Infusion therapy of an oncologic patient: pros and cons
Background. The goals of infusion therapy (IT) include the restoration of adequate tissue perfusion, maintaining the quantity and quality of the body fluid sectors, correction of homeostasis parameters. In addition, IT can be used for parenteral nutrition, reducing the risk of thrombosis and urinary tract infections.
Objective. To identify key IT parameters of a cancer patient.
Materials and methods. Analysis of the available literature on this topic.
Results and discussion. Indications for IT include hypovolemia, cellular and protein deficiency of blood, nutrition disorders, intoxication, disorders of hemostasis, hemorheological properties, fluid and electrolyte balance, acid-base status. Cancer patients often have the listed syndromes. The appropriate infusion volume should not be exceeded, as the hypervolemia is accompanied by edema, multiorgan dysfunction and worsening of the prognosis. On the other hand, dehydration is the most common fluid and electrolyte balance disorder in the elderly. It is an independent predictor of mortality and high healthcare costs. At any IT administration it is necessary to assess the volemia condition, to determine the cause of the deficiency, to choose the optimal solution and infusion rate, to set and to monitor target values. Capillary filling time, heart rate, blood pressure, jugular veins’ condition, skin turgor, pulmonary and cardiac auscultation data, edema control, diuresis rate, and weight changes are used to assess volemia. Peculiarities of the elderly and debilitated patients, which should be taken into account when prescribing IT, include the loss of thirst feeling, deterioration of renal function and worsening of hormonal regulation of fluid and electrolyte balance. Anticancer therapy has a number of side effects, and some of them can be eliminated with the help of IT. The amount of fluid required should be calculated based on physiological needs (30-40 ml/kg/day), deficiency severity and pathological losses (fever, blood loss, polyuria, perspiration, drainage losses). Plasma replacement solutions can be divided into crystalloids (iso- and hypertonic saline, Ringera lactate) and colloids (albumin, solutions of gelatin, dextranes, hydroxyethyl starch). Crystalloids are recommended for short-term interventions, while long-term therapy requires colloids or balanced solutions, as the introduction of unbalanced solutions is accompanied by such risks as hyperchloremia, dilutive acidosis, acute kidney damage, and systemic vasoconstriction. In settings of the chronic inflammation, which often accompanies oncological diseases, the role of thirst as a means of controlling osmolarity changes. Hyperosmolarity may also accompany central diabetes mellitus and tumor metastases to the hypothalamus. Hyperosmolarity leads to the microcirculatory disorders, increased inflammation, cachexia development and multiple organ failure. Another feature of IT in oncology settings is the disruption of tissue energy supply due to nutritional deficiencies and changes in metabolism. Xylitol (Xylate, “Yuria-Pharm”) can be used to eliminate this problem. Xylitol is a five-atom alcohol, which is directly included into the pentose phosphate cycle. The benefits of xylitol include metabolism stabilization in people with diabetes, promotion of slow but stable energy production, antiketogenic properties, improved metabolism of B vitamins, cholekinetic action, and high safety. Xylitol is not used by the tumor cells as an energy substrate. The role of xylitol (Xylate) in IT is to increase the volume of circulating plasma, to reduce the interstitial edema, to decrease the production of ketone bodies, to activate the antioxidant systems, and to increase alkaline blood reserve. It has been reported that xylitol infusion has an oncosuppressive effect due to its antioxidant effect and inhibition of glucose utilization by tumor cells.
Conclusions. 1. IT is an important component of cancer treatment; it should be based on the individual features of the patient. 2. Rational IT eliminates chronic inflammation, endothelial dysfunction and microcirculatory disorders. 3. Rational IT is based on the correct choice of solution, its timely introduction and frequent evaluation of the infusion response. 4. Xylate (“Yuria-Pharm”) has a multifunctional effect in oncology: eliminates dehydration, corrects energy deficiency, and has a direct oncosuppressive effect.
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