Korean J Med.  2004 Nov;67(5):545-550.

Four cases of transient hyperammonemic encephalopathy following continuous infusion of 5-fluorouracil

• Baek KK
• Kim SH
• Kim ST
• Lim DH
• Ji SH
• Park JO
• Kang WK

Abstract

5-Fluorouracil (5-FU) is a chemotherapeutic agent commonly used in the treatment of a variety of solid tumors. Common adverse effects of fluorouracil chemotherapy include diarrhea, mucositis and myelosuppression. However, neurologic toxicities including hyperammonemic encephalopathy are rare and not well recognized. Transient hyperammonemic encephalopathy related to continuous infusion of high-dose 5-FU has rarely been reported. We report four cases of transient hyperammonemic encephalopathy in patients receiving continuous infusion of 5-FU. The mentality of all patients was altered during or just after the infusion of 5-FU. There were no focal neurological signs, laboratory excluding hyperammonemia or radiological abnormalities. After patients received adequate hydration and repeated lactulose enema, the mental status completely recovered within one or two days, and serum ammonium level subsequently returned to normal. In conclusion, we suggest that a transient hyperammonemic encephalopathy should be considered in differential diagnosis of patients receiving continuous 5-FU infusion with altered mentality.

Keyword

5-Fluorouracil; Hyperammonemia; Encephalopathy

MeSH Terms

Ammonium Compounds
Diagnosis, Differential
Diarrhea
Drug Therapy
Enema
Fluorouracil*
Humans
Hyperammonemia
Lactulose
Mucositis
Fluorouracil
Lactulose