Please use this identifier to cite or link to this item: https://doi.org/10.1097/MD.0000000000024313
Title: Sunitinib-associated hyperammonemic encephalopathy successfully managed with higher intensity conventional hemodialysis: A case report
Authors: Haroon, S 
Ko, S 
Wong, A
Tan, PS 
Lee, E
Lau, T
Keywords: Aged
Antineoplastic Agents
Carcinoma, Renal Cell
Hepacivirus
Hepatitis C
Humans
Hyperammonemia
Kidney Failure, Chronic
Kidney Neoplasms
Liver Cirrhosis
Male
Neurotoxicity Syndromes
Renal Dialysis
Sunitinib
Issue Date: 5-Feb-2021
Publisher: Ovid Technologies (Wolters Kluwer Health)
Citation: Haroon, S, Ko, S, Wong, A, Tan, PS, Lee, E, Lau, T (2021-02-05). Sunitinib-associated hyperammonemic encephalopathy successfully managed with higher intensity conventional hemodialysis: A case report. Medicine 100 (5) : e24313-. ScholarBank@NUS Repository. https://doi.org/10.1097/MD.0000000000024313
Abstract: RATIONALE: Hyperammonemia encephalopathy is a rare but severe complication that has been reported in association with the use of sunitinib, a tyrosine kinase inhibitor. We report here a unique case of a patient with end stage renal disease that was initiated on sunitinib for metastatic renal cell carcinoma. PATIENT CONCERNS: A 65-year-old man with end stage renal disease on maintenance conventional hemodialysis and had concomitant stable Child-Pugh class B liver cirrhosis consequent of hepatitis C infection was started on sunitinib for metastatic renal cell carcinoma. He developed confusion few weeks after starting therapy with no other indication of worsening liver dysfunction otherwise. DIAGNOSIS: He was later diagnosed with hyperammonemia encephalopathy. INTERVENTIONS: His treatment was discontinued and reinitiated at a lower dose after recovery and titrated according to tolerance. As ammonia is a very low molecular weight molecule and is cleared well with diffusive clearance, we intensified his dialysis regimen by increasing intensity for each session and frequency per week. OUTCOMES: With this change in dialysis regimen, patient was able to continue treatment with sunitinib. LESSONS: Clinicians prescribing sunitinib should be vigilant to monitor for this complication in patients receiving sunitinib, apart from the more usual presentation of hepatotoxicity. We found that a more intensive hemodialysis regimen consisting of 4× a week conventional high-flux hemodialysis (HD) can permit the continuation of treatment with sunitinib in an end stage renal disease (ESRD) patient with Child-Pugh class B liver cirrhosis.
Source Title: Medicine
URI: https://scholarbank.nus.edu.sg/handle/10635/206179
ISSN: 03045412
15365964
DOI: 10.1097/MD.0000000000024313
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