Acute severe hypokalemia caused by treatment of tongue squamous cell carcinoma with docetaxel and cisplatin: A case report

Abstract

BACKGROUND

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.

CASE SUMMARY

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 via 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.

CONCLUSION

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.

Keywords: Tongue squamous cell carcinoma; Docetaxel; Hypokalemia; Hypomagnesemia; Case report

Core Tip: The patient with tongue squamous cell carcinoma who had severe hypokalemia combined with hypomagnesaemia on the third cycle of docetaxel combined with cisplatin chemotherapy, and recovered to normal after active potassium supplementation and other measures. After analysis, it was considered that the occurrence of hypokalemia in this patient may be related to docetaxel therapy, and docetaxel may cause increased potassium ion (K⁺) transfer into the cell, but the mechanism is still unclear. We hope to get the attention of peers through this case: For example, mechanistic studies of whether docetaxel might increase K⁺ to intracellular transfer, and healthy care should pay attention to any complaints and discomfort symptoms during the process of chemotherapy from cancer patients.