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Phenylketonuria (PKU) is a protein metabolism disorder characterized by high blood levels of the amino acid phenylalanine. This results from a mutation in the gene responsible for phenylalanine hydroxylase, an enzyme that converts phenylalanine into tyrosine. When this enzyme is deficient, phenylalanine builds up in the blood, leading to symptoms such as vomiting, rashes, seizures, growth deficiency, and severe mental retardation. An early diagnosis and a diet restricting phenylalanine intake...
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Ezocgabine or retigabine, an antiepileptic drug of remarkable efficacy, has revolutionized the management of seizures. It is a potassium channel activator, explicitly targeting the family of Q subtype potassium channels. It enhances the transmembrane potassium currents, regulating neuronal excitability. This action stabilizes the resting membrane potential, a pivotal factor in mitigating the hyperexcitability that characterizes epilepsy.
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Acute Kidney Injury (AKI) progresses through distinct clinical phases: the oliguric, diuretic, and recovery phases, each marked by unique manifestations and challenges.Oliguric Phase:The oliguric phase is the initial stage of AKI, typically lasting 10 to 14 days. This phase is marked by a significant reduction in urine output, usually less than 400 mL per day, indicating decreased kidney function. Fluid retention is a prominent feature, leading to symptoms such as edema, hypertension, and...
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Dopamine receptor antagonists, also known as antipsychotic agents, are critical in managing chemotherapy-induced vomiting. These antiemetic agents block dopamine receptors in the chemoreceptor trigger zone (CTZ), inhibiting signal transmission to the vomiting center. Antipsychotic agents encompass phenothiazines (PTZ), butyrophenones, benzamides, and thienobenzodiazepines (Zyprexa), which are utilized for their antiemetic and sedative properties.
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Updated: Dec 11, 2025

Quantifying Antibody-Dependent Cellular Cytotoxicity in a Tumor Spheroid Model: Application for Drug Discovery
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Sunitinib-associated hyperammonemic encephalopathy.

Demis N Lipe1, Besim Hoxha1, Sunil K Sahai2

  • 1Department of Emergency Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, United States of America.

The American Journal of Emergency Medicine
|August 20, 2020
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Summary

Sunitinib, a cancer drug, can cause hyperammonemic encephalopathy, a rare brain condition. Early identification and lactulose treatment are crucial for patients presenting with altered mental status.

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Area of Science:

  • Oncology
  • Neurology
  • Emergency Medicine

Background:

  • Sunitinib is a tyrosine kinase inhibitor used for various cancers.
  • Rare adverse effects of cancer therapies are increasingly recognized as patients live longer.
  • Hyperammonemic encephalopathy is a serious neurological condition characterized by elevated ammonia levels in the blood.

Observation:

  • A 71-year-old woman with metastatic breast cancer developed confusion after 12 days of sunitinib treatment.
  • Emergency department workup revealed significantly elevated ammonia levels (202 μmol/L) without underlying liver disease.
  • The patient's mental status and ammonia levels fluctuated during a 12-day hospitalization despite lactulose treatment.

Findings:

  • This case represents the first reported instance of sunitinib-associated hyperammonemic encephalopathy in emergency medicine literature.
  • Magnetic resonance imaging and electroencephalogram results were unremarkable, ruling out other neurological causes.
  • Ammonia levels normalized, and neurological symptoms resolved after discontinuing sunitinib, with no recurrence at three months follow-up.

Implications:

  • Clinicians should consider sunitinib-induced hyperammonemic encephalopathy in patients presenting with altered mentation.
  • Prompt measurement of ammonia levels and initiation of lactulose are recommended for early diagnosis and management.
  • Awareness of this rare adverse effect is critical for preventing severe complications like seizures, brain edema, and death.