内容紹介
Summary
Systemic chemotherapy based on 5-fluorouracil(5-FU)is a standard treatment for unresectable or recurrent colon cancers. Here, we report a case of hyperammonemia induced by chemotherapy using 5-FU for metastatic colon cancer. An 84-year-old male patient with past histories of liver cirrhosis related to hepatitis C virus and renal dysfunction underwent an operation for the rectosigmoid colon cancer 8 years ago. Three years after that operation, a local recurrence of the colon cancer was diagnosed, and chemotherapy using sLV5FU2 was initiated. The recurrence lesion reduced markedly by this chemotherapy, which was ceased 2 years ago. Two years after the cessation the recurrent tumor had been enlarged, and the chemotherapy using the same drugs at the same dose was performed. On the treatment day 3, he was emergently transported to our hospital due to the disturbance of consciousness. Since laboratory tests showed the high concentration of plasma ammonia and the progressed renal dysfunction with no other definite cause of obnubilation, he was diagnosed as the hyperammonemia induced by 5-FU. He was treated by administrating the branched-chain amino acids solutions combined with fluid therapy, which quickly recovered him from the encephalopathy. He is followed up without any chemotherapy because of his high age. When a patient treated with the chemotherapy using 5-FU is sent with the disturbance of consciousness, we should take hyperammonemia into consideration, especially when he or she has the hepatic or renal dysfunction.
要旨
大腸癌再発例に対する5-fluorouracil(5-FU)投与中に高アンモニア血症を生じた1例を経験したので報告する。症例は84歳,男性。既往歴にC型肝硬変,腎機能障害などがあった。8年前に直腸S状部癌に対して直腸前方切除術を施行された。3年前に局所再発を指摘され,sLV5FU2療法を開始した。病変は著明に縮小し病勢コントロールが得られていたため,2年前に化学療法を中断した。中断2年後に再発巣の増大を認め同レジメンを同量で再開したところ,投与3日目に意識障害のため救急搬送された。血液検査で高アンモニア血症を認め他に意識障害の原因を認めず,5-FU投与による高アンモニア血症と考えられた。補液,分岐鎖アミノ酸製剤投与によって意識障害は速やかに改善し,第15病日に退院した。高齢であるため,その後化学療法は行わず経過観察している。5-FU投与中に意識障害を認めた場合,高アンモニア血症に留意すべきであり,肝または腎機能障害を有する場合は特に留意すべきと考えられた。
目次
Systemic chemotherapy based on 5-fluorouracil(5-FU)is a standard treatment for unresectable or recurrent colon cancers. Here, we report a case of hyperammonemia induced by chemotherapy using 5-FU for metastatic colon cancer. An 84-year-old male patient with past histories of liver cirrhosis related to hepatitis C virus and renal dysfunction underwent an operation for the rectosigmoid colon cancer 8 years ago. Three years after that operation, a local recurrence of the colon cancer was diagnosed, and chemotherapy using sLV5FU2 was initiated. The recurrence lesion reduced markedly by this chemotherapy, which was ceased 2 years ago. Two years after the cessation the recurrent tumor had been enlarged, and the chemotherapy using the same drugs at the same dose was performed. On the treatment day 3, he was emergently transported to our hospital due to the disturbance of consciousness. Since laboratory tests showed the high concentration of plasma ammonia and the progressed renal dysfunction with no other definite cause of obnubilation, he was diagnosed as the hyperammonemia induced by 5-FU. He was treated by administrating the branched-chain amino acids solutions combined with fluid therapy, which quickly recovered him from the encephalopathy. He is followed up without any chemotherapy because of his high age. When a patient treated with the chemotherapy using 5-FU is sent with the disturbance of consciousness, we should take hyperammonemia into consideration, especially when he or she has the hepatic or renal dysfunction.
要旨
大腸癌再発例に対する5-fluorouracil(5-FU)投与中に高アンモニア血症を生じた1例を経験したので報告する。症例は84歳,男性。既往歴にC型肝硬変,腎機能障害などがあった。8年前に直腸S状部癌に対して直腸前方切除術を施行された。3年前に局所再発を指摘され,sLV5FU2療法を開始した。病変は著明に縮小し病勢コントロールが得られていたため,2年前に化学療法を中断した。中断2年後に再発巣の増大を認め同レジメンを同量で再開したところ,投与3日目に意識障害のため救急搬送された。血液検査で高アンモニア血症を認め他に意識障害の原因を認めず,5-FU投与による高アンモニア血症と考えられた。補液,分岐鎖アミノ酸製剤投与によって意識障害は速やかに改善し,第15病日に退院した。高齢であるため,その後化学療法は行わず経過観察している。5-FU投与中に意識障害を認めた場合,高アンモニア血症に留意すべきであり,肝または腎機能障害を有する場合は特に留意すべきと考えられた。