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Berardi et al. J Cancer Metastasis Treat 2019;5:79 I http://dx.doi.org/10.20517/2394-4722.2019.008 Page 27 of 33

Figure 7. Algorithm of hypomagnesemia management [48,159-162] . The treatment of hypomagnesemia is based on the correction of the
underlying cause and the integration of magnesium, which can be oral or intravenous based on the degree and symptoms reported. The
differential diagnosis of hypomagnesemia is based on fractional excretion of magnesium: if it is > 2%, it might indicate renal loss, while, if
it is < 2%, hypomagnesemia might depend on gastrointestinal losses or reduced intake . FE Mg: fractional excretion of magnesium; U Ca/
Cr: urinary calcium/creatinine ratio

The maximum infusion rate should be 8 mEq/h in asymptomatic patients, since rapid intravenous
administration of magnesium sulfate induces elevated serum magnesium levels, which favor magnesium
[163]
renal excretion. Therefore, a slow infusion is crucial to obtain an adequate correction of hypomagnesemia .
Concomitant electrolyte disorder and vitamin D deficiency should be corrected [164] .

Hypermagnesemia
Hypermagnesemia is defined as a magnesium plasma level > 2.2 mEq/L. It is a rare electrolyte disorder and
is usually iatrogenic (intravenous magnesium, magnesium-containing laxatives, or anti-acids).

Patient with hypomagnesemia might complain of hypotension, respiratory depression, confusion, and ECG
alterations such as bradycardia and complete AV-block until asystole. Treatment requires discontinuation
of magnesium intake. In symptomatic patients presenting cardiac arrhythmias, respiratory depression, and
hypotension, intravenous infusion of calcium gluconate 10% is suggested. In severe cases, hemodialysis
may be necessary [164] .

CONCLUSION
Electrolyte alterations are common disorders in cancer patients and they are demonstrated to worsen
prognosis. Altered electrolyte blood balance might depend on the presence of concomitant diseases
and treatments, antineoplastic therapies, or paraneoplastic syndrome. Moreover, electrolytic alterations
often cause important morbidity, negatively influencing quality of life and possibility of administration
and response to the antineoplastic therapies. Furthermore, recent evidence shows the potential role
of electrolyte channels in carcinogenesis, suggesting an important role of electrolyte balance in cancer
patients. An improvement of knowledge about these conditions is necessary to monitor patients at risk for
a prompt diagnosis and effective treatment, in order to improve patient outcome. Considering the lack of
data in the literature supported by clinical trials enrolling cancer patients, the treatment recommendations