy with 5-FU, bevacizumab, and leucovorin. On cycle 1 day 2 of chemotherapy, the patient became drowsy and confused at home, prompting a visit to the emergency department and ultimately hospital admission. Laboratory tests revealed an elevated blood ammonia level (838 μg/dL). After an extensive negative workup, his altered state of consciousness was thought to be secondary to 5-FU-induced hyperammonemia. Upon admission, 5-FU was immediately discontinued and the patient was treated with lactulose enemas, intravenous fluids, rifaximin, and continuous renal replacement therapy with gradual recovery to baseline mental status. It is crucial for advanced practitioners to be aware of this rare side effect to ensure prompt diagnosis and maximize treatment effectiveness.

Abstract Image

5-氟尿嘧啶继发高氨血症。
5-氟尿嘧啶(5-FU)是最常用的辅助抗肿瘤药物之一,用于治疗局部和转移性结肠癌。5-FU的常见副作用包括骨髓抑制、粘膜炎、恶心、呕吐和腹泻。然而,高氨血症脑病是一种罕见的神经系统毒性,可发生在5-FU化疗后。5- fu诱导的高氨血症脑病患者通常表现出精神状态改变的症状,除了氨水平明显升高并偶有乳酸酸中毒和呼吸性碱中毒外,无放射学异常或实验室异常。我们报告一例IV期结肠腺癌患者,在使用5-FU、贝伐单抗和亚叶酸素姑息性化疗期间,由于高氨血症而经历意识状态改变。在化疗的第1周期第2天,患者在家中变得昏昏欲睡和困惑,促使前往急诊科并最终住院。实验室检查显示血氨水平升高(838 μg/dL)。在广泛的阴性检查后,他的意识状态改变被认为是继发于5- fu诱导的高氨血症。入院后立即停用5-FU,患者接受乳果糖灌肠、静脉输液、利福昔明和持续肾脏替代治疗,逐渐恢复至基线精神状态。对于高级从业人员来说,了解这种罕见的副作用是至关重要的,以确保及时诊断和最大限度地提高治疗效果。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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