Open AccessHyperammonemic Encephalopathy Associated With Fibrolamellar Hepatocellular Carcinoma: Case Report, Literature Review, and Proposed Treatment Algorithm
Author(s) -
Chapuy Claudia I.,
Sahai Inderneel,
Sharma Rohit,
Zhu Andrew X.,
Kozyreva Olga N.
Publication year - 2016
Publication title -
the oncologist
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.176
H-Index - 164
eISSN - 1549-490X
pISSN - 1083-7159
DOI - 10.1634/theoncologist.2015-0267
Subject(s) - medicine , hyperammonemia , oxaliplatin , encephalopathy , ornithine transcarbamylase deficiency , hepatocellular carcinoma , complication , hepatic encephalopathy , gemcitabine , ornithine transcarbamylase , pathophysiology , gastroenterology , pediatrics , intensive care medicine , urea cycle , chemotherapy , colorectal cancer , cancer , cirrhosis , biochemistry , chemistry , amino acid , arginine
We report a case of a 31‐year‐old man with metastatic fibrolamellar hepatocellular carcinoma (FLHCC) treated with gemcitabine and oxaliplatin complicated by hyperammonemic encephalopathy biochemically consistent with acquired ornithine transcarbamylase deficiency. Awareness of FLHCC‐associated hyperammonemic encephalopathy and a pathophysiology‐based management approach can optimize patient outcome and prevent serious complications. A discussion of the management, literature review, and proposed treatment algorithm of this rare metabolic complication are presented. Implications for Practice: Pathophysiology‐guided management of cancer‐associated hyperammonemic encephalopathy can improve patient outcome and prevent life‐threatening complications. Community and academic oncologists should be aware of this serious metabolic complication of cancer and be familiar with its management.