Cisplatin Pre & Post Hydration

Not shocked at all by the hyper-hydration, and in fact, we go further.

Depending on the protocol, 1 - 2 litres pre-hydration. The patient must have urinated a litre minimum before we proceed. Our cisplat goes in 250 mls usually giving us a final volume of 340 mls. We used to pass Mannitol concurrently but that's now been stopped as it's no longer deemed beneficial.

We give 2 litres post hydration supplementing in potassium, magnesium and calcium.

Obviously we modify in the case of frail elderly patients or known cardiac failure.

Cisplat is highly nephrotoxic and you have make the kidneys work hard. In 11 years using it I've very rarely seen patients go into overload. Some need a bit of Lasix to help them offload, but not often. We usually end up with a final diuresis of 4 or 5 litres which is the goal. Given that alot of the patients are fit young men with testicular tumours, they can usualy take it.

So no, your level of hydration doesn't shock me. In fact it's rather tame!

On 7/11/2020 at 9:57 PM, DavidFR said:

Not shocked at all by the hyper-hydration, and in fact, we go further.

Depending on the protocol, 1 - 2 litres pre-hydration. The patient must have urinated a litre minimum before we proceed. Our cisplat goes in 250 mls usually giving us a final volume of 340 mls. We used to pass Mannitol concurrently but that's now been stopped as it's no longer deemed beneficial.

We give 2 litres post hydration supplementing in potassium, magnesium and calcium.

Obviously we modify in the case of frail elderly patients or known cardiac failure.

Cisplat is highly nephrotoxic and you have make the kidneys work hard. In 11 years using it I've very rarely seen patients go into overload. Some need a bit of Lasix to help them offload, but not often. We usually end up with a final diuresis of 4 or 5 litres which is the goal. Given that alot of the patients are fit young men with testicular tumours, they can usualy take it.

So no, your level of hydration doesn't shock me. In fact it's rather tame!

Thank you for responding.

In my neck of the woods, 99% of our patients are elderly. I'm often giving Cisplatin to patients 65+ for bladder, head/neck cancer, or esophageal cancer. Many have hypertension as a comorbidity. We have been additionally hydrating the patients twice weekly with 1L of fluid at least, with some patients getting up to an additional liter or two if needed. We do give Lasix to about half those patients, typically 20 mg. I've recently had several incidents with patients being unable to make it to the restroom on time and having accidents who typically are not incontinent, which brought about this post.

10 minutes ago, DowntheRiver said:

I've recently had several incidents with patients being unable to make it to the restroom on time and having accidents who typically are not incontinent, which brought about this post.

I have actually had that happen with young people, not often, but it does occur.