KUN-HUEI YEHANN-LII CHENG2021-01-282021-01-2819940929-6646https://www.scopus.com/inward/record.uri?eid=2-s2.0-0028577519&partnerID=40&md5=aabf819c77bf7ec5f22821f975a09e0ahttps://scholars.lib.ntu.edu.tw/handle/123456789/543582A 61-year-old man was treated with combination chemotherapy incorporating cisplatinum, etoposide, high-dose 5-fluorouracil (2,250 mg/m2/24 hours) and folinic acid for an inoperable gastric adenocarcinoma. He developed acute neurologic symptoms of mental confusion, disorientation and irritability, and then lapsed into a deep coma, lasting for approximately 40 hours during the first dose (day 2) of 5-fluorouracil and folinic acid infusion. This complication reappeared on day 25 during the second dose of 5-fluorouracil and folinic acid, which were then the only drugs given. Because folinic acid was unlikely to be associated with this condition, neurotoxicity due to high-dose 5-fluorouracil was highly suspected. The pathogenesis of 5-fluorouracil neurotoxicity may be due to a Krebs cycle blockade by fluoroacetate and fluorocitrate, thiamine deficiency, or dihydrouracil dehydrogenase deficiency. High-dose 5-fluorouracil/folinic acid infusion therapy has recently become a popular regimen for various cancers. It is necessary that both oncologists and neurologists be fully aware of this unusual complication.[SDGs]SDG3biperiden; cisplatin; diazepam; etoposide; fluorouracil; folinic acid; metoclopramide; ondansetron; adult; article; case report; confusion; disorientation; human; intravenous drug administration; male; neurotoxicity; pathogenesis; stomach adenocarcinoma; Acute Disease; Brain Diseases; Case Report; Coma; Confusion; Fluorouracil; Human; Leucovorin; Male; Middle Agejournal article78584592-s2.0-0028577519