In outlining the pathology of various
electrolyte metabolism abnormalities in
cancer patients we considered the main clinical points between pathologies and
emergency treatment. In regard to
sodium (Na+) metabolism, one pathologic state that requires our attention is
hypernatremia.
Hypernatremia is accompanied with
dehydration and is due to water loss,
vomiting,
diarrhea and
renal insufficiency. One of the major causes of this condition is lack of the
antidiuretic hormone due to intracranial
metastasis of the
tumor. When
hypernatremia becomes severe, it is accompanied with
circulatory failure, muscular
asthenia, disorientation, convulsions,
coma and other cerebral symptoms. Treatment consists of replenishing the water content by infusion of
electrolyte solutions which should be carefully conducted after complete diagnose of the severity of the patient's pathological condition.
Hyponatremia, like sick cell syndrome, is observed relatively frequently in
cancer patients. When the serum Na level falls markedly, it induces
cerebral edema and causes
disorders of consciousness. The major treatment consists of providing both water and
sodium supplements.
Hyperkalemia is observed at the time of
renal insufficiency, tissue lesions,
vomiting, and
diarrhea. When serum
potassium level rises, it causes
bradycardia,
ventricular fibrillation, or
cardiac arrest. It is important to diagnostically apprehend the severity of this condition using EKG and determining the serum K1+ level. For
emergency treatment injection of
calcium gluconate is very effective.
Hypokalemia is often manifested by the loss of intestinal fluids due to
diarrhea or during administration of
diuretic agents. Clinical symptoms include neural
paralysis but emergencies occur relatively infrequently. K C1
injections are used in treating this condition.
Hypercalcemia is manifested in
cancer patients during
hyperparathyroidism. Its clinical symptoms include
lassitude,
tachycardia,
nausea,
vomiting, and renal dys-function, leading to neural symptoms in severe cases. The main treatment consists of injection of physiological
saline solution and administration of
calcitonin,
mithramycin. Hypocalemia is manifested during
renal insufficiency, lack of
vitamin D, and
hypothyroidism. In classic cases it causes tetanic
spasms. Injection of
calcium is an effective treatment but since during tetanic
spasms alcalosis may easily occur, treatment should only be provided after obtaining a complete understanding of the patient's condition. The pathological conditions described above can not be said to specific to
cancer but it should be kept in mind that one of their main causative factors is the involvement of mechanism which produces
ectopic hormones from cancerous tissues.