title: The successful treatment of 5-fluorouracil (5-FU) overdose in a patient with malignancy and HIV/AIDS with uridine triacetate.
abstract: According to the NIH, about 275000 patients receive treatment with 5-Fluorouracil (5-FU) and more than 1300 die from 5-FU toxicity every year from life-threatening myelosuppression, gastrointestinal complications, and neurotoxicity. Immunocompromised persons are at higher risk of developing toxicity. Recently uridine triacetate (Vistagard®) has been approved by the Food and Drug Administration (FDA) as the only specific antidote available for 5-FU poisoning. In a clinical trial (n=135), 96% of patients with 5-FU toxicity recovered after treatment, where as in a historical control group only 10% survived. This is the first published case report of survival after 5-FU overdose who also was immunocompromised from HIV/AIDs. A 52year old male with history of HIV/AIDS (CD4 70), CNS toxoplasmosis and anal cancer presented to the emergency department after realizing he had received an entire course of 5-FU in 24 instead of 96h. Treatment with uridine triacetate was arranged in the emergency department. After receiving treatment the patient was asymptomatic and had an uncomplicated hospital course. 5-FU poisoning must be recognized early as uridine triacetate is approved by the FDA for use within 96h following the end of 5-FU administration. Emergency medicine physicians should promptly recognize and treat 5-FU poisoning. However, this may be challenging as patients may not seek medical attention until many hours or several days after last administration since symptoms are often delayed with 5-FU poisoning.
authors.affiliation: Georgia Poison Center, Atlanta, GA, USA; Department of Emergency Medicine, Emory University, Atlanta, GA, USA. Electronic address: cynthia.d.santos@emory.edu.
authors.forename: Cynthia
authors.initials: C
authors.lastname: Santos
authors.affiliation: Georgia Poison Center, Atlanta, GA, USA; Department of Emergency Medicine, Emory University, Atlanta, GA, USA.
authors.forename: Brent W
authors.initials: BW
authors.lastname: Morgan
authors.affiliation: Georgia Poison Center, Atlanta, GA, USA; Department of Emergency Medicine, Emory University, Atlanta, GA, USA.
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Geller
mesh_terms: D000085:Acetates / Q000627:therapeutic use*; D000964:Antimetabolites, Antineoplastic / Q000008:administration & dosage / Q000493:pharmacokinetics / Q000506:poisoning*; D001005:Anus Neoplasms / Q000188:drug therapy*; D003863:Depression / Q000188:drug therapy*; D062787:Drug Overdose; D004635:Emergency Medicine; D005472:Fluorouracil / Q000008:administration & dosage / Q000493:pharmacokinetics / Q000506:poisoning*; D015658:HIV Infections / Q000188:drug therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D016781:Toxoplasmosis, Cerebral / Q000188:drug therapy*; D016896:Treatment Outcome; D014529:Uridine / Q000031:analogs & derivatives* / Q000627:therapeutic use
chemical_list: D000085:Acetates; D000964:Antimetabolites, Antineoplastic; C000609666:uridine triacetate; D005472:Fluorouracil; D014529:Uridine
keywords: 5-FU; AIDS; Chemotherapeutic drug; Chemotherapy drug; HIV; Oncology; Overdose; Toxicology; Uridine triacetate