Retentissements hydroélectrolytiques et acidobasiques de la chimiohyperthermie intrapéritonéale

Background

Hyperthermic intraperitoneal chemoperfusion (HIPEC) is an innovative treatment of the peritoneal carcinomatosis with potential iatrogenicity. This observational study was designed to improve our understanding of HIPEC's impact on the renal and respiratory functions, on temperature, blood cells counts, body fluids/electrolytes and acid-base balance.

Methods

We retrospectively analyzed the perioperative care of 20 patients that underwent HIPEC with oxaliplatin (n = 19) and mitomycin C (n = 1). The abdominal cavity was filled with the peritoneal dialysis fluid with dextrose 5%: volume of 2 L/m². Follow-up for the study was stopped on postoperative day 7.

Results

The main changes were appearing just after the HIPEC procedure: increased diuresis, lactic acidosis, hyponatremia and hyperglycaemia (despite aggressive intravenous insulin therapy). In our series, there was no renal failure or impact on blood cells counts until the 7^th day, neither some changes on the arterial blood gases.

Conclusion

Hyperglycemia might explain increased diuresis of lactic acidosis and the rapid installation of hyponatremia. Taken together, these results suggest that glycemic control must be improved in order to avoid the other metabolic disturbances.