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Disturbance of consciousness due to hyperammonemia and lactic acidosis during mFOLFOX6 regimen: Case report
INTRODUCTION: FOLFOX therapy is the main chemotherapy regimen for colorectal cancer. Peripheral neuropathy, hematotoxicity, and digestive symptoms are known to be the most frequent adverse events. Hyperammonemia and lactic acidosis rarely occur simultaneously during treatment with FOLFOX therapy; th...
Autores principales: | , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
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Lippincott Williams & Wilkins
2020
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7437776/ https://www.ncbi.nlm.nih.gov/pubmed/32872062 http://dx.doi.org/10.1097/MD.0000000000021743 |
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author | Fukuda, Masafumi Nabeta, Masakazu Muta, Takanori Cho, Tomonori Shimamatsu, Yutaka Shimotsuura, Yasutaka Fukami, Kei Takasu, Osamu |
author_facet | Fukuda, Masafumi Nabeta, Masakazu Muta, Takanori Cho, Tomonori Shimamatsu, Yutaka Shimotsuura, Yasutaka Fukami, Kei Takasu, Osamu |
author_sort | Fukuda, Masafumi |
collection | PubMed |
description | INTRODUCTION: FOLFOX therapy is the main chemotherapy regimen for colorectal cancer. Peripheral neuropathy, hematotoxicity, and digestive symptoms are known to be the most frequent adverse events. Hyperammonemia and lactic acidosis rarely occur simultaneously during treatment with FOLFOX therapy; the number of case reports is limited worldwide. We report a case of disturbance of consciousness, considered to be caused by hyperammonemia and lactic acidosis that occurred during treatment with mFOLFOX6 therapy that was administered as postoperative adjuvant treatment for rectal cancer. PATIENT CONCERNS: This case was of a 71-year-old man who had been receiving oral treatment for chronic kidney disease and diabetes mellitus. Laparoscopic low anterior resection and artificial anal construction surgery were performed for stage III rectal cancer. As adjuvant postoperative therapy, mFOLFOX6 therapy was started but was followed by a disturbance of consciousness. DIAGNOSES: Results of the blood tests revealed notable hyperammonemia (ammonia level, 1,163 μg/dl) and lactic acidosis (pH 7.207; lactate, 17.56 mmol/L); however, imaging diagnosis did not reveal intracranial lesions that could cause disturbance of consciousness. INTERVENTIONS: For hyperammonemia, branched-chain amino acid agents and Ringers solution supplementation were administered. For acidosis, 7% sodium hydrogen carbonate was administered as treatment. OUTCOMES: The disturbance of consciousness improved within 12 hours of initiating the treatment, and the patient was discharged with no sequelae on 7th day after hospitalization. CONCLUSION: In patients with chronic kidney disease, FOLFOX regimen may confer risks of hyperammonemia and lactic acidosis. |
format | Online Article Text |
id | pubmed-7437776 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2020 |
publisher | Lippincott Williams & Wilkins |
record_format | MEDLINE/PubMed |
spelling | pubmed-74377762020-09-02 Disturbance of consciousness due to hyperammonemia and lactic acidosis during mFOLFOX6 regimen: Case report Fukuda, Masafumi Nabeta, Masakazu Muta, Takanori Cho, Tomonori Shimamatsu, Yutaka Shimotsuura, Yasutaka Fukami, Kei Takasu, Osamu Medicine (Baltimore) 3900 INTRODUCTION: FOLFOX therapy is the main chemotherapy regimen for colorectal cancer. Peripheral neuropathy, hematotoxicity, and digestive symptoms are known to be the most frequent adverse events. Hyperammonemia and lactic acidosis rarely occur simultaneously during treatment with FOLFOX therapy; the number of case reports is limited worldwide. We report a case of disturbance of consciousness, considered to be caused by hyperammonemia and lactic acidosis that occurred during treatment with mFOLFOX6 therapy that was administered as postoperative adjuvant treatment for rectal cancer. PATIENT CONCERNS: This case was of a 71-year-old man who had been receiving oral treatment for chronic kidney disease and diabetes mellitus. Laparoscopic low anterior resection and artificial anal construction surgery were performed for stage III rectal cancer. As adjuvant postoperative therapy, mFOLFOX6 therapy was started but was followed by a disturbance of consciousness. DIAGNOSES: Results of the blood tests revealed notable hyperammonemia (ammonia level, 1,163 μg/dl) and lactic acidosis (pH 7.207; lactate, 17.56 mmol/L); however, imaging diagnosis did not reveal intracranial lesions that could cause disturbance of consciousness. INTERVENTIONS: For hyperammonemia, branched-chain amino acid agents and Ringers solution supplementation were administered. For acidosis, 7% sodium hydrogen carbonate was administered as treatment. OUTCOMES: The disturbance of consciousness improved within 12 hours of initiating the treatment, and the patient was discharged with no sequelae on 7th day after hospitalization. CONCLUSION: In patients with chronic kidney disease, FOLFOX regimen may confer risks of hyperammonemia and lactic acidosis. Lippincott Williams & Wilkins 2020-08-14 /pmc/articles/PMC7437776/ /pubmed/32872062 http://dx.doi.org/10.1097/MD.0000000000021743 Text en Copyright © 2020 the Author(s). Published by Wolters Kluwer Health, Inc. http://creativecommons.org/licenses/by/4.0 This is an open access article distributed under the Creative Commons Attribution License 4.0 (CCBY), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. http://creativecommons.org/licenses/by/4.0 |
spellingShingle | 3900 Fukuda, Masafumi Nabeta, Masakazu Muta, Takanori Cho, Tomonori Shimamatsu, Yutaka Shimotsuura, Yasutaka Fukami, Kei Takasu, Osamu Disturbance of consciousness due to hyperammonemia and lactic acidosis during mFOLFOX6 regimen: Case report |
title | Disturbance of consciousness due to hyperammonemia and lactic acidosis during mFOLFOX6 regimen: Case report |
title_full | Disturbance of consciousness due to hyperammonemia and lactic acidosis during mFOLFOX6 regimen: Case report |
title_fullStr | Disturbance of consciousness due to hyperammonemia and lactic acidosis during mFOLFOX6 regimen: Case report |
title_full_unstemmed | Disturbance of consciousness due to hyperammonemia and lactic acidosis during mFOLFOX6 regimen: Case report |
title_short | Disturbance of consciousness due to hyperammonemia and lactic acidosis during mFOLFOX6 regimen: Case report |
title_sort | disturbance of consciousness due to hyperammonemia and lactic acidosis during mfolfox6 regimen: case report |
topic | 3900 |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7437776/ https://www.ncbi.nlm.nih.gov/pubmed/32872062 http://dx.doi.org/10.1097/MD.0000000000021743 |
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