Magnesium imbalance during cisplatin administration persists despite supplementation in hydration

Imbalances in magnesium levels have been observed in a recent study even with routine supplementation of magnesium and potassium in hydration. In addition, potassium levels following cisplatin administration are maintained with minimal routine supplementation.

The investigators conducted a single-region retrospective study to characterize the impact of magnesium and potassium-supplemented hydration during cisplatin administration on subsequent magnesium and potassium imbalances. Patients treated with two or more cycles of cisplatin were included in the analysis.

Standard hydration was defined as normal saline before and after cisplatin along with potassium chloride 10 mEq and magnesium sulfate 1 g added to the cisplatin bag.

In total, 477 patients met the eligibility criteria, of whom 376 were receiving the standard hydration. Seventeen percent of patients had a potassium level <3.5 mEq/L, but no major depletion occurred. On the other end, 33 percent experienced a magnesium level <1.8 mg/dL. Time to first rescue magnesium supplementation was 4 weeks.

A recent study demonstrated safety and feasibility of a short hydration regimen with 20 mEq of magnesium supplementation for patients with lung cancer receiving cisplatin-based chemotherapy. [Int J Clin Oncol 2020;25:1928-1935]

“Cisplatin-associated electrolyte dysregulation is a prevalent therapy-related adverse effect,” the investigators said. “There are numerous electrolyte-supplemented hydration regimens that have been evaluated, [but] these studies focused on the development of nephrotoxicity.”