mercaptopurine and Acidosis

Acute lymphoblastic leukemia maintenance chemotherapy includes mercaptopurine, a purine analog with uncommon side effects, that can be life-threatening. We describe a 7-year-old female patient with ALL that presented with altered state of consciousness after maintenance chemotherapy with methotrexate and 6-mercaptopurine, due to severe hypoglycemia with metabolic acidosis. She initiated metabolic corrections with rapid resolution of symptoms. Hypoglycemia secondary to 6-mercaptopurine is a rare and transient side effect. The cause effect relation is difficult to establish, leading to underdiagnosis. Hypoglycemia is preventable without compromising maintenance therapy efficacy.

Topics: Acidosis; Child; Female; Humans; Hypoglycemia; Mercaptopurine; Precursor Cell Lymphoblastic Leukemia-Lymphoma; Severity of Illness Index

Topics: Acidosis; Humans; Lactates; Leukemia, Myeloid, Acute; Male; Mercaptopurine; Middle Aged; Vincristine

Topics: Acidosis; Blood Pressure; Child; Chronic Disease; Cyclophosphamide; Diet, Sodium-Restricted; Dietary Proteins; Diuretics; Glomerulonephritis; Humans; Hypertension; Mercaptopurine; Nephrotic Syndrome; Potassium; Prednisone; Reserpine; Water-Electrolyte Balance