Electrolyte and acid-base disturbances in the management of leukemia

Abstract

Electrolyte disturbances in leukemia can be the result of the disease process or drug therapy. One group of electrolyte abnormalities is related to the stage of the leukemic process. Included in this group are newly diagnosed patients who may show elevated serum potassium, phosphorus, and magnesium--a result of their release from malignant cells after cytotoxic therapy or their accumulation due to urate nephropathy. Patients in remission usually have normal serum electrolyte concentrations, but acute leukemia patients during relapse may have hypokalemia, hypophosphatemia, and hypomagnesemia. This imbalance may be related to cellular uptake of these electrolytes in the presence of inadequate dietary intake. Other factors contributing to electrolyte derangements, and related to the leukemic process, include hyponatremia and hypochloremia secondary to the SIADH, hypokalemia in acute monocytic or acute myelomonocytic leukemia due to lysozyme-induced tubular damage, hypercalcemia possibly secondary to leukemic infiltration of bone or parathyroid glands (with PTH release), or production of a PTH-like substance by leukemic cells. Nonspecific factors related to the disease process which may aggravate the electrolyte imbalance include gastrointestinal loss through nausea, vomiting, and malnutrition. The drug-related electrolyte abnormalities include cyclophosphamide- and vincristine-induced SIADH; decreased serum sodium, chloride, potassium, and calcium concentrations as a result of polymyxin B nephrotoxicity; hypokalemia and hypomagnesemia secondary to amphotericin B; hypocalcemia, hypophosphatemia, and hyperphosphaturia due to L-asparaginase-induced hypoparathyroidism; hypokalemia due to a nonreabsorbable anion effect of antibiotics in the distal tubule or changes in membrane ionic transport of all cells by large doses of antibiotics. Electrolyte disturbance in leukemia thus have a multifactorial pathogenesis which can best be delineated according to the stage of the leukemic process and the drugs being used. Recognition of the cause or causes in a particular patient is essential for an effective approach to management. This review emphasizes the need for routine measurement of serum electrolytes during all phases of the leukemic process.

Electrolyte Disorders Associated With Cancer

“…Hypokalemia is the second most common electrolyte disorder encountered in the patient with cancer. 35 In most cases, the etiology of hypokalemia is multifactorial and includes medications that can cause tubular damage (such as cisplatin, ifosfamide, amphotericin B, and aminoglycoside antibiotics) as well as gastrointestinal and kidney losses of potassium. Hypokalemia is also commonly seen in conjunction with other electrolyte disorders such as hyponatremia and hypomagnesemia and reflects the underlying etiologies such as diuretic use.…”

“…38 A prominent association between hypokalemia and acute myelogenous leukemia (specifically subtypes M4 and M5) has been noted, with 40% to 60% of these patients developing significant hypokalemia at some point in their disease course. 35,40 Of importance is that hypokalemia in these patients is usually associated with other electrolyte and acid-base disorders (hyponatremia, hypocalcemia, hypophosphatemia, hypomagnesemia and non-anion gap metabolic acidosis), suggesting a more global tubular defect in these patients. 40 The mechanism of hypokalemia is due to inappropriate kaliuresis and has been postulated to be secondary to increased serum lysozyme levels and lysozymuria-induced tubular damage.…”

To Study the Spectrum of Leukemia and Lymphoma with LDH and Sodium Levels with Pre- and Post-Chemotherapy

“…11 Hypocalcaemia is occasionally seen in patients with hematologic malignancies and appear to be multifactorial in origin. 12 Brindlay et al reported the LDH exists in many different cell systems, and subsequent to tissue or cell damage, serum LDH levels may be elevated. A relationship between neoplasia and increased levels of LDH has been reported by many workers in both human and animal tumours.…”

Gangguan Keseimbangan Elektrolit Sesudah Kemoterapi Induksi Remisi pada Anak dengan Leukemia Limfoblastik Akut

“…Penegakan diagnosis, penentuan kelompok risiko dan Gangguan elektrolit dan metabolik sering ditemukan pada pemberian kemoterapi dilakukan oleh peneliti. Sebanyak pasien anak dengan keganasan hematologi termasuk LLA 34 pasien yang memiliki data klinis, pemeriksaan (3)(4)(5). Gangguan tersebut dapat disebabkan oleh proses laboratorium dan penunjang serta kemoterapi induksi leukemik, infiltrasi sel-sel leukemia ke organ (khususnya remisi (selama minggu 0 sampai 6) yang lengkap diikutkan tulang) maupun lisis sel-sel leukemia akibat pemberian sebagai subjek dalam penelitian ini.…”

“…Gangguan tersebut dapat disebabkan oleh proses laboratorium dan penunjang serta kemoterapi induksi leukemik, infiltrasi sel-sel leukemia ke organ (khususnya remisi (selama minggu 0 sampai 6) yang lengkap diikutkan tulang) maupun lisis sel-sel leukemia akibat pemberian sebagai subjek dalam penelitian ini. obat-obat sitostatika, dan dapat terjadi sebelum, selama Dilakukan pencatatan data pasien saat inklusi (sebelum maupun sesudah pemberian kemoterapi (4,5). Beberapa kemoterapi) meliputi umur, jenis kelamin, tipe LLA (L-1 hasil penelitian yang telah dipublikasi sebelumnya atau L-2), pengelompokan faktor risiko (kelompok risiko menunjukkan bahwa gangguan elektrolit dan metabolik standar atau risiko tinggi), serta data hematologi dasar yang sering ditemukan pada anak dengan leukemia meliputi kadar hemoglobin (Hb), hitung leukosit dan limfoblastik akut antara lain hiperkalemia, hipokalsemia, hitung trombosit.…”