Side Effects of Chemotherapy: Electrolyte Wasting and What You Can Do About It

The diagnosis of cancer is devastating for every individual. The anxiety of treatment, prognosis, and options of therapy are hard to deal with. Most have seen one of their family or friends with a diagnosis of cancer, go through the difficult times during chemotherapy. Naturally, the potential of side effects of chemotherapy and their own individual response is what requires the most mental preparation before starting therapy.

Advances in chemotherapy over the last decade

Conventional chemotherapy, particularly in the 90s, used to be a combination of drugs that would prevent the growth of the cancer cells. These would frequently be called anti-metabolites which prevent the cell from going through its cycle of maturity.

Over the last two decades, new small molecular biological therapies have been introduced. These typically utilize a specific medication (an antibody or a drug) to inhibit a specific protein, typically a receptor, which cancer cells need to grow. The blockade of this protein signals “no -go” to the cancer cells which selectively die. 

The last set of new drugs used to treat cancer is called Immunotherapy. These medications specifically allow the immune cells to be activated within the patient and then attack the cancer cells. These have been proven very promising in certain cancers of the lung and kidney for example.

Side effects of chemotherapy: dehydration and electrolyte wasting.

While there has been a great progress in creating the least toxic therapies for cancer, one of the major side effects that patients frequently experience is nausea, vomiting and diarrhea—all of which eventually lead to dehydration. 

With loss of fluids, electrolytes leave the body and causing the ill- effects of dehydration to persist. Below, we summarize the specific side effects of chemotherapy that result from electrolyte imbalance:

Low sodium or hyponatremia: One of the commonest side effect with chemotherapeutic medication such as cisplatin (given in ovarian and breast cancer e.g.) is hyponatremia. The rate of sodium drop in the blood can be so fast that it may cause headaches, confusion, seizures and even coma. Almost 50% of all patients undergoing chemotherapy can have mild-moderate degree of hyponatremia. The persistent headache and fatigue that patients with chemotherapy experience is thought to be due to hyponatremia.

Low magnesium or hypomagnesemia: One of the most common reason that patients are required to go back to the infusion center is to get magnesium replacement. Magnesium participates in hundreds of cellular reactions and allows proper functioning of the muscles and cardiovascular system.  

Chemotherapy causes significant loss of magnesium from the gut and the urinary source and often leads to palpitations, weakness, fatigue and muscle cramps. Newer therapies (those target EGF or epidermal growth factor receptors for certain cancers) have reported a magnesium wasting in about 80% of patients.

Low potassium or hypokalemia: Potassium is lost from the gut during dehydration resulting from diarrhea as a result of chemotherapy. Potassium is critical in muscle contraction, and low potassium can lead to cramps, muscle weakness, fatigue and cardiac rhythm abnormalities.

Minimizing side effects of chemotherapy by electrolyte-rich nutrition

The science of electrolyte loss is complicated but the therapy is not. Most Oncologists ensure adequate hydration for their patients undergoing chemotherapy and order electrolyte replacement as required. The goal being minimizing electrolyte imbalance that causes symptoms.

However, such “reactive” approach is not as best as a “proactive” one since replacing electrolytes after the deficiency has set in does not maintain the same quality of life for the patient. A proactive approach to maintaining the electrolyte levels significantly changes the outcome, tolerance to therapy and quality of life for these patients. 

Below are some fundamental tips to prevent electrolyte imbalance with chemotherapy and reduce their side effects on human body:

• Supplement magnesium in diet at least a week prior to starting chemotherapy: Magnesium is available in nuts, green leafy vegetables, bran, fish, eggs and certain seeds. Magnesium supplements (oxide or citrate) in addition is a good choice.

• Increase some sodium intake in your food: One easy way is to be slightly generous with salting food. Salt and protein intake both allow blood sodium levels to be regulated within range.

• Drink plenty of fluids but not just water: Hydrate but with fluids that contain electrolytes. An electrolyte drink mix such as HuMOLYTE can allow delivery of a proper amount of electrolytes in addition to water. Drinking water alone can worsen hyponatremia (low sodium) from chemotherapy. Natural drinks such as coconut water or vegetable juices can also supplement enough potassium and magnesium.

• Use a high potassium diet: Leafy vegetables, tomatoes, potatoes, avocados and bananas are excellent sources of potassium since loss of this electrolyte is expected with most chemotherapies.

• Use alkaline foods as much as possible: Chemotherapy can be catabolic, which can generate more acid in the body. Using alkaline rich foods such as green leafy vegetables and citrus foods can improve acid base balance in cancer.

• Don’t forget your protein: Keeping your blood albumin (the dominant protein in plasma) within range allows body to heal quickly and prevents ill effects like infections after chemotherapy. High protein diet allows blood sodium to be regulated and keeps your body ready to fight infections.

With these simple techniques, chemotherapy side effects can be kept to a minimum. It is usually a good idea to prepare for it before you start—staying hydrated and using an electrolyte supplement such as HuMOLYTE that delivers all three electrolytes will keep the body ready to face the battle. 

To learn how HuMOLYTE can aid in hydrating patients during chemotherapy and alleviating chemotherapy side effects, visit here.

About Dr. Sourabh Kharait

Dr. Sourabh Kharait (MD / PhD) is Clinical Nephrologist and Medical Director of Clinical Trials at Summit Nephrology Medical Group, and the Founder and CEO of IGH Naturals, a platform company that designs Functional Foods and Nutritional products for athletes and patients with chronic diseases.