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Severe Hypomagnesemia Associated with Tipifarnib
Description
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A6934 - Severe Hypomagnesemia Associated with Tipifarnib
Author Block: S. Basyal1, M. Bachan2, Z. Khan2, A. Nugent2, D. Acharya2; 1Internal Medicine, Bronx VAMC, New York, NY, United States, 2Internal Medicine, Bronx VAMC, NY, NY, United States.
Tipifarnib is a farnesyl inhibitor which is under Phase III trials for Acute Myeloid Leukemia and Myelodysplastic syndrome in the elderly. Electrolyte abnormality is reported to be rare. We present a case with severe hypomagnesemia.
Case discussion
74-year-old man with history of Stage III B (T3 N1b M0) cecal adenocarcinoma s/p R-hemicolectomy 11 years ago. He had adjuvant Folfox with no evidence of disease recurrence. He presented with worsening anemia with normal EGD and colonoscopy. Bone marrow biopsy showed myelodysplastic syndrome. He completed 6 cycles of 5 Azacytidine unsuccessfully and became dependent on blood transfusion for anemia. He was enrolled in Trial with Tifarnib. His transfusion need had been decreasing. At start of therapy he had nausea and the dosage of Tipifarnib was decreased. Because of severe nausea he was not eating or drinking. Due to weakness and lethargy he came to Emergency Room. Labs were remarkable for magnesium of 0.2 and potassium of 3.3. He was admitted for repletion of electrolytes. His review of system was otherwise unremarkable. He was afebrile, blood pressure 148/70, pulse 72, respiratory rate 18, saturation 98% @ RA. He had pallor and dry mucus membrane. Lab showed H/H 6/ 17.5; platelets and white count were within normal limits; EKG revealed QTC 496. He received supplementation of magnesium, potassium and pack red blood cells. Day 2, magnesium 2.2. QTC 420. On day 3 of hospitalization he was feeling well.
Conclusion
Tipifarnib has shown promising results in elderly patients with Acute Myeloid Leukemia. This is an investigational drug and many side effects have not been reported. Nausea is a common side effect which can lead to poor oral intake and cause electrolyte disturbances. Electrolytes should be checked routinely to prevent devastating complications.
Author Block: S. Basyal1, M. Bachan2, Z. Khan2, A. Nugent2, D. Acharya2; 1Internal Medicine, Bronx VAMC, New York, NY, United States, 2Internal Medicine, Bronx VAMC, NY, NY, United States.
Tipifarnib is a farnesyl inhibitor which is under Phase III trials for Acute Myeloid Leukemia and Myelodysplastic syndrome in the elderly. Electrolyte abnormality is reported to be rare. We present a case with severe hypomagnesemia.
Case discussion
74-year-old man with history of Stage III B (T3 N1b M0) cecal adenocarcinoma s/p R-hemicolectomy 11 years ago. He had adjuvant Folfox with no evidence of disease recurrence. He presented with worsening anemia with normal EGD and colonoscopy. Bone marrow biopsy showed myelodysplastic syndrome. He completed 6 cycles of 5 Azacytidine unsuccessfully and became dependent on blood transfusion for anemia. He was enrolled in Trial with Tifarnib. His transfusion need had been decreasing. At start of therapy he had nausea and the dosage of Tipifarnib was decreased. Because of severe nausea he was not eating or drinking. Due to weakness and lethargy he came to Emergency Room. Labs were remarkable for magnesium of 0.2 and potassium of 3.3. He was admitted for repletion of electrolytes. His review of system was otherwise unremarkable. He was afebrile, blood pressure 148/70, pulse 72, respiratory rate 18, saturation 98% @ RA. He had pallor and dry mucus membrane. Lab showed H/H 6/ 17.5; platelets and white count were within normal limits; EKG revealed QTC 496. He received supplementation of magnesium, potassium and pack red blood cells. Day 2, magnesium 2.2. QTC 420. On day 3 of hospitalization he was feeling well.
Conclusion
Tipifarnib has shown promising results in elderly patients with Acute Myeloid Leukemia. This is an investigational drug and many side effects have not been reported. Nausea is a common side effect which can lead to poor oral intake and cause electrolyte disturbances. Electrolytes should be checked routinely to prevent devastating complications.
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