内容紹介
Summary
A 70-year-old man was diagnosed with colon cancer with multiple liver metastases. He was administered modified FOLFOX6 plus panitumumab as first-line chemotherapy. He showed consciousness disturbance on the 3rd day during the 8 cycle and was hospitalized urgently. We diagnosed him with 5-FU-induced hyperammonemia. Administration of branched-chain amino acid preparation improved his consciousness disturbance. After changing the regimen of chemotherapy to another one containing oral fluoropyrimidine, the recurrence of hyperammonemic encephalopathy was not found.
要旨
症例は70歳,男性。上行結腸癌および多発肝転移の診断でmodified FOLFOX6+panitumumab療法を開始した。忍容性に問題はなく腫瘍の縮小も得られ経過は良好であったが,8サイクル目の3日目に高アンモニア血症(NH3 474 μg/dL)を伴う意識障害を発症し,5-FUに起因する高アンモニア血症と診断した。補液管理,分岐鎖アミノ酸製剤の投与で意識レベルは速やかに改善した。次治療として静注5-FUから経口フッ化ピリミジン製剤(S-1)へ変更したが,その後は高アンモニア血症の発症は認めていない。
目次
A 70-year-old man was diagnosed with colon cancer with multiple liver metastases. He was administered modified FOLFOX6 plus panitumumab as first-line chemotherapy. He showed consciousness disturbance on the 3rd day during the 8 cycle and was hospitalized urgently. We diagnosed him with 5-FU-induced hyperammonemia. Administration of branched-chain amino acid preparation improved his consciousness disturbance. After changing the regimen of chemotherapy to another one containing oral fluoropyrimidine, the recurrence of hyperammonemic encephalopathy was not found.
要旨
症例は70歳,男性。上行結腸癌および多発肝転移の診断でmodified FOLFOX6+panitumumab療法を開始した。忍容性に問題はなく腫瘍の縮小も得られ経過は良好であったが,8サイクル目の3日目に高アンモニア血症(NH3 474 μg/dL)を伴う意識障害を発症し,5-FUに起因する高アンモニア血症と診断した。補液管理,分岐鎖アミノ酸製剤の投与で意識レベルは速やかに改善した。次治療として静注5-FUから経口フッ化ピリミジン製剤(S-1)へ変更したが,その後は高アンモニア血症の発症は認めていない。