Electrolyte Complications of Malignancy
Section snippets
Hyponatremia
Hyponatremia is a common electrolyte disorder, reported to occur in 3.8% of emergency department patients.1 Among the population of emergency department patients with underlying malignancy, hyponatremia occurs most commonly with small cell lung cancers. Hyponatremia has been reported with other malignancies, including primary and metastatic malignancies of the brain, pancreatic adenocarcinoma, and prostate cancer.2 Hyponatremia has also been reported in association with treatment with
Osmotic demyelination syndrome
The most feared complication of the treatment of hyponatremia is the ODS, previously known as central pontine myelinolysis. ODS was first reported in 1959 as a consequence of the treatment of a severely hyponatremic alcoholic patient.13 Histologically, ODS is characterized by the destruction of oligodendrocytes and myelin in the central portion of the pons as well as the basal ganglia and cerebellum.14 The clinical presentation of patients who develop ODS as a consequence of treatment of
Hypoglycemia of malignancy
Tumor-associated hypoglycemia is a relatively rare complication of malignancy. Hypoglycemia of malignancy has been described in association with 3 main etiologies. The most common cause is nonislet cell tumor hypoglycemia (NICTH).26 Second, but perhaps more well known, is hypoglycemia due to insulin secretion by islet cell tumors of the pancreas.27 Finally, end-stage metastatic carcinoma of nearly any source that has heavily infiltrated the liver or adrenal glands may cause hypoglycemia.28 In
Hypercalcemia
Hypercalcemia is the most common serious electrolyte abnormality in adults with malignancies. It has been reported to occur in 20% to 40% of patients during their disease.33 The presence of hypercalcemia associated with cancer is associated with a poor prognosis, as this metabolic disorder may result in numerous life-threatening complications, including severe dehydration, bradycardia, seizures, pancreatitis, and coma. Up to 50% of patients die within 30 days of detection of elevated calcium
Hypomagnesemia
Hypomagnesemia frequently complicates the stay of hospitalized patients and seems to correlate with severity of illness. Up to 60% of patients in intensive care have low serum magnesium. Symptoms become present at levels below 1.2 mg/dL; however, they may be very nonspecific and are often overlooked. Most often, the symptoms manifest as neurologic or cardiovascular abnormalities. A neurologic examination may reveal muscle weakness, tremors, hyperreflexia, or tetany. Other neurologic
Hypophosphatemia
Hypophosphatemia is an additional electrolyte abnormality common to hospitalized patients. It is also a known complication of bisphosphonate treatment. Mild to moderate hypophosphatemia is usually asymptomatic; however, if the serum phosphate levels drop below 1.0 mg/dL, serious clinical symptoms may be present. The symptoms are related to impaired energy metabolism from decreased ATP production. As a result, all organ systems can be affected. Clinical signs and symptoms range from muscle
Summary
A thorough working knowledge of the diagnosis and treatment of life-threatening electrolyte abnormalities in cancer patients, especially hyponatremia, hypoglycemia, and hypercalcemia, is essential to the successful practice of emergency medicine. Newer therapies that are targeted at the pathophysiological mechanisms underlying these electrolyte abnormalities have recently been developed and appear to have a promising future.
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Cited by (11)
DELIRIUM IN ONCOLOGIC PATIENT
2017, Revista Medica Clinica Las CondesDevelopment of high accuracy methods for the certification of calcium, iron, magnesium and potassium in human serum
2017, Journal of Trace Elements in Medicine and BiologyCitation Excerpt :Homoeostasis is achieved by various mechanisms such as osmosis, passive diffusion and active transport channels at the cellular level [1–3]. Abnormal levels of these elements are often an indication of underlying medical condition(s) or due to medication side effects [4–8]. In an emergency setting where patients may be unconscious, electrolyte (such as calcium, potassium and magnesium) imbalances require immediate medical attention as it could be life-threatening.
Emergencias oncológicas
2011, Revista Medica Clinica Las CondesEndocrine Manifestations of Tumors: "Ectopic" Hormone Production
2012, Goldman's Cecil Medicine: Twenty Fourth Edition
A version of this article was previously published in the Emergency Medicine Clinics of North America, 27:2.