osteogent sarcoma in children young adults

  1. Hello!

    I am working with children from 8 to 18 years, and older persons witch have osteogent sarcom and get MTX in high-dosis (19 g..). Our doctor has a very strict regime about drinking pr. os:

    The same day and the following 24 hours the patients can only get 20 ice-cubes (ordinary size).

    The second MTX dag with following the diuresis, ph and hb-stix, the patient can only take 600 ml (cc) pr os. Food is ok

    The next day mtx- level is near normal again, and the patiens can drink what ever he want.

    Can any oncol. nurse tell me WHY this is so importent? Is MTX working better with full control over fluid in pr. iv? Why cant the parents/patiens wrigt a note about pr. os drinking?

    NOte: This is MTX-cure in very high dosis and spec. for osteogenic
    sarcoma patients!

    Thank you for every answer!
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  2. 6 Comments

  3. by   jule
    hi florry,
    im not very experinced yet cause I started working @ pediatric oncology only 6 months ago, but maybe i can help.. i dont know this kind of fluids restriction anyway.
    what we do is do is "check the balnace" of exportation and importation whentheres a infusion which is more than 3000ml/m2/day. if theres more importation than exportation, we need to give lasix (furosemid), or, if platin is given, osmofundin and so we force the diuresis. as the pt get lots of fluid intravenuost o clear the kidneys, many aof them need the lasix. so we avoid edema.
    maybe your doctors restrict the fluids because they want to avoid giving additional medicine?
    let meknow if you know the reason!
    julia from germany
  4. by   florry
    Hello Jule!

    Thank you for your answer. Yes, we have also theese furosemid-regime, but we are not mesuring the fluid-balance! We only measure the urine coming out every 6/h and the ph and of course excactly the ml. the doctor has ordered; if too little: we give furosemid, as you said.

    The problem is that our doctor is not NOT (!) interested in fluid-balance; she only want theese regime I told you about 6 ice-cubes the first 24/h and so on. She dont want the child or the patients to drink at all!!! Only food is allowed! She cant explain why!!! She said something about some reseserach in Finland, that MTX was working better if the consentration was excactly, with no fluid pr. os espes. the first 24 hour. Of course, the patients get fluid after the MTX (as the regime is, you know).

    But;

    I cant understand why she is only interested in the urine coming out, not the food or soft thing patients take pr. os!

    Can you ask some doctor about it? May be MTX is working better with full controll by all iv fluid (we have to measure the iv-bag, and take out the ml too much, (you know every bag is different, even it is a 1000 ml. bag) before we put in bicarbonat and Kcl and tho measure the bag fore controlling again: it has to be excactly fex. 1000 ml.)

    You know, this is very difficult to go thrue for a child, and when they cant drink anything too..

    Its hard! Thank you, for answering!
  5. by   jule
    hi florry,
    today ai talked to a (very experienced) colleague of mine who told me that e.g. in vienna, the kids have a bladder- catheter for exact balancing. but she couldnt imagine why your parents are not allowed to drink anyway. so our regime is that the kidneys have to be "rinsed" with lots of fluid to keep the risc of damaging them minimal.
    today, there was so much to do that i couldnt ask a doctor about that, but tomorrow ill try, o.k.?
    bye, julia
  6. by   florry
    Hello!

    Thank you very much for your interests in my questions here! Yes, measuring the fluid out is because we/they have to rinse the kidneys as you said. That is because of the crystle-making in the nephrons..And I know that we often used foley-catheter in theese children earlier, to measure excactlly. We dont du that any longer, because of the infection risici. You said "vienna"?
    Is it in Austria; or maybe some place in Italy?

    I know that North Europa (Scandinavia inkl. norway) are cooperating with the treatment of sarcoma with Italy medical staff. Maybe that would be a link?

    I am VERY pleased that you want to find out theese thigs about the issue! Thank you!!! -And ask your medical doctor when you have time too....
  7. by   jule
    hi florry,
    vienna is capital of austria. i only know about that bc a colleague of mine told me. we never used catheters as far as i know.
    today i had no time to ask a doctor again, lots of therapies and so on.. now im off for a couple of days, but i wont forget!
    bye,julia
    p.s.whats the amount of fluid "your"kids get via infusion during high-dose mtx?
  8. by   florry
    Hello again!

    Again: I really appreciate your interest in my question!

    The excactly amount of fluid after MTX is based on high and weight (m2), and every child has their own chart made by the assistent-doctor, and of course the doctor wiht treatment-responsibillity.

    I am off a few days too, now. but next time I will find out how much they get after MTX. It depends of course on how they can disengage (wright word?) the medicine. We have standards to use, and you must fall from x0000 to x1000 in a certain ours...

    Keep in touch!

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