title: [A case of hyperammonemic encephalopathy related to 5-FU in an aged patient with recurrent colon cancer treated with FOLFIRI therapy].
abstract: We report a case of hyperammonemic encephalopathy related to 5-FU in an aged patient with recurrent colon cancer treated with FOLFIRI therapy. An 80-year-old man underwent right hemicolectomy for cecal cancer. After 10 months, surgical resection was performed for its local recurrence. He was then treated with FOLFIRI therapy, and during the fifth course, he presented with a sudden onset of congestive disturbances. Through radiographic examination and laboratory data, only hyperammonemia was found; he was therefore diagnosed with hyperammonemic encephalopathy. By starting branchedamino acid solutions for its treatment, his consciousness and serum ammonia were promptly improved. Hyperammonemic encephalopathy related 5-FU is caused by increasing ammonia production and its metabolic inhibition, and is worsened by renal dysfunction, dehydration, constipation, infections, or body weight loss. On account of the potential decrease of metabolic function of liver and kidney, an aged person tends to have hyperammonnemia more than a youth. Clinicians should be aware of the adverse events associated with hyperammonemia when then administer a large amount of 5-FU to elderly patients.
authors.affiliation: Dept. of Surgical, Nagaoka Chuo General Hospital, Japan.
authors.forename: Takuma
authors.initials: T
authors.lastname: Okamura
authors.forename: Yasuyuki
authors.initials: Y
authors.lastname: Kawachi
authors.forename: Keiya
authors.initials: K
authors.lastname: Nikkuni
authors.forename: Atsushi
authors.initials: A
authors.lastname: Nishimura
authors.forename: Shigeto
authors.initials: S
authors.lastname: Makino
authors.forename: Mikako
authors.initials: M
authors.lastname: Kawahara
authors.forename: Chie
authors.initials: C
authors.lastname: Kitami
authors.forename: Yoshifumi
authors.initials: Y
authors.lastname: Hashimoto
mesh_terms: D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000627:therapeutic use*; D001063:Appendiceal Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery; D001928:Brain Diseases, Metabolic / Q000209:etiology*; D002166:Camptothecin / Q000008:administration & dosage / Q000031:analogs & derivatives; D003131:Combined Modality Therapy; D005472:Fluorouracil / Q000008:administration & dosage / Q000009:adverse effects*; D006801:Humans; D022124:Hyperammonemia / Q000139:chemically induced* / Q000188:drug therapy; D002955:Leucovorin / Q000008:administration & dosage; D008297:Male; D012008:Recurrence
chemical_list: D002955:Leucovorin; D005472:Fluorouracil; D002166:Camptothecin