Fluid and electrolyte problems
Water retention
Water retention is simply the buildup of excess fluid in tissues. Swelling of the feet, ankles and hands are generally the first sign of water retention. But it can also affect other parts of the body such as the abdomen, chest cavity, face and neck. Possible causes include:
- Certain medications (some chemotherapy drugs can cause water retention)
- Heart, liver or kidney disease
- Blockage of veins or lymph system
Some symptoms to look for and report to your physician include:
- Feelings of tightness in the arms or legs.
- Difficulty fitting into clothing.
- Rings, wristwatch or shoes fit tighter than usual.
- Pitting of the lower legs and arms – when you press on your skin with your finger is there an indentation that remains for a few seconds.
- A sense of heaviness or weakness in the arms or legs.
- Skin that feels stiff or taut.
- Any redness, changes in skin temperature or pain in swollen areas can be a sign of infection and should be reported immediately.
Things that you can do to help manage swelling are:
- Do not stand for long periods of time.
- When sitting or lying keep feet/legs elevated as much as possible.
- Avoid tight clothing (including socks)
- Do not cross your legs when sitting or lying.
- Try to reduce your salt intake. Avoid foods that are high in salt content such as chips, tomato juice, cured meats, and canned soups.
- Weight yourself daily – a weight gain of 5 pounds or more in one week should be reported to the physician immediately.
- If your physician has prescribed medications for your swelling take them exactly as prescribed. Do not reduce or increase the dose.
Treatment of fluid retention depends upon the underlying cause. Since some of the causes of water retention can be related to organ disease/damage and are potentially severe, it is important that you speak with your physician or nurse promptly if you are experiencing this problem.
Electrolyte imbalance
Electrolytes are chemicals in your body that help to regulate important functions such as proper workings of nerves and muscles. An imbalance in electrolytes, whether too high or too low, can lead to serious problems. Examples of electrolytes are: calcium, potassium, sodium, magnesium, and chloride.
Calcium is necessary for muscle contraction, nerve function, blood clotting, cell division and healthy bones and teeth. Hypercalcaemia (high calcium) is associated with multiple malignancies, including breast and lung cancers and multiple myeloma. It can also be a result of benign parathyroid disease.
Potassium is particularly important in heart contraction and maintaining fluid balance within the body.
Sodium is also involved in maintaining fluid balance in the body and is necessary for muscle contraction and nerve function.
Magnesium is necessary for muscle and never function, heart rhythm, bone strength, energy levels and protein storage.
Chloride primarily helps to maintain fluid balance in the body.
Cancer itself can lead to multiple electrolyte abnormalities. Some cancers produce substances which lead to decrease of sodium in the blood; other cancers can cause elevated calcium levels, either by producing substances which wash calcium out of the bones, or by invading and destroying bones directly. Cancer can also lead to Tumor Lysis Syndrome (see below), when dying cancer cells spill their content into the blood stream and cause elevation in potassium and phosphorus, among others.
Electrolyte imbalance could also be caused by vomiting, diarrhea, sweating, high fevers, kidney disease, medications unrelated to cancer therapy, certain chemotherapy drugs such as Cisplatin and targeted therapies such as Erbitux.
Because electrolytes regulate activity of nerves and muscles, their imbalance could lead to malfunctions in multiple organ systems. It could cause muscle spasms, weakness and twitching; irregular heartbeat and blood pressure changes; lethargy, confusion, and neurological problems. Severe electrolyte imbalance can result in death. Monitoring for electrolyte imbalance is a simple process and is accomplished through routine lab work.
Treatment of electrolyte imbalance is based on identifying and treating the underlying problem causing the imbalance, and actively correcting the imbalance itself. Treatment may include intravenous replacement of fluids or electrolytes, dietary changes and/or oral replacement of a particular electrolyte.
Tumor lysis syndrome
Tumor Lysis Syndrome is a serious and sometimes life-threatening complication of chemotherapy. Occasionally, low grade tumor lysis syndrome can happen even in untreated patients. It is caused by release of breakdown products from dying cancer cells and most frequently occurs in patients with leukemia or lymphoma that have a high tumor burden (large tumor). Patients with pre-existing kidney disease are also at increased risk for this complication. Rapid death of multiple tumor cells can cause electrolyte imbalance, including high levels of potassium and phosphorus and decreased levels of calcium. It also results in elevated levels of uric acid, a byproduct of the breakdown of DNA, which can damage kidneys.
Persons at high risk for tumor lysis syndrome are usually treated prophylatically with hydration and medications which decrease uric acid levels like Allopurinol. Treatment for tumor lysis is directed toward stabilizing electrolyte and uric acid levels. Aggressive hydration with IV fluids and use of diuretics may be instituted. In some cases persons have undergone renal dialysis.
Symptoms of tumor lysis syndrome include: