Urinary Specific Gravity (USG) as an Assessment Tool for the Management of Dehydration in Head and Neck Cancer Patients Receiving Chemo-Radiation with Weekly CisplatinMarcelo Bonomi1,2, Tamjeed Ahmed1,2*, Thomas Lycan1,2, David Warner3, Christopher Sullivan3,4, Joshua Waltonen2,4, Kathryn Greven2,5, Bart Frizzell2,5, Mercedes Porosnicu1,2, Katharine Batt 1,2, Jimmy Ruiza1,2, and Ralph D’Agostino2,6
- *Corresponding Author:
- Tamjeed Ahmed
Hematology Oncology, Wake Forest Baptist Medical Center
Medical Center Blvd, Winston Salem NC 27157, USA
Tel: (336) 283-1145
E-mail: [email protected]
Received date: November 08, 2016; Accepted date: December 03, 2016; Published date: December 12, 2016
Citation: Bonomi M, Ahmed T, Lycan T, Warner D, Sullivan C et al. (2016) Urinary Specific Gravity (USG) as an Assessment Tool for the Management of Dehydration in Head and Neck Cancer Patients Receiving Chemo-Radiation with Weekly Cisplatin. Biol Syst Open Access 5:172. doi:10.4172/2329-6577.1000172
Copyright: ©2016 Bonomi M, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution and reproduction in any medium, provided the original author and source are credited.
Background: Concomitant chemo-radiation therapy (CRT) with cisplatin is the mainstay of treatment for patients with locally advanced head and neck cancer. Nephrotoxicity is a well-documented adverse effect of cisplatin, which is exacerbated by dehydration, a common complication in this group of patients. This study prospectively assessed the utility of urine specific gravity (USG) as a guide for fluid replacement, and its preventive effect in cisplatin induced nephrotoxicity.
Methods: Patients with head and neck cancer who received CRT with weekly cisplatin at our institution were included in the analysis. All patients received 1 L normal saline (NS) with 1 g of magnesium and 10 mEq of potassium pre and post cisplatin. USG was measured weekly, patients with USG>1.020 was considered dehydrated and received 2 L NS twice weekly. Those patients with USG>1.025 while on the twice-weekly regimen were deemed very dehydrated and received 2 L NS daily. The primary objective was renal toxicity of any grade.
Results: 44 patients were identified and completed CRT in less than 7.5 weeks. Eighteen of 44 patients (41%) had initial USG>1.020 and were started on NS twice weekly. By week 5, 44 of 44 patients (100%) needed supplemental fluid hydration with only 4 of 44 (9%) requiring daily IV fluids (IVF). No patient experienced renal toxicity of any grade. Five patients (11%) had grade I hypomagnesemia.
Conclusion: USG is a very sensitive marker of dehydration and can be used as a guide for fluid replacement which can minimize cisplatin induced nephrotoxicity in this population.