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A 5-Fluorouracil-Induced Hyperammonemic Encephalopathy Challenged with Capecitabine
Joint Authors
Chahin, Michael
Krishnan, Nithya
Chhatrala, Hardik
Shaikh, Marwan
Source
Case Reports in Oncological Medicine
Issue
Vol. 2020, Issue 2020 (31 Dec. 2020), pp.1-4, 4 p.
Publisher
Hindawi Publishing Corporation
Publication Date
2020-01-31
Country of Publication
Egypt
No. of Pages
4
Main Subjects
Abstract EN
Cancer patients presenting with altered mental status demand a broad differential with early recognition of the etiology.
Failure to do so is associated with increased morbidity and mortality.
Causes that must be considered include organ involvement of the cancer, electrolytes abnormalities, and even chemotherapeutic agents.
A 32-year-old female patient had been recently started on FOLFOX for metastatic colon cancer.
Her initial treatments were uneventful, but she later developed encephalopathy during day three of cycle five.
During her evaluation, she was found to have hyperammonemia (84 mcmol/L), without hepatic failure, that resolved with stopping chemotherapy and supportive care.
After a trial of home infusion fluorouracil, she developed hyperammonemic encephalopathy again.
During both admissions, her symptoms resolved with IV hydration and cessation of chemotherapy.
She was then successfully challenged with capecitabine (1000 mg/m2 daily), and additional hydration, and continued chemotherapy without recurrence of symptoms.
Hyperammonemia is associated with fluorouracil though the mechanism is unclear.
Suspected etiologies include either elevated levels of the drug due to slower metabolism or accumulation of certain metabolites.
Additionally, risk factors such urease-producing bacterial infections, dehydration, and increased catabolism are thought to increase the risk for hyperammonemia.
This case demonstrates the need for greater awareness of fluorouracil as a cause of hyperammonemic encephalopathy.
Knowledge of this may allow for earlier recognition and reduced unnecessary testing.
American Psychological Association (APA)
Chahin, Michael& Krishnan, Nithya& Chhatrala, Hardik& Shaikh, Marwan. 2020. A 5-Fluorouracil-Induced Hyperammonemic Encephalopathy Challenged with Capecitabine. Case Reports in Oncological Medicine،Vol. 2020, no. 2020, pp.1-4.
https://search.emarefa.net/detail/BIM-1149403
Modern Language Association (MLA)
Chahin, Michael…[et al.]. A 5-Fluorouracil-Induced Hyperammonemic Encephalopathy Challenged with Capecitabine. Case Reports in Oncological Medicine No. 2020 (2020), pp.1-4.
https://search.emarefa.net/detail/BIM-1149403
American Medical Association (AMA)
Chahin, Michael& Krishnan, Nithya& Chhatrala, Hardik& Shaikh, Marwan. A 5-Fluorouracil-Induced Hyperammonemic Encephalopathy Challenged with Capecitabine. Case Reports in Oncological Medicine. 2020. Vol. 2020, no. 2020, pp.1-4.
https://search.emarefa.net/detail/BIM-1149403
Data Type
Journal Articles
Language
English
Notes
Includes bibliographical references
Record ID
BIM-1149403