Severe hyperglycemia as a complication of big ICE chemotherapy in a patient with acute myeloblastic leukemia.
BACKGROUND
Big ICE chemotherapy (consisting of Idarubicin, high dose Cytosine arabinoside and Etoposide), has proven its efficacy in the treatment of patients with relapse/refractory acute myeloblastic leukemia. In this case report, we present a patient developing the complication of severe hyperglycemia following administration of big ICE because of a relapse of acute myeloblastic leukemia.


METHODS
When a 41-year-old woman with acute myeloblastic leukemia in relapse was treated using the big ICE protocol, because of lack of efficacy of other chemotherapy regimens. On the 7th day and 9th day of chemotherapy, glycemia was 13.2 mmol/l and 25.8 mmol/l, respectively. Hyperglycemia was controlled with continuous regular insulin infusion and neutralization of parenteral nutrition solution with regular insulin. After the regulation of the glycemia, regular insulin was injected four times daily. Following days, hematological remission was obtained and requirement of insulin becomes less and glycemia decreased to the normal levels.


CONCLUSIONS
Severe hyperglycemia/diabetes mellitus likely due to chemotherapy may develop in patients with acute leukemia. This may have a negative effect on mortality and morbidity. For this reason, these patients should be followed closely.
Beyan
Cengiz
C
Gülhane Military Medical Academy, Department of Hematology, 06018 Etlik-Ankara, Turkey. cengizbeyan@hotmail.com
Kaptan
Kürşat
K
Cetin
Türker
T
Nevruz
Oral
O
D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects*; D001786:Blood Glucose / Q000378:metabolism; D003561:Cytarabine / Q000009:adverse effects*; D005047:Etoposide / Q000009:adverse effects*; D005260:Female; D006801:Humans; D006943:Hyperglycemia / Q000097:blood / Q000139:chemically induced* / Q000188:drug therapy; D015255:Idarubicin / Q000009:adverse effects*; D007328:Insulin / Q000627:therapeutic use; D015470:Leukemia, Myeloid, Acute / Q000188:drug therapy*; D012008:Recurrence; D013997:Time Factors
D001786:Blood Glucose; D007328:Insulin; D003561:Cytarabine; D005047:Etoposide; D015255:Idarubicin