Severe hyponatremia, hyperglycemia, and hyperlactatemia are associated with intraoperative hyperthermic intraperitoneal chemoperfusion with oxaliplatin.
BACKGROUND
Since the introduction of surgical debulking in combination with intraoperative hyperthermic intraperitoneal chemoperfusion (HIPEC) with oxaliplatin in our institution, severe hyponatremia (sodium: 126.5 +/- 3.8 mmol/L), hyperglycemia (glucose: 22.37 +/- 4.89 mmol/L), and hyperlactatemia (lactate: 3.17 +/- 1.09 mmol/L) have been observed post HIPEC. This metabolic disorder was not observed in patients in whom cisplatin or mitomycin C was used as a chemotherapeutic drug.


METHODS
In order to understand the pathophysiology of this finding, an analysis of our data was made. In a first analysis, plasma sodium was corrected for hyperglycemia based on the formula of Hillier. In a second analysis, the influence of total exchangeable sodium, total exchangeable potassium, and total body water on plasma sodium concentration was modeled.


RESULTS
Analysis of our data revealed a double mechanism for the observed metabolic disorder: hyperglycemia caused by dextrose 5%, which is used as a carrier for the oxaliplatin, and major loss of sodium into the dialysate (256.7 +/- 68.7 mmol).


CONCLUSIONS
Better control of hyperglycemia and intravenous compensation of sodium loss into the dialysate can attenuate the reported biochemical disturbance.
De Somer
Filip
F
Department of Cardiac Surgery, University Hospital Ghent, Ghent, Belgium. Filip.DeSomer@ugent.be
Ceelen
Wim
W
Delanghe
Joris
J
De Smet
Dirk
D
Vanackere
Martin
M
Pattyn
Piet
P
Mortier
Eric
E
D000008:Abdominal Neoplasms / Q000188:drug therapy / Q000601:surgery; D000140:Acidosis, Lactic / Q000209:etiology* / Q000503:physiopathology; D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000008:administration & dosage / Q000009:adverse effects*; D001786:Blood Glucose / Q000378:metabolism; D017024:Chemotherapy, Adjuvant / Q000009:adverse effects; D010478:Chemotherapy, Cancer, Regional Perfusion / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006801:Humans; D006943:Hyperglycemia / Q000209:etiology* / Q000503:physiopathology; D006979:Hyperthermia, Induced / Q000009:adverse effects; D007010:Hyponatremia / Q000209:etiology* / Q000503:physiopathology; D007263:Infusions, Parenteral / Q000009:adverse effects; D007430:Intraoperative Care / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D008954:Models, Biological; D009944:Organoplatinum Compounds / Q000008:administration & dosage / Q000009:adverse effects*; D000077150:Oxaliplatin; D012189:Retrospective Studies; D012964:Sodium / Q000378:metabolism; D014882:Water-Electrolyte Balance
D000970:Antineoplastic Agents; D001786:Blood Glucose; D009944:Organoplatinum Compounds; D000077150:Oxaliplatin; D012964:Sodium