• PDF / 170,996 Bytes
• 1 Pages / 595.245 x 841.846 pts (A4) Page_size
• 60 Downloads / 171 Views

DOWNLOAD

REPORT

---

1 S

Various toxicities: case report A 71-year-old man developed nausea, disturbed consciousness, hyperammonaemia and lactic acidosis during treatment with fluorouracil, folinic acid and oxaliplatin for rectal cancer. The man, who was diagnosed with stage IIIa rectal cancer, subsequently underwent a laparoscopic low anterior resection and artificial anal construction surgery. His medical history was significant for diabetes and chronic kidney disease. Postoperatively, he received one course of mFOLFOX6 regimen comprising fluorouracil infusion 2400 mg/m2/week, oxaliplatin infusion and folinic acid [not all routes and dosages stated]. Concurrently, he had been receiving linagliptin, mitiglinide and enalapril. Subsequently, he developed nausea, mild lack of appetite, poor oral intake and reduced water consumption. The man was treated with central vein nutritive therapy. After 48 hours, second course of the chemotherapy was administered, and 60 minutes after initiation of the second course of the chemotherapy, he developed stertorous breathing, disquietness and a disturbance of consciousness with Glasgow Coma Scale (GCS) score of approximately 7. MRI and CT scan did not show significant abnormal findings. He was therefore hospitalised. On admission, investigations showed GCS score of 8, BP 160/110mm Hg, pulse rate 110 /minute and breathing rate 34 breaths/minute. Tachypnoea and tonic seizures in both arms with no abnormalities of the pupils were noted. Blood gas analysis under administration of 2L of oxygen showed pH 7.207, PaO2 158.7mm Hg, PaCO2 7.9mm Hg and HCO33.0 mmol/L. Lactic acid and ammonia levels were found to be significantly high. Liver function test was unremarkable, but kidney function impairment was noted. The drug screening result was negative. His triglyceride level was low, but thiamine level had normal. Chest radiography showed a central catheter inserted from the right internal jugular vein without significant abnormal findings. Head-to-abdomen CT scan did not show abnormal findings. Based on these findings, lactic acidosis and hyperammonaemia were suspected to be the cause of the disturbance of consciousness. The tongue root had sunk due to the disturbance of consciousness. Therefore, a nasal airway tube was inserted. He was treated with branched-chain amino acid agents and Ringer’s solution for hyperammonaemia and sodium bicarbonate and tartaric acid for acidosis. After 12 hours, his disturbance of consciousness improved, and ammonia level was normalised. His lactic acidosis also improved. Blood gas analysis showed PaO2 125.4mm Hg, pH 7.456, PaCO2 26.9mm Hg, HCO3 18.7 mmol/L and lactic acid 1.4 mmol/L. He was discharged on hospitalisation day 7 [times to reactions onsets not stated; not all outcomes stated]. Fukuda M, et al. Disturbance of consciousness due to hyperammonemia and lactic acidosis during mFOLFOX6 regimen: Case report. Medicine 99: No. 33, 14 Aug 2020. 803505456 Available from: URL: http://doi.org/10.1097/MD.0000000000021743

0114-9954/20/1825-0001/$14.95 Adis © 2020 Springer Nature Sw