HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Cashin, R. Articles by Seki, J. T. Search for Related Content PubMed PubMed Citation Articles by Cashin, R. Articles by Seki, J. T.

RICHARD CASHIN, B.SC.PHARM., PHARM.D., ACPR, is Regional Clinical Coordinator, Pharmacy, David Thompson Health Region, Red Deer, Alberta, Canada. LISA BURRY, B.SC.PHARM., PHARM.D., FCCP, is Clinical Pharmacy Specialist—Critical Care, Department of Pharmacy, and Associate Scientist, Department of Medicine, Mount Sinai Hospital University, University of Toronto, Toronto, Ontario. KENNETH PECKHAM, M.D., is Clinical Associate, Hematology Services, Princess Margaret Hospital, University Health Network (UHN), Toronto. STUART REYNOLDS, M.D., FRCPC, is Staff Intensivist, UHN, Toronto, and Staff Intensivist, Mount Sinai Hospital, Toronto. JACK T. SEKI, B.SC.PHARM., PHARM.D., is Clinical Site Leader, Princess Margaret Hospital, UHN, and Assistant Professor, Pharm.D. Program, University of Toronto, Toronto.

Address correspondence to Dr. Seki at the Pharmacy, Princess Margaret Hospital, University Health Network, 610 University Avenue, Toronto, Ontario, Canada M5G 2M9 (jack.seki{at}uhn.on.ca).

Purpose. The case of a patient who developed acute renal failure, gastrointestinal bleeding, and cardiac arrhythmia after receiving arsenic trioxide for the treatment of acute promyelocytic leukemia (APL) is described. Summary. An 84-year-old Caucasian woman with a history of osteoarthritis sought medical attention for relapse of her APL, which had initially been diagnosed approximately 30 months earlier. Complete remission was accomplished with three cycles of i.v. daunorubicin for 3 days and oral tretinoin for 28 days. After 19 months in remission, she was noted to have increased bruising and blood test values consistent with APL relapse. Two additional trials of oral tretinoin were unsuccessful, and arsenic trioxide was initiated at a daily dosage of 0.15 mg/kg of actual body weight. Less than 24 hours after receiving arsenic trioxide, the patient had "bile-like emesis" and her hemoglobin level decreased. Upper gastrointestinal bleeding was suspected and managed aggressively with transfusions of platelets and fresh frozen plasma and i.v. desmopressin. She became anuric, and her serum creatinine level more than doubled. Hemodialysis was started due to a sudden increase in potassium and fluid overload that did not respond to i.v. furosemide. One hour after hemodialysis, the patient was found pulseless and unresponsive by nursing staff. The cardiac arrest team rapidly responded and noted atrial fibrillation with a fast ventricular rate. Postresuscitation, the patient was transferred to the intensive care unit. Despite aggressive life-support therapy, the patient remained unresponsive. Conclusion. An 84-year-old woman developed acute renal failure, gastrointestinal bleeding, and cardiac arrhythmia after receiving arsenic trioxide for the treatment of APL. Index terms: Antidiuretic agents; Antineoplastic agents; Arsenic trioxide; Blood; Desmopressin; Dialysis; Geriatrics; Leukemia; Toxicity