Presenter(s)
N. Thawani1,2, G. Johnson2, S. P. Srivastava2, S. P. Sorensen3, S. Patel2, M. Patel2, V. Torri4, S. Jani2, S. Sands2, K. Schultheis2, and D. Pinnaduwage2,5; 1Creighton University SOM, Phoenix, AZ, 2Dignity Health Cancer Institute, Phoenix, AZ, 3Dignity Health Can er Institute, Phoenix, AZ, 4Dignity Health cancer Institute, Phoenix, AZ, 5University of Arizona Cancer Center / Dignity Health Saint Joseph Hospital, Phoenix, AZ
Purpose/Objective(s): Hyperkalemia is a potentially fatal complication in patients receiving peptide receptor radionuclide therapy for metastatic neuroendocrine tumors (NETs), as it can lead to life-threatening cardiac arrhythmias. Current guidelines recommend checking potassium levels 2.5 hours post-infusion, leading to delays in care and reduced patient throughput. Conventional management methods, such as diuretics and Kayexalate, interfere with radiation safety measures, and sending patients to emergency care or managing hyperkalemia via internal medicine may jeopardize radiation safety. This study aims to develop a protocol to manage hyperkalemia in these patients while maintaining efficacy, improving operational efficiency, and ensuring radiation safety at a single institution.
Materials/Methods: A protocol was developed for managing hyperkalemia in all patients with metastatic NETs receiving peptide receptor radionuclide therapy at a single institution. Pre-treatment potassium levels were tested, and if levels exceeded 5.5 mEq/L, patients were treated with insulin/D50 (0.1 U/kg insulin and 25-50g D50). Potassium was rechecked one hour after the infusion, and if levels exceeded 5.7 mEq/L, patients received bicarbonate infusion (1-2 mEq/kg). For patients who developed hyperkalemia after the first infusion, oral bicarbonate tablets (650 mg, PO, TID) were prescribed one week before each subsequent infusion. Diuretics and Kayexalate were excluded due to concerns about radiation safety, and no patients were referred to emergency or internal medicine for management, avoiding risks to radiation safety. The protocol was tested over six months in all patients treated with peptide receptor radionuclide therapy at the institution.
Results:
The protocol successfully managed hyperkalemia without compromising the efficacy of treatment. Post-treatment spectroscopic evaluations showed no reduction in treatment effectiveness in any patient. The incidence of severe hyperkalemia was reduced, with potassium levels remaining within the safe range for most patients. Testing potassium one hour after the infusion instead of the recommended 2.5-hour window improved throughput and minimized unnecessary delays. The exclusion of emergency interventions and the management of hyperkalemia within the institution maintained radiation safety.
Conclusion:
The protocol offers an effective strategy for managing hyperkalemia in patients with metastatic NETs receiving peptide receptor radionuclide therapy. By reducing prolonged monitoring, enhancing patient throughput, and ensuring radiation safety, the protocol optimizes treatment management. Excluding diuretics, Kayexalate, and external interventions aligns with safety protocols, providing a comprehensive approach to hyperkalemia management. Future studies should refine this protocol for broader application and assess long-term outcomes.
