RESUMEN
OBJECTIVES: Positively charged amino acids (AA) such as arginine/lysine are coinfused with radiolabeled somatostatin analogs to reduce rates of nephrotoxicity. In the phase 3 NETTER-1 trial, commercial AA formulations were used in association with 177Lu-DOTA-0-Tyr3-Octreotate (DOTATATE). These formulations were also used in an early-access program (EAP) before regulatory approval of 177Lu-DOTATATE. Our program transitioned to compounded l-arginine 2.5%/l-lysine 2.5% in 0.9% NaCl after commercial approval of 177Lu-DOTATATE. We sought to compare rates of nausea/vomiting with arginine/lysine versus commercial parenteral AA formulations. METHODS: Rates of nausea/vomiting of all 20 EAP patients who received commercial AAs (15% Clinisol) were compared with the first 29 patients to receive 177Lu-DOTATATE after commercial approval and coinfused with arginine/lysine. Other parameters reviewed included infusion rates, need for PRN nausea medications, and other toxicities. RESULTS: Seventeen percent of patients who received compounded arginine/lysine experienced nausea, compared with 100% of patients in the EAP group (P < 0.0001). Infusion-related reactions occurred in 3% of the arginine/lysine cohort versus 35% in the EAP group. Infusion durations were substantially shorter in the arginine/lysine cohort (reduced by 61%). CONCLUSIONS: Coinfusions of arginine/lysine with radiolabeled somatostatin analogs result in substantially lower rates of nausea/vomiting compared with commercial AA formulations designed for parenteral nutrition.
Asunto(s)
Aminoácidos/uso terapéutico , Náusea/diagnóstico , Tumores Neuroendocrinos/terapia , Octreótido/análogos & derivados , Compuestos Organometálicos/uso terapéutico , Nutrición Parenteral/métodos , Vómitos/diagnóstico , Anciano , Anciano de 80 o más Años , Aminoácidos/administración & dosificación , Aminoácidos/efectos adversos , Arginina/administración & dosificación , Arginina/efectos adversos , Arginina/uso terapéutico , Terapia Combinada/efectos adversos , Terapia Combinada/métodos , Femenino , Humanos , Bombas de Infusión , Lisina/administración & dosificación , Lisina/efectos adversos , Lisina/uso terapéutico , Masculino , Persona de Mediana Edad , Náusea/etiología , Octreótido/administración & dosificación , Octreótido/efectos adversos , Octreótido/uso terapéutico , Compuestos Organometálicos/administración & dosificación , Compuestos Organometálicos/efectos adversos , Evaluación de Resultado en la Atención de Salud/métodos , Evaluación de Resultado en la Atención de Salud/estadística & datos numéricos , Nutrición Parenteral/efectos adversos , Radiofármacos/administración & dosificación , Radiofármacos/efectos adversos , Radiofármacos/uso terapéutico , Receptores de Péptidos/química , Estudios Retrospectivos , Vómitos/etiologíaRESUMEN
We report a case of intracranial hypotension caused by chiropractic manipulation which, in contrast to previously reported cases, documents the location of the cerebrospinal fluid leak by radionuclide cisternography. Cervical spinal manipulation produced a remote lumbar dural tear in our patient. Spinal magnetic resonance imaging may falsely localize the dural tear in this condition. Although conservative management is often sufficient, precise localization is required for more invasive therapies.