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A case of massive cisplatin overdose managed by plasmapheresis
1Department of Internal Medicine, Ewha Women's University College of Medicine, Seoul, Korea.
The Korean Journal of Internal Medicine
|July 1, 1995
Summary
Accidental massive cisplatin overdose caused severe toxicities. Prompt management with plasmapheresis effectively reduced platinum levels and aided recovery, highlighting the importance of swift intervention for chemotherapy overdose.
Area of Science:
- Oncology
- Nephrology
- Toxicology
Background:
- Cisplatin is a widely used chemotherapy agent for various cancers.
- Accidental overdoses of cisplatin are an increasing concern due to its rising therapeutic use.
- Safeguards in prescription and administration are crucial but not always sufficient.
Observation:
- A 59-year-old male patient received a massive accidental overdose of cisplatin (300mg/m2).
- The patient experienced severe toxicities including emesis, myelosuppression, renal failure, and neurological and visual disturbances.
- Laboratory analysis confirmed high platinum concentrations using flameless atomic absorption spectroscopy.
Findings:
- Plasmapheresis significantly reduced platinum levels from 2979 ng/ml to 185 ng/ml, demonstrating its efficacy in massive overdose.
- Granulocyte-macrophage colony-stimulating factor (GM-CSF) was administered to manage myelosuppression.
- The patient's renal function recovered after 3 months, and a partial response in esophageal cancer was observed.
Implications:
- This case underscores the critical need for heightened awareness regarding accidental cisplatin overdose.
- Prompt and appropriate management, including plasmapheresis, can mitigate severe toxicity and improve patient outcomes.
- Effective management strategies are vital for patients experiencing high-dose chemotherapy accidental overdoses.