A Case of Hyperammonemic Encephalopathy Related to the Modified FOLFOX6 Regimen for Metastatic Colon Cancer

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  • SHIMIZU Tetsuya
    Department of Surgery, National Hospital Organization Yokohama Medical Center
  • SEKIDO Hitoshi
    Department of Surgery, National Hospital Organization Yokohama Medical Center
  • MATSUDA Goro
    Department of Surgery, National Hospital Organization Yokohama Medical Center
  • MIYAKE Kentaroh
    Department of Surgery, National Hospital Organization Yokohama Medical Center
  • TUCHIYA Nobuhiro
    Department of Surgery, National Hospital Organization Yokohama Medical Center
  • DEN Kanechika
    Department of Surgery, National Hospital Organization Yokohama Medical Center

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  • mFOLFOX6 療法後に 5FUに起因する高アンモニア血症をきたした1例
  • 症例 mFOLFOX6療法後に5FUに起因する高アンモニア血症をきたした1例
  • ショウレイ mFOLFOX6 リョウホウ ゴ ニ 5FU ニ キイン スル コウアンモニア ケッショウ オ キタシタ 1レイ

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We report a rare case of hyperammonemic encephalopathy after modified FOLFOX6 therapy (mFOLFOX6). A 72-year-old man was diagnosed with ascending colon cancer, sigmoid colon cancer, multiple liver metastasis, lung metastasis, and peritoneal metastasis. Right hemicolectomy and sigmoidectomy were performed. Postoperative TS1 was carried out, but the serum carcinoembryonic antigen level was elevated. We started the mFOLFOX6 regimen. He became confused upon treatment after 49 hours. A blood test revealed that his serum ammonia level was 399μg/dL. We diagnosed 5-fluorouracil-induced hyperammonemia. Conservative treatment with high-volume drip infusion and branched -chain amino acid solutions resulted in improvement of his mental status. We changed his chemotherapy to FOLFOX4 a month later. He received the FOLFOX4 treatment without any significant adverse effect.

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