Cutaneous Management after Extravasation of High-Concentrated Amino Acid Solution Administered for Renal Protection in PRRT
Issued Date
2022-02-01
Resource Type
ISSN
23791381
eISSN
2379139X
Scopus ID
2-s2.0-85124354088
Pubmed ID
35202194
Journal Title
Tomography
Volume
8
Issue
1
Start Page
356
End Page
363
Rights Holder(s)
SCOPUS
Bibliographic Citation
Tomography Vol.8 No.1 (2022) , 356-363
Suggested Citation
Sakulpisuti C. Cutaneous Management after Extravasation of High-Concentrated Amino Acid Solution Administered for Renal Protection in PRRT. Tomography Vol.8 No.1 (2022) , 356-363. 363. doi:10.3390/tomography8010029 Retrieved from: https://repository.li.mahidol.ac.th/handle/20.500.14594/86152
Title
Cutaneous Management after Extravasation of High-Concentrated Amino Acid Solution Administered for Renal Protection in PRRT
Author(s)
Author's Affiliation
Other Contributor(s)
Abstract
High-concentrated amino acid solution is used to protect the kidneys during peptide receptor radionuclide therapy (PPRT) in patients with neuroendocrine tumors (NETs). Extravasation of the solution can cause cutaneous complications. In this study, we described a 66-year-old man with metastatic medullary thyroid cancer and a 32-year-old woman with metastatic pancreatic NET who developed cutaneous lesions caused by the extravasation of an amino acid solution (25 g of lysine and 25 g of arginine in 1 L of normal saline) during PRRT with [177 Lu]Lu-DOTA-TATE. Both were treated conservatively, and these cutaneous lesions gradually improved. The patient with metastatic pancreatic NET rejected the amino acid infusion in subsequent cycles of PRRT and therefore received [177 Lu]Lu-DOTA-TATE alone, and her serum creatinine level and estimated glomerular filtration rate (eGFR) remained normal for 2 months after the last treatment. These two cases revealed cutaneous complications resulting from high-concentrated amino acid solution during PRRT because of hyperosmolarity. Health care providers should be aware of this complication to ensure its prevention and appropriate management. Preserved renal function was demonstrated after [177 Lu]Lu-DOTA-TATE treatment in the absence of the infusion of a high-concentrated amino acid solution. However, long-term follow-up of renal function is suggested.