Abstract
Hydroelectrolytic disorders are one of the most common metabolic complications in cancer patients. Although often metabolic alterations affecting various ions are part of the manifestations of the oncological disease, even in the form of paraneoplastic syndrome, we must not forget that very often, these disorders could be caused by various drugs, including some of the antineoplastic agents most frequently used, such as platin derivatives or some biologics. These guidelines review major management of diagnosis, evaluation and treatment of the most common alterations of sodium, calcium, magnesium and potassium in cancer patients. Aside from life-sustaining treatments, we have reviewed the role of specific drug treatments aimed at correcting some of these disorders, such as intravenous bisphosphonates for hypercalcemia or V2 receptor antagonists in the management of syndrome of inappropriate antidiuretic hormone secretion-related hyponatremia.
Highlights
Hydroelectrolytic disorders are one of the most common metabolic complications in cancer patients
Often metabolic alterations affecting various ions are part of the manifestations of the oncological disease, even in the form of paraneoplastic syndrome, we must not forget that very often, these disorders could be caused by various drugs, including some of the antineoplastic agents most frequently used, such as platin derivatives or some biologics
Aside from life-sustaining treatments, we have reviewed the role of specific drug treatments aimed at correcting some of these disorders, such as intravenous bisphosphonates for hypercalcemia or V2 receptor antagonists in the management of syndrome of inappropriate antidiuretic hormone secretion-related hyponatremia
Summary
Hydroelectrolytic disorders are one of the most common metabolic complications in cancer patients. The use of other pharmaceutical drugs recommended for the treatment of hyponatremia is more controversial in the SIADH scenario: there are no meta-analyses or systematic reviews to assess the efficacy of lithium salts, urea, demeclocycline or loop diuretics Their possible recommendation by consensus guidelines is based exclusively on acase series published [2] (evidence level IV, recommendation grade D). Mg deficiency can be caused by three pathophysiological mechanisms [15]: decreased intake (dietary factor); diminished absorption due to resection of small intestine, cholestasis, pancreatic failure, diarrhea, stoma, fistula and others; and increased excretion such as in the case of alcoholism, diabetes mellitus, interstitial nephritis, polyuric phase of acute tubular necrosis, hyperthyroidism and hyperparathyroidism This mechanism occurs when nephrotoxic drugs are used such as aminoglycoside antibiotics, amphotericin, cyclosporine, loop diuretics and in cancer patients treated with some antitumor drugs, in particular cisplatin (CDDP) and anti-EGFR monoclonal antibodies (mAb). Patients with renal failure should receive 50 % of the usual Mg dose if serum creatinine is higher than 2
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