Hyperammonemic encephalopathy after induction chemotherapy for acute lymphoblastic leukemia.
The syndrome of hyperammonemic encephalopathy occurs in patients who have received high-dose cytoreductive therapy for the treatment of hematologic malignancy. It is characterized by acute alteration in mental status and respiratory alkalosis associated with markedly elevated plasma ammonium levels in the absence of any identifiable cause and frequently results in cerebral edema, coma, and eventually death. Although the etiology of this syndrome is yet to be determined, it seems to be invariably multifactorial in nature. Optimal therapy remains elusive, and the critical step is increased awareness of the syndrome by measurement of plasma ammonia levels in patients with neurologic symptoms, leading to accurate diagnosis and the rapid implementation of therapy.
Jaing
Tang-Her
TH
Division of Hematology and Oncology, Department of Pediatrics, Chang Gung Children's Hospital, Chang Gung University, Taoyuan, Taiwan. jaing001@cgmh.org.tw
Lin
Ju-Li
JL
Lin
Yu-Pi
YP
Yang
Shu-Ho
SH
Lin
Jiann-Jim
JJ
Hsia
Shao-Hsuan
SH
D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects*; D001215:Asparaginase / Q000009:adverse effects; D003630:Daunorubicin / Q000009:adverse effects; D006801:Humans; D022124:Hyperammonemia / Q000139:chemically induced* / Q000628:therapy; D007223:Infant; D008297:Male; D020258:Neurotoxicity Syndromes / Q000209:etiology* / Q000628:therapy; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000188:drug therapy*; D011241:Prednisone / Q000009:adverse effects; D012074:Remission Induction; D016896:Treatment Outcome; D014750:Vincristine / Q000009:adverse effects
D014750:Vincristine; D001215:Asparaginase; D011241:Prednisone; D003630:Daunorubicin