Peer-reviewed veterinary case report
Dog with fatal high ammonia levels after L-asparaginase treatment
By Lyles, Sarah E et al.·Published in Journal of veterinary emergency and critical care (San Antonio, Tex. : 2001)·2011·Department of Small Animal Clinical Sciences, United States·View original on PubMed →
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Original publication title: Acute hyperammonemia after L-asparaginase administration in a dog.
- Species:
- dog
Plain-English summary
A 7-year-old female spayed Beagle was brought to the vet after a week of not eating and being unusually tired. Tests revealed she had stage Vb lymphoma and liver problems, so she was treated with a chemotherapy drug called L-asparaginase, along with steroids and IV fluids. Unfortunately, within hours, she became very lethargic, started vomiting, and developed severe abdominal pain. Her condition worsened rapidly, leading to a coma and high blood ammonia levels, but despite aggressive treatment, she suffered a cardiac arrest and did not survive.
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Abstract
OBJECTIVE: To describe a previously unreported and potentially fatal complication of L-asparaginase (L-asp) administration in a dog. CASE SUMMARY: A 7-year-old, 6.6 kg, female spayed Beagle presented with a 1-week history of progressive inappetance and lethargy. Diagnostic tests identified the presence of stage Vb lymphoma and liver dysfunction. The dog was treated with L-asp at 400 IU/kg, corticosteroids, and IV fluids. Within 12 hours the dog became depressed, vomited, and developed abdominal pain. Within 24 hours, the dog's mentation progressed from obtunded to comatose; subsequently the dog developed a "decerebrate posture." Blood ammonia concentrations exceeded 1,000 μmol/L (1,700 μg/dL). Treatment with broad-spectrum antimicrobials, lactulose enemas, and continuous renal replacement therapy were initiated without response and the dog suffered cardiopulmonary arrest. NEW OR UNIQUE INFORMATION PROVIDED: The purpose of this report is to describe the development of severe hyperammonemia after L-asp therapy in a dog, which has not been previously reported in the literature. Given the rapid progression and fatal outcome observed in this case, early recognition may be crucial for management and treatment of this complication.
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Search related cases →Original publication on PubMed: https://pubmed.ncbi.nlm.nih.gov/22316261/