The use of sodium benzoate in a ten-fold overdose of asparaginase

A three year old boy with acute lymphoblastic leukaemia (ALL) was administered chemotherapy consisting of asparaginase, vincristine, daunorubicin and dexamethasone. On day 15 the patient received a tenfold overdose of asparaginase and was hospitalised for care. Despite a very high plasma ammonia level the patient remained well clinically and other biochemical results remained normal. Ammonia-trapping therapy with sodium benzoate at 206 mg/kg/day associated with a low protein diet was undertaken for two days. Once the ammonia level returned to normal, chemotherapy was continued with a reduced dose of asparaginase.