内容紹介
A Case of Hyperammonemic Encephalopathy Related to 5-FU in an Aged Patient with Recurrent Colon Cancer Treated with FOLFIRI Therapy
Summary
We report a case of hyperammonemic encephalopathy related to 5-FU in an aged patient with recurrent colon cancer treated with FOLFIRI therapy. An 80-year-old man underwent right hemicolectomy for cecal cancer. After 10 months, surgical resection was performed for its local recurrence. He was then treated with FOLFIRI therapy, and during the fifth course, he presented with a sudden onset of congestive disturbances. Through radiographic examination and laboratory data, only hyperammonemia was found; he was therefore diagnosed with hyperammonemic encephalopathy. By starting branched-amino acid solutions for its treatment, his consciousness and serum ammonia were promptly improved. Hyperammonemic encephalopathy related 5-FU is caused by increasing ammonia production and its metabolic inhibition, and is worsened by renal dysfunction, dehydration, constipation, infections, or body weight loss. On account of the potential decrease of metabolic function of liver and kidney, an aged person tends to have hyperammonnemia more than a youth. Clinicians should be aware of the adverse events associated with hyperammonemia when then administer a large amount of 5-FU to elderly patients.
要旨
われわれはFOLFIRI療法を施行中,高アンモニア血症を来した高齢者の症例を経験した。症例は80歳,男性。盲腸癌根治切除後の局所再発に対し,再切除後にFOLFIRI療法を開始した。5コース目を施行中,高アンモニア血症による意識障害を認め,分岐鎖アミノ酸製剤を投与したところ速やかに回復した。5-FU投与による高アンモニア血症は,アンモニア産生増加と代謝低下に起因し,腎機能障害,脱水,便秘,感染症,体重減少により増悪する。高齢者は,肝腎代謝機能の潜在的低下があり,若年者より大量5-FU投与により高アンモニア血症を来しやすい状態であるため注意が必要である。
目次
Summary
We report a case of hyperammonemic encephalopathy related to 5-FU in an aged patient with recurrent colon cancer treated with FOLFIRI therapy. An 80-year-old man underwent right hemicolectomy for cecal cancer. After 10 months, surgical resection was performed for its local recurrence. He was then treated with FOLFIRI therapy, and during the fifth course, he presented with a sudden onset of congestive disturbances. Through radiographic examination and laboratory data, only hyperammonemia was found; he was therefore diagnosed with hyperammonemic encephalopathy. By starting branched-amino acid solutions for its treatment, his consciousness and serum ammonia were promptly improved. Hyperammonemic encephalopathy related 5-FU is caused by increasing ammonia production and its metabolic inhibition, and is worsened by renal dysfunction, dehydration, constipation, infections, or body weight loss. On account of the potential decrease of metabolic function of liver and kidney, an aged person tends to have hyperammonnemia more than a youth. Clinicians should be aware of the adverse events associated with hyperammonemia when then administer a large amount of 5-FU to elderly patients.
要旨
われわれはFOLFIRI療法を施行中,高アンモニア血症を来した高齢者の症例を経験した。症例は80歳,男性。盲腸癌根治切除後の局所再発に対し,再切除後にFOLFIRI療法を開始した。5コース目を施行中,高アンモニア血症による意識障害を認め,分岐鎖アミノ酸製剤を投与したところ速やかに回復した。5-FU投与による高アンモニア血症は,アンモニア産生増加と代謝低下に起因し,腎機能障害,脱水,便秘,感染症,体重減少により増悪する。高齢者は,肝腎代謝機能の潜在的低下があり,若年者より大量5-FU投与により高アンモニア血症を来しやすい状態であるため注意が必要である。