Title: Hypomagnesemia– A Toxicity of Platinum Co-Ordination Compounds
Authors: Dr Farhat Mustafa, Dr M. Ashraf Bhat
DOI: https://dx.doi.org/10.18535/jmscr/v7i3.136
Abstract
Hypomagnesemia is a know side effect of platinum coordination complexes (cisplatin, carboplatin and oxaliplatin) which have revolutionised the treatment of many human cancers.
The objective of the study was to determine association of hypomagnesemia with platinum based chemotherapy and to study the association of hypomagnesemia with hypocalcemia and hypomagnesemia with hypokalemia. 70 newly diagnosed cancer patients who were put on combination chemotherapy were evaluated for various electrolyte abnormalities during chemotherapy and were subsequently followed at six monthly intervals for a period of 18 months to ascertain any improvrment or persistence of dyselectrolytemias.we found that among the 70 patients studied, 42 patients received a cisplatin based chemotherapy; 7 received carboplatin based chemotherapy and 21 received oxaliplatin based chemotherapy. Cisplatin was the most nephrotoxic among the three with hypomagnesemia occurring in 87.5% of cases. Serum magnesium fell sequentially from pre-treatment value from 0.9±0.2mg/dl to 0.61±0.17 mg/dl at sixth cycle. Hypomagnesia persisted in 23 of 35 patients at follow up. Hypocalcemia and hypokalemia both occurred in the presence of hypomagnesemia. Hypokalemia occurred more frequently than hypocalcemia in cisplatin group. Electrolyte abnormalities were less common with carboplatin and oxaliplatin.
Our study indicated that hypomagnesemia occurs sequentially and commonly with platinum based chemotherapy despite corrective measures. A strong association (p<0.05) is seen between hypomagnesemia with hypocalcemia and hypomagnesemia with hypokalemia. There is persistence of electrolyte disturbances even after discontinuation of chemotherapy which makes continous monitoring and replacement mandatory.
Keywords: Hypomagnesemia, cisplatin, monitoring.
References
- Parfitt AM, Kelerekoper M. Clinical disorders of calcium phosphorus and magnesium metabolism. 1980; 947-1151.
- Levine BS, Coburn JW. Magnesium:the mimic /antagonist of calcium. N England J Med 1984;310:1253-1255.
- Schilsky RL, Barlock A, Ozols RF. Persistent hypomagnesemia following cisplatin chemotherapy for testicular cancer. Cancer Treat Rep. 1982 sep; 66 (9):1767-9
- Buckley JE, Clark VL, Meyer TJ, Pearlman NW. Hypomagnesemia after combination chemotherapy. Arch of Intrn Medicine, 1984Dec; 144(12): 2347-8
- Sitze Meijer MD, Dirk TH. Sliejfer MD, Nanno H. Mulder MD, Wim J. Sluiter PhD, Jan Marrink PhD, Hemen Scraffordt Koops MD, Theo M. Brouwers MD, Jan Oldhoff MD, Gjalt K Van DER hem MD and EnnoMandema MD. Effects of combination chemotherapy with cisplatinum on renal functions in patients with non-seminomatous testicular cancer. Cancer 51: 2035-2040, 1983
- Lipmann A J, Helson C, Helson L, Krakoff I H. Clinical trials ofCDDP. Cancer Chemother Rep 1973: 57: 191-200.
- Schilsky RL, Barlock A, Ozols RF. Persistent hypomagnesemia following cisplatin chemotherapy for testicular cancer. Cancer Treat Rep. 1982 sep; 66 (9):1767-9
- Stewart AF, Keating T. Magnesium hemostasis following chemotherapy with cisplatin : A prospective study. American Journal of Obstetrics and Gynaecology. 1985. Nov; 153 (6)160-65.
- Lajer H, Duagaard G. Cisplatin and hypomagnesemia. Cancer Treat Rev. 1999Feb. 25 (1) 47-58.
- Mohammad Wasif Saif M.B.B.S, M.D. Management of Hypomagnesemia in cancer patients receiving chemotherapy. The Journal of Supportive Oncology. Vol. 6 No. 5, 2008: 243-48.
- Stohr W, Paulides M, Bielack S, Jurgens H, Koscielniak E, Rossi R, Langer T, Beck JD. Nephrotoxicity of cisplatin and carboplatin in sarcoma patients : a report from the late effects surveillance system. Pediatr Blood Cancer. 2007 Feb. 48(2): 140-7.
- Wasif Saif, John Reardon. Management of oxaliplatin induced peripheral neuropathy. Thereupeutics and Clinical risk Management, 2005 1 (4)
- Kintzel , Polly E. Anticancer Drug – Induced Kidney Disorders: Incidence , Prevention and Management. Drug safety , Vol. 24 (1) 2001, 19-38
- Jon D. Blachley M.D., Julian B, Hill M. Renal and electrolyte disturbances associated with cisplatin. Annals of Internal Medicine 1981; 95 : 628-632.