Cisplatin preparation error; patient management and morbidity

Area of Science:

• Oncology
• Pharmacology
• Nephrology

Background:

• Antineoplastic drug errors pose significant risks to oncology patients due to narrow therapeutic ranges and complex regimens.
• Chemotherapy errors can lead to severe morbidity and mortality.

Observation:

• A 57-year-old head and neck cancer patient received a 180 mg/m² cisplatin overdose despite safety protocols.
• The patient experienced nausea, vomiting, acute renal failure, tinnitus, and severe myelodepression.

Findings:

• The patient recovered after a 9-day hospital stay with prophylactic and symptomatic treatments.
• Mild tinnitus and mild renal impairment were the only lasting effects.
• This case demonstrates successful management of cisplatin toxicity, differing from other reported cases.

Implications:

• Prompt and appropriate management is crucial for mitigating cisplatin overdose toxicity.
• This case underscores the importance of vigilance and effective interventions in chemotherapy administration.
• Early treatment can lead to favorable patient outcomes even after significant medication errors.