An Unusual Cause of Disturbed Consciousness in the Emergency Department: High-dose Fluorouracil and Leucovorin Induced Hyperammonemia

這是一個造成意識不清少見原因的病例報告。一位罹患食道癌合併多處轉移的48歲男性患者，因為意識變得昏睡被送到急診處。在這前一天，他接受了第三次高劑量的化學治療(High-dose fluorouracil and leucovorin, HDFL)。5-fluorouracl (5-FU)及leucovorin的劑量分別為2600毫克／平方米與300毫克／平方米。實驗室檢查發現血銨值高達495 umol/L。住院給予輸液及支持治療後，血銨值在14小時內回到正常，出院時病患的意識完全恢復清醒。HDFL造成的高血銨性腦病變是在給予5-FU治療時一種少見但嚴重的併發症，最重要且有效的治療方式就是立刻停止使用5-FU。幾乎所有的病患在藥物停止後幾小時內都可以恢復正常意識，而且不會有任何後遺症。

關鍵字

高血銨性腦病變； 5-FU ； fluorouracil ； HDFL

並列摘要

Herein, we present a case of an individual suffering disturbed consciousness from an unusual cause, our patient being a 48-year-old male afflicted with esophageal cancer with multiple metastases. The patient initially presented to our emergency department with lethargy and somnolence. This man had received his third course of high-dose fluorouracil (2,600 mg/m^2) and leucovorin (300 mg/ m^2) (HDFL) chemotherapy on an outpatient basis one day prior to his visiting our emergency department. Laboratory examination revealed a serum ammonia level of 495 umol/L. Following admission, only supportive treatment and hydration were provided, the patient's serum ammonia level returning to the normal range within 14 hours of admission. This man was discharged revealing clear consciousness. HDFL-induced hyperammonemia encephalopathy is a rare but serious complication of 5-fluorouracil (5-FU) treatment. Discontinuation of drug use is the most-important and most-effective therapy for such medical situations. By such drug discontinuation, virtually all such patients regain their consciousness a few hours subsequent to discontinuation and recover from their ordeal without any apparent sequelae.

並列關鍵字

Hyperammonemia encephalopathy ； 5-FU ； fluorouracil ； HDFL

國際替代計量

An Unusual Cause of Disturbed Consciousness in the Emergency Department: High-dose Fluorouracil and Leucovorin Induced Hyperammonemia

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