title: Incidence and impact of baseline electrolyte abnormalities in patients admitted with chemotherapy induced febrile neutropenia.
abstract: BACKGROUND
  Febrile neutropenia (FN) and myelosupression remain a challenging oncologic medical emergency and dose limiting toxicity associated with chemotherapy for cancers. Various factors are known to affect the outcomes for patients diagnosed with FN. Electrolyte abnormalities have commonly been observed, but the real incidence and their impact has been only scarcely studied in literature.
  
  
  METHODS
  This was a prospective, observational study. A total of two hundred and fifteen (215) patients admitted between January 2007 and August 2008 were included. Analysis of data was made using SPSS version16.0.Toxicity profile was graded according to CTC version 3.0.
  
  
  RESULTS
  Almost equal number of FN was observed in both solid tumors and hematological cancers with almost equal gender distribution. Of all 83.5% patients demonstrated some electrolyte abnormalities. All grades combined, hypokalemia was seen in 48% of patients, with 51.4% having grade I, 33.3% grade III and 15.2% G IV (life threatening) hypokalemia. Hyponatremia of all grades was seen in 67.9% patients, of them 60.3% had Grade I, 33.3% grade III and 0.7% patients had grade IV hyponatremia. Hypomagnesaemia (70 patients assessed) was seen in 54.3% patient, 94.7% having grade I decline. Average length of stay for patients who received IV electrolyte replacement was 6.3 days compared to 4.9 days in those who did not. Out of 90 patients who required special care unit 75 had electrolyte abnormalities, of 15 patients who expired 13 had electrolyte abnormalities
  
  
  CONCLUSIONS
  This analysis, which is first of its kind, suggests that decline in electrolyte levels is frequently observed in patients presenting with FN. These abnormalities can have independent negative impact on the outcome for such patients. Special attention should be paid to electrolyte imbalance right from the outset.
authors.affiliation: 1. Department of medicine, Section of Hematology and Oncology, The Aga Khan University Hospital, Karachi, Pakistan.
authors.forename: Asim Jamal
authors.initials: AJ
authors.lastname: Shaikh
authors.forename: Samira Ahmed
authors.initials: SA
authors.lastname: Bawany
authors.forename: Nehal
authors.initials: N
authors.lastname: Masood
authors.forename: Ausaf Ahmed
authors.initials: AA
authors.lastname: Khan
authors.forename: Ahmed Nadeem
authors.initials: AN
authors.lastname: Abbasi
authors.forename: Syed Najeeb
authors.initials: SN
authors.lastname: Niamutullah
authors.forename: Adnan
authors.initials: A
authors.lastname: Zaidi
authors.forename: Salman
authors.initials: S
authors.lastname: Adil
authors.forename: Shiyam
authors.initials: S
authors.lastname: Kumar