意識障害をきたした5-FU高アンモニア血症例

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CDDP and 5-FU (CF) therapy is widely used chemotheraphy in head and neck cancer, although acute neurotoxicity is rare and poorly recognized. We report a case of CF-induced hyperammonemia encephalopathy in epipharynx cancer. A 68-year-old man with a epipharynx cancer history underwent CDDP 100 mg/body weight and 5-FU 1000 mg/body weight continuously infused for 5 days. During the second chemotherapy cycle, suddenly he showed onset of confusion and cognitive disturbances unexplained by any other radiographic examinations or laboratory tests except hyperammonemia. High-volume drip infusion within 24 hours resolved the encephalopathy. Ammonia accumulates in the body under insufficient catabolism due to impaired urea cycle. Excessive ammonium production from 5-FU catabolites and aggravating factors such as renal dysfunction, constipation, and body weight loss may explain such transient hyperammonemia. The incidence of 5-FU-induced hyperammonemia is thus an adverse event to be monitored and decreased by being aware of renal dysfunction, taking measures against constipation, and implementing nutritrional management.
2011-03-01