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Electrolytes

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I’m curious if there’s any known connection between CML and/or TKIs with electrolytes. I’ve had fairly pronounced heart rhythm issues for over three years, which I’m sure includes time when the CML was gathering steam yet before it was diagnosed. I’ve noticed a link between bad episodes with high sodium meals, and then recently I was in the ER for really bad palpitations—felt like a fib but apparently weren’t—and labs indicated slightly low potassium. When they gave me potassium pills there a pretty rapid improvement. And of course there’s the magnesium issue that we already know about. The increased palpitations parallels resuming Sprycel two months ago. I’m kind of lumping three different issues together, but wondered if there’s any known connection with CML, CML treatment, and electrolyte issues. Thanks for any ideas :)

Hi Bill,

I am absolutely no expert in this area - but I had a bit of a look around and have one line of thinking that may be worth discussing with your doctor.

Some CML drugs can cause issues with lengthening the QT Interval of your heart - I believe dasatinib and nilotinib are the main culprits, particularly nilotinib (I might be wrong, someone else might know better). So can a lack of potassium, and other salts & electrolytes. Combined, it's not unreasonable to consider that the sum of these things could cause issues. 

Palpitations and fainting (and worse) are symptoms of a long QT interval. Typically you use an EKG to check for long-QT. In my case this was done before I commenced dasatinib.

Have you had an EKG?

David.

 

Thanks David. Yes, over the past 6 months I've had probably 20 EKGs. Last fall when the CML diagnosis happened, it began with tachycardia, then a- fib and a flutter. I had an SVT ablation this past January which hopefully helped stave off those issues. Most recently I had one in the ER.... palpitations were so aggressive that I thought it was a fib. The EKG said just PVCs. They took labs and found me slightly deficient in potassium. When they gave me two potassium chloride tablets there was a fairly noticeable improvement. Not like the palpitations were "all gone", but they were markedly less aggressive, and slowly went away for awhile. When they came back they more more like my normal PVC palpitations. In the ER my nurse said chemo can cause all kinds of crazy heart issues. I just wish I knew exactly where the nexus was so I could try to address it.