Jiang Hong-Mei, Sun Rong, Ning Bing-Jie, Yang Xue-Qin, Zhu Xiao-Ju
Department of Cancer Center, Daping Hospital, Army Medical University, Chongqing 400042, China.
World J Clin Oncol. 2024 Oct 24;15(10):1309-1314. doi: 10.5306/wjco.v15.i10.1309.
The tongue squamous cell carcinoma (TSCC) is an oral malignant tumor arising from the squamous epithelium of the tongue mucosa, characterized by a high malignant degree, invasive growth, early lymph node metastasis, and poor prognosis. Paclitaxel, represented by docetaxel, is now the standard first-line treatment for head and neck squamous cell carcinoma. Docetaxel, which belongs to the class of drugs known as paclitaxel, is an antitumor drug that inhibits cell mitosis and proliferation. Its adverse effects include myelosuppression, hair loss, gastrointestinal reactions, fluid retention, and allergic reactions. However, hypokalemia is rare, most cases are mild or moderate, and severe hypokalemia is seldom reported.
During chemotherapy with docetaxel and cisplatin, a patient with TSCC developed severe hypokalemia. His potassium level was found to have been reduced to 1.85 mmol/L at the most critical situation. The patient had grade 1 muscle strength in all four limbs and could not perform any action, which was considered to be a sign of severe hypokalemia. Measures taken included intravenous infusion micro-pump, intravenous injection, and oral potassium supplement, which gradually improved muscle strength and serum potassium levels. The patient survived the critical period of severe hypokalemia after chemotherapy. He was generally in good condition following treatment and discharged in stable condition.
Docetaxel may cause severe hypokalemia with hypomagnesemia and the mechanism for this is not yet known to researchers yet. This means that nurses specializing in chemotherapy must exercise a high degree of responsibility, closely observe the patient's reaction to the anticancer medication, notice any symptoms of adverse effects early. It is necessary to be considerate regarding individual differences between patients when selecting chemotherapy regimens and adhere to the principle of individualized treatment. Following multiple cycles of chemotherapy, patients should be aware of the accumulation of toxic side effects and receive blood tests reviewed within 24 hours of completion. It is essential to monitor electrolyte levels in patients suffering from severe gastrointestinal reactions to avoid complications that may result in death.
舌鳞状细胞癌（TSCC）是一种起源于舌黏膜鳞状上皮的口腔恶性肿瘤，具有恶性程度高、浸润性生长、早期淋巴结转移及预后差的特点。以多西他赛为代表的紫杉醇类药物是目前头颈部鳞状细胞癌的标准一线治疗药物。多西他赛属于紫杉醇类药物，是一种抑制细胞有丝分裂和增殖的抗肿瘤药物。其不良反应包括骨髓抑制、脱发、胃肠道反应、液体潴留及过敏反应。然而，低钾血症较为罕见，多数病例为轻度或中度，严重低钾血症鲜有报道。
一名TSCC患者在接受多西他赛和顺铂化疗期间发生严重低钾血症。在最危急情况下，其血钾水平降至1.85mmol/L。患者四肢肌力均为1级，无法进行任何活动，被认为是严重低钾血症的表现。采取的措施包括静脉微量泵输注、静脉注射及口服补钾，肌力和血钾水平逐渐改善。患者度过了化疗后严重低钾血症的危险期。治疗后一般情况良好，病情稳定出院。
多西他赛可能导致严重低钾血症伴低镁血症，其机制尚不清楚。这意味着化疗专科护士必须高度负责，密切观察患者对抗癌药物的反应，尽早发现不良反应症状。选择化疗方案时要考虑患者个体差异，坚持个体化治疗原则。经过多个周期化疗后，患者应意识到毒副作用的累积，并在化疗结束后24小时内复查血常规。对于有严重胃肠道反应的患者，监测电解质水平至关重要以避免可能导致死亡的并发症。
