Vicki Nussbaum1, Nicole Lubcke2, Russell Findlay2. 1. Department of Pharmacy, American Family Children's Hospital, University of Wisconsin Hospitals and Clinics, Madison, WI, USA vnussbaum@uwhealth.org. 2. Department of Pharmacy, American Family Children's Hospital, University of Wisconsin Hospitals and Clinics, Madison, WI, USA.
Abstract
OBJECTIVE: To report on hyperammonemia noted in a series of patients receiving asparaginase products at our institution. SUMMARY OF CASES: We present four patients who experienced symptomatic hyperammonemia after receiving either pegaspargase (three patients) or Erwinia asparaginase (one patient). Presenting symptoms included lethargy, difficulty awakening, confusion, dizziness, numbness and tingling, hallucinations, and paranoia. All patients were treated with lactulose, which led to a decrease in ammonia level and resolution of symptoms. DISCUSSION: Hyperammonemia secondary to asparaginase products has been reported in the literature. The signs and symptoms of increased ammonia should be included in consent documents and discussed with patients and their families. Monitoring of ammonia or asparagine levels may help individualize therapy with asparaginase products in the future. CONCLUSION: Hyperammonemia can occur during treatment of acute lymphoblastic leukemia with asparaginase products. Lactulose appears to be a useful treatment strategy. Further study is warranted to determine whether dose modifications are required for pegaspargase in some patients. Whether these dose modifications would be in the dose itself or frequency of administration remains to be determined.
OBJECTIVE: To report on hyperammonemia noted in a series of patients receiving asparaginase products at our institution. SUMMARY OF CASES: We present four patients who experienced symptomatic hyperammonemia after receiving either pegaspargase (three patients) or Erwinia asparaginase (one patient). Presenting symptoms included lethargy, difficulty awakening, confusion, dizziness, numbness and tingling, hallucinations, and paranoia. All patients were treated with lactulose, which led to a decrease in ammonia level and resolution of symptoms. DISCUSSION: Hyperammonemia secondary to asparaginase products has been reported in the literature. The signs and symptoms of increased ammonia should be included in consent documents and discussed with patients and their families. Monitoring of ammonia or asparagine levels may help individualize therapy with asparaginase products in the future. CONCLUSION: Hyperammonemia can occur during treatment of acute lymphoblastic leukemia with asparaginase products. Lactulose appears to be a useful treatment strategy. Further study is warranted to determine whether dose modifications are required for pegaspargase in some patients. Whether these dose modifications would be in the dose itself or frequency of administration remains to be determined.
Authors: Sumit Gupta; Cindy Wang; Elizabeth A Raetz; Reuven Schore; Wanda L Salzer; Eric C Larsen; Kelly W Maloney; Len A Mattano; William L Carroll; Naomi J Winick; Stephen P Hunger; Mignon L Loh; Meenakshi Devidas Journal: J Clin Oncol Date: 2020-04-10 Impact factor: 44.544
Authors: Stacy L Cooper; David J Young; Caitlin J Bowen; Nicole M Arwood; Sarah G Poggi; Patrick A Brown Journal: Pediatr Blood Cancer Date: 2019-05-16 Impact factor: 3.167
Authors: Michael J Burke; Meenakshi Devidas; Kelly Maloney; Anne Angiolillo; Reuven Schore; Kimberly Dunsmore; Eric Larsen; Len A Mattano; Wanda Salzer; Stuart S Winter; William Carroll; Naomi J Winick; Mignon L Loh; Elizabeth Raetz; Stephen P Hunger; Archie Bleyer Journal: Leuk Lymphoma Date: 2017-11-08
Authors: Hien Anh Nguyen; Ying Su; Jenny Y Zhang; Aleksandar Antanasijevic; Michael Caffrey; Amanda M Schalk; Li Liu; Damiano Rondelli; Annie Oh; Dolores L Mahmud; Maarten C Bosland; Andre Kajdacsy-Balla; Sofie Peirs; Tim Lammens; Veerle Mondelaers; Barbara De Moerloose; Steven Goossens; Michael J Schlicht; Kasim K Kabirov; Alexander V Lyubimov; Bradley J Merrill; Yogen Saunthararajah; Pieter Van Vlierberghe; Arnon Lavie Journal: Cancer Res Date: 2018-01-17 Impact factor: 12.701
Authors: André Baruchel; Patrick Brown; Carmelo Rizzari; Lewis Silverman; Inge van der Sluis; Benjamin Ole Wolthers; Kjeld Schmiegelow Journal: ESMO Open Date: 2020-09