Electrolyte Disturbances in Critically Ill Cancer Patients: An Endocrine Perspective

Khan, Maryam I.; Dellinger, R. Phillip; Waguespack, Steven G.

doi:10.1177/0885066617706650

Cited by 17 publications

(25 citation statements)

References 58 publications

(78 reference statements)

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“…Previous studies reported the incidence of hyponatremia and hypokalemia in cancer patients was up to 47-64% [4,5] and 41-48% [6,7] respectively. The occurrence of various EAD is concomitant and can trigger a series of symptoms such as delirium, fatigue, constipation, nausea, vomiting, and even the in-hospital death [8,9]. In most cases, EAD is associated with the etiology seen in general inpatients and not specifically allied to the underlying cancer.…”

Section: Introductionmentioning

confidence: 99%

Electrolyte and acid-base disorders in cancer patients and its impact on clinical outcomes: evidence from a real-world study in China

et al. 2020

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Background: This study aims to delineate the incidence of electrolyte and acid-base disorders (EAD) in cancer patients, to figure out the risk factors of EAD, then to assess the impact of EAD on patients' in-hospital clinical outcomes. Methods: Patients with the diagnosis of malignancies hospitalized during 1 October 2014 and 30 September 2015 were recruited in Zhongshan Hospital, Fudan University in Shanghai of China. Demographic characteristics, comorbidities, and clinical data, including survival, length of stay and hospital cost, were extracted from the electronic medical record system. Electrolyte and acid-base data were acquired from the hospital laboratory database. Results: Of 25,881 cancer patients with electrolyte data, 15,000 (58.0%) cases had at least one electrolyte and acid-base abnormity. Hypocalcemia (27.8%) was the most common electrolyte disorder, followed by hypophosphatemia (26.7%), hypochloremia (24.5%) and hyponatremia (22.5%). The incidence of simple metabolic acidosis (MAC) and metabolic alkalosis (MAL) was 12.8% and 22.1% respectively. Patients with mixed metabolic acid-base disorders (MAC þ MAL) accounted for 30.2%. Lower BMI score, preexisting hypertension and diabetes, renal dysfunction, receiving surgery/chemotherapy, anemia and hypoalbuminemia were screened out as the major risk factors of EAD. In-hospital mortality in patients with EAD was 2.1% as compared to those with normal electrolytes (0.3%). The risk of death significantly increased among patients with severe EAD. Similarly, the length of stay and hospital cost also tripled as the number and grade of EAD increased. Conclusion: EAD is commonly encountered in cancer patients and associated with an ominous prognosis. Patients with comorbidities, renal/liver dysfunction, and anti-tumor therapy have a higher risk of EAD. Regular monitoring of electrolytes, optimum regimen for intravenous infusion, timely correction of modifiable factors and appropriate management of EAD should not be neglected during anti-tumor treatment.

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Section: Introductionmentioning

confidence: 99%

Electrolyte and acid-base disorders in cancer patients and its impact on clinical outcomes: evidence from a real-world study in China

et al. 2020

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“…Sodium imbalance is common in patients who have cancer. [17][18][19][20] Hyponatraemia is more commonly observed in comparison with hypernatraemia. 20 The derangements can be categorised as follows.…”

Section: Sodium Homeostasis In Patients With Cancermentioning

confidence: 99%

“…17,21 Syndrome of inappropriate secretion of ADH (SIADH) is the most common cause and can occur as a paraneoplastic manifestation, as a response to central nervous system (CNS) lesions (intracranial tumours, meningitis, cranial irradiation, primary or metastatic lesions), pulmonary disease (pneumonia, tuberculosis, metastasis) or as an adverse effect of cancer therapy. 19,[22][23][24] Conversely, certain drugs like cyclophosphamide (CYC), nonsteroidal anti-inflammatory drugs and antiepileptic drugs (e.g., carbamazepine) can increase renal ADH sensitivity, causing a nephrogenic syndrome of inappropriate antidiuresis (NSIAD). 25 Apart from SIADH, usual causes of hypovolaemic (e.g., due to renal or extra-renal fluid losses) and hypervolaemic (e.g., heart failure, cirrhosis) hyponatraemia can also occur in individuals with cancer.…”

Section: Hyponatraemiamentioning

confidence: 99%

Anticancer Medications and Sodium Dysmetabolism

Bhattacharya

Lathia

Kantroo

et al. 2020

European Endocrinology

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“…A commonly Figure 1. Evaluation of hyponatremia [10,19,46] used medication to treat SIAD, especially chronic disease, is the tetracycline antibiotic demeclocycline, which has the side effect of causing nephrogenic diabetes insipidus [34] . A few of the other side effects of demeclocycline include GI intolerance, renal toxicity, and photosensitivity.…”

Section: Clinical Management/treatment Optionsmentioning

confidence: 99%

Recent advances in the management of hyponatremia in cancer patients

Khan¹,

Waguespack²,

Ahmed³

2019

JCMT

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Hyponatremia is the most frequently encountered electrolyte disorder in cancer patients and is usually multifactorial in its origin. In this review, we discuss the predisposing factors, pathophysiology, clinical symptomatology, and currently available diagnostic and therapeutic options for the management of hyponatremia. In addition to paraneoplastic syndromes, concurrent chemotherapy and comorbidities predispose oncology patients to the risk of hyponatremia. Initial symptoms and signs can be subtle and the prompt evaluation and initiation of treatment is of paramount importance to prevent neurocognitive and other complications. The syndrome of inappropriate antidiuresis (SIAD) is the most common cause of hyponatremia, and the use of serum and urine parameters that distinguish SIAD from other etiologies is discussed. Individualized treatment is preferred depending on the underlying cause and severity of hyponatremia. The treatment of hyponatremia is reviewed and the importance of avoiding rapid overcorrection of the sodium level to reduce the risk of osmotic demyelination syndrome is emphasized. Vasopressin receptor antagonists (vaptans) offer a direct approach to the management of euvolemic and hypervolemic hyponatremia, but the indications for their use and long-term safety need to be clarified. The treatment of hyponatremia is likely to reduce complications and improve survival in cancer patients.

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Electrolyte Disturbances in Critically Ill Cancer Patients: An Endocrine Perspective

Cited by 17 publications

References 58 publications

Electrolyte and acid-base disorders in cancer patients and its impact on clinical outcomes: evidence from a real-world study in China

Electrolyte and acid-base disorders in cancer patients and its impact on clinical outcomes: evidence from a real-world study in China

Anticancer Medications and Sodium Dysmetabolism

Recent advances in the management of hyponatremia in cancer patients

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