Hyperammonaemic Encephalopathy During Continuous Infusion of 5-Fluorouracil in the FLOT Regimen for Respectable Gastric Cancer: Two Cases

1. Introduction
5-Fluorouracil (5-FU) is a pyrimidine analog and is the backbone of systemic treatment of a wide variety of solid malignancies [1]. In the recent years, the administration of continuous infusion of 5-fluorouracil is becoming more popular in the (neo)adjuvant setting in gastric, pancreatic and metastatic colorectal cancer. We report two cases who developed hyperammonaemic encephalopathy after the continuous administration of high dose continuous infusion of 5-fluorouracil. The aim of this case series is to create awareness of neurological deterioration due to hyperammonaemic encephalopathy in patients treated with 5-FU, especially with higher dose of continuous infusion. Furthermore, we discuss the underlying pathology and possible treatment consequences.