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Cisplatin Hydration — SCE Medical Oncology MCQ

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EasyHead & Neck CancerCisplatin HydrationSCE Medical Oncology

A 62-year-old man with head and neck cancer on concurrent cisplatin-CRT develops acute kidney injury (creatinine doubles from baseline). He has been receiving weekly cisplatin 40 mg/m². What immediate renal-protective measure should have been in place?

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Correct answer: B — Aggressive IV hydration (pre and post-cisplatin) with 0.9% NaCl ± mannitol — the most important measure for preventing cisplatin nephrotoxicity; magnesium supplementation is also important

Cisplatin nephrotoxicity prevention requires: (1) aggressive IV pre-hydration (1-2 L 0.9% NaCl over 2-4 hours before cisplatin), (2) IV post-hydration (1-2 L over 4-6 hours after cisplatin), (3) IV magnesium supplementation (cisplatin causes renal magnesium wasting), (4) avoidance of concurrent nephrotoxins (NSAIDs, aminoglycosides, contrast), (5) dose adjustment for renal impairment (cisplatin contraindicated if eGFR <60). For weekly low-dose cisplatin (40 mg/m²), hydration protocols may be abbreviated but should not be omitted.

Reference: BNF Cisplatin; NICE NG36; ESMO Supportive Care