2019 Research Forum

ACUTE TUBULAR DYSFUNCTION WITH LOWER DOSES OF CISPLATIN

Simmer Kaur MD R2, Sabitha Eppanapally MD, Arash Heidari MD, Department of Internal Medicine, Kern Medical, Bakersfield, CA

Introduction

Treatment She received fluids and electrolyte replacement. Once her nausea was controlled she was switched to oral supplementation of magnesium, potassium, and calcium. Daily serum levels of potassium, phosphorous and calcium were stable, however, magnesium levels continued to be low. Patient was clinically stable and was subsequently discharged home with a plan for daily IV infusions of magnesium at an infusion center with close monitoring of serum electrolytes. Conclusion Long-term effects of cisplatin toxicity may lead to subclinical and/or permanent reduction in GFR. Clinician should monitor renal functions closely as tubular dysfunction can occur after only a dose of 360 mg and hypomagnesemia can occur after only 120 mg of cumulative drug is administered. References

Laboratory Studies

Cisplatin is a cancer chemotherapeutic agent widely used for the treatment of many solid-organ cancers however its clinical use is complicated by its dose-related variety or renal injury. Nephrotoxicity due to cisplatin is manifested as progressive renal impairment, salt-wasting, a fanconi- like syndrome, hypomagnesemia. One study suggested that decrease in GFR and magnesium concentration happens after doses higher than 50 mg/m2 body surface area per dose. Another study reported renal damage occurs when approximately 500 mg of cumulative drug had been administered. 63-year old Caucasian female with stage III endometrial carcinoma completed 9 cycles of 40mg/m2/week cisplatin chemotherapy with radiation presented to the emergency department with intractable nausea and vomiting which started after completing her 7 th cycle of cisplatin. Physical Exam On presentation, her vitals were stable, physical exam was remarkable for orthostatic hypotension and a resting tremor in both upper extremities. Case History

BMP

134 mEq/L

Sodium

2 .5 mEq/L

Potassium

89 mEq/L

Chloride

33 mEq/L

Bicarbonate

14 mg/dL

BUN

0 .74 mg/dL

Creatinine

Magnesium

<0.3 mg/dL

5 .4 mg/dL

Calcium

24 Hour Urine electrolytes

Potassium

82 mEq/24Hr

Seski JC, Edwards CL, Herson J, Rutledge FN. Cisplatin chemotherapy for disseminated endometrial cancer. Obstet Gynecol. 1982 Feb;59(2) 225-228.

646 mEq/24Hr

Phosphorous

Ries F, Klastersky J. Nephrotoxicity induced by cancer chemotherapy with special emphasis on cisplatin toxicity. Am J Kidney Dis. 1986 Nov;8(5) 368-379. doi:10.1016/s0272-6386(86)80112-3.

Magnesium

420 mEq/24Hr

Cornelison TL, Reed E. Nephrotoxicity and hydration management for cisplatin, carboplatin, and ormaplatin. Gynecol Oncol. 1993 Aug;50(2) 147-158. doi:10.1006/gyno.1993.1184.

Sodium

286 mEq/24Hr

63