Zhang Xiaoni, Ren Xiudong, Dai Lingling
A 55-year-old male patient with rectal adenocarcinoma received oxaliplatin (200-mg intravenously infused on day 1) and capecitabine (1-500-mg orally twice daily from day 2 to 15) after operation, and 21 days was a cycle. Next day after the first intravenous infusion of oxaliplatin and before capecitabine administration, the patient developed fatigue, nausea, lower limb muscle soreness, muscle weakness, and dark urine. Laboratory tests showed creatine kinase (CK) 1-453-U/L, myoglobin>1-000-μg/L, urea nitrogen 50.0-mmol/L, serum creatinine (Scr) 192-μmol/L, uric acid 1-071-μmol/L, blood sodium 123-mmol/L, blood phosphorus 4.36-mmol/L, and bicarbonate 5.0-mmol/L. Blood gas analysis showed pH 7.3, carbon dioxide partial pressure (PCO2) 19-mmHg, partial pressure of oxygen (PO-) 110-mmHg, lactic acid 1.5-mmol/L, and base excess -15.5-mmol/L. Rhabdomyolysis, acute renal injury, electrolyte disorder, and metabolic acidosis combined with respiratory alkalosis were diagnosed, which were considered to be related to oxaliplatin. Nutritional supportive treatments, rehydration, alkalinized urine, correction of electrolyte disorders, correction of acidosis, and other treatments were given. On day 2 of treatments, the patient′s lower limb muscle soreness was relieved. On day 3, the lower limb muscle soreness subsided and the muscle strength returned to normal. On day 4, laboratory tests showed CK 73-U/L, CK-MB 1.0-μg/L, myoglobin 51-μg/L, urea nitrogen 4.8-mmol/L, Scr 66-μmol/L, uric acid 179-μmol/L, sodium 134-mmol/L, and phosphorus 0.43-mmol/L; blood gas analysis showed pH 7.4, PCO2-35-mmHg, PO- 100-mmHg, lactic acid 1.2-mmol/L, and base excess -1.3-mmol/L.
