高劑量5-Fluorouracil持續輸注引起之暫時性高血氨症

Transient Hyperammonemia Related to Continuous Infusion of High-dose 5-Fluorouracil

吳玉琴(Yu-Chin Wu) ； 李惠娟(Huei-Jan Lee)

《台灣醫學》 10卷5期 (2006/09) Pp. 595-599

https://doi.org/10.6320/FJM.2006.10(5).05

摘要

5-Fluorouracil (5-FU)屬於抗代謝作用的抗腫瘤藥品，一般用於治療各種實體的腫瘤(solid tumors)，如：大腸癌、直腸癌、乳癌、胃癌、胰臟癌、肝癌、頭頸部癌及膀胱癌等。其常見的副作用有血液惡病質(dyscrasia)、噁心、嘔吐、腹瀉、缺乏食慾(anorexia)，而神經毒性(neurotoxicity)是很少被報告，我們報導一案例，疑似因高劑量5-FU 24小時輸注而導致高氨腦病變。確實的作用機轉仍不明確，所以建議若使用高劑量5-FU治療發生精神狀態改變時應立即檢測血氨值，以排除因5-FU引發的高氨腦病變。若病患血中的三酸甘油酯較低或有肝功能障礙時，則不建議使用高劑量5-FU療程來治療。

關鍵字

高氨血症 ； 5-fluorouracil ； 腦病變

並列摘要

Fluorouracil (5-FU), a fluorinated pyrimidine, is an antineoplastic antimetabolite. It is used in the treatment of a variety of solid tumors, such as carcinoma of the colon, rectum, breast, stomach, pancreas, liver, head, neck and bladder. Common adverse effects of 5-FU are related to dyscrasia, nausea, vomiting, diarrhea and anorexia. 5-FU-induced neurotoxicity is uncommon. We reported a case with transient hyperammonemia suspected relative to 24- hours continuous infusion of high-dose 5-fluorouracil in NCKU. The true mechanism of transient hyperammonemia is unclear. We suggest check the level of plasma ammonium be ruled out in patients receiving continuous infusion of high-dose 5-FU if they have a change in consciousness. Hyperammonemia encephalopathy usually occurs in patients with serious liver dysfunction and hypotriglyceridemia, we suggest continuous infusion of high-dose 5-FU should not be used in these patients.

並列關鍵字

Hyperammonemia ； 5-fluorouracil ； encephalopathy