2008
DOI: 10.3747/co.v15i5.252
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The Confused Cancer Patient: A Case of 5-Fluorouracil—Induced Encephalopathy

Abstract: The fluorinated pyrimidine 5-fluorouracil (5-FU) is an anticancer agent used in most adjuvant and palliative treatment regimens for colorectal cancer. Neurotoxicities are considered extremely rare side effects of 5-FU. Here, we report a case of 5-FU-induced encephalopathy, manifesting as seizures and delirium, in an era of oxaliplatin-containing chemotherapy. If ammonia levels are elevated, lactulose may be considered in the initial management of neuropsychiatric complications from 5-FU. KEY WORDSColorectal ca… Show more

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Cited by 25 publications
(16 citation statements)
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“…Clinical features can vary from a subtle encephalopathy to severe form including akinetic mute state and even death. Strong clinical suspicion and neuroimaging tools: Magnetic resonance imaging especially diffusion weighted sequence helps in early diagnosis of this potentially dreadful condition [2,3].…”
Section: Introductionmentioning
confidence: 99%
“…Clinical features can vary from a subtle encephalopathy to severe form including akinetic mute state and even death. Strong clinical suspicion and neuroimaging tools: Magnetic resonance imaging especially diffusion weighted sequence helps in early diagnosis of this potentially dreadful condition [2,3].…”
Section: Introductionmentioning
confidence: 99%
“…We decided to continue FOLFIRI and reduce only the infusional 5-FU dose, not the bolus 5-FU dose, because omitting 5-FU may have shortened the patient's survival. Discontinuation of 5-FU is reportedly the initial treatment for 5-FU encephalopathy [8], and we usually do not use the same anticancer drugs that have induced encephalopathy. However, 5-FU is the most important drug for chemotherapy of colorectal cancer, and we should ensure that this key drug is utilized wisely.…”
Section: Discussionmentioning
confidence: 99%
“…Although we were not able to check the level of decreased DPD activity, we indirectly suspected she had a DPD enzyme deficiency according to her clinical symptoms. We thought that the cause of the neurotoxicity in this patient was the reduced level of DPD enzyme, and we stopped using the previous regimen, including the 5-FU, and we started conservative treatment for the encephalopathy such as fluid supplementation, a lactulose enema and intravenous thiamine supplementation (4,10). Her symptoms then recovered in a week.…”
Section: Discussionmentioning
confidence: 99%