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Perit Dial Int 28(1): 61-66 2008
© 2008 International Society for Peritoneal Dialysis
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ORIGINAL ARTICLES

SEVERE HYPONATREMIA, HYPERGLYCEMIA, AND HYPERLACTATEMIA ARE ASSOCIATED WITH INTRAOPERATIVE HYPERTHERMIC INTRAPERITONEAL CHEMOPERFUSION WITH OXALIPLATIN

Filip De Somer1, Wim Ceelen2, Joris Delanghe3, Dirk De Smet1, Martin Vanackere1, Piet Pattyn2 and Eric Mortier4

Departments of Cardiac Surgery,1 Abdominal Surgery,2 Central Laboratory,3 and Anaesthesia,4 University Hospital Ghent, Ghent, Belgium

Correspondence to: F. De Somer, University Hospital Ghent, Heart Centre 5IE-K12, De Pintelaan 185, B-9000 Ghent, Belgium. Filip.DeSomer{at}ugent.be

{diamondsuit} Background: Since the introduction of surgical debulking in combination with intraoperative hyperthermic intraperitoneal chemoperfusion (HIPEC) with oxaliplatin in our institution, severe hyponatremia (sodium: 126.5 ± 3.8 mmol/L), hyperglycemia (glucose: 22.37 ± 4.89 mmol/L), and hyperlactatemia (lactate: 3.17 ± 1.09 mmol/L) have been observed post HIPEC. This metabolic disorder was not observed in patients in whom cisplatin or mitomycin C was used as a chemotherapeutic drug.

{diamondsuit} Methods: In order to understand the pathophysiology of this finding, an analysis of our data was made. In a first analysis, plasma sodium was corrected for hyperglycemia based on the formula of Hillier. In a second analysis, the influence of total exchangeable sodium, total exchangeable potassium, and total body water on plasma sodium concentration was modeled.

{diamondsuit} Results: Analysis of our data revealed a double mechanism for the observed metabolic disorder: hyperglycemia caused by dextrose 5%, which is used as a carrier for the oxaliplatin, and major loss of sodium into the dialysate (256.7 ± 68.7 mmol).

{diamondsuit} Conclusion: Better control of hyperglycemia and intravenous compensation of sodium loss into the dialysate can attenuate the reported biochemical disturbance.

KEY WORDS: Hyperthermic intraperitoneal chemoperfusion; metabolic disorder; oxaliplatin.

Received 2 March 2007; accepted 29 August 2007.






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