How should I prepare and administer an 80 mg/m² cisplatin infusion for an adult patient with normal renal and cardiac function, including dose calculation, dilution, electrolyte supplementation, forced diuresis with mannitol or furosemide, and hydration schedule?

Cisplatin 80 mg/m² Infusion Preparation and Administration

For an adult patient with normal renal and cardiac function receiving cisplatin 80 mg/m², administer 1-2 liters of normal saline over 8-12 hours pre-hydration, then dilute cisplatin in 2 liters of 5% dextrose in 1/2 or 1/3 normal saline containing 37.5 g mannitol, infuse over 6-8 hours, and maintain hydration for 24 hours post-infusion with target urine output ≥100 mL/hour. 1

Dose Calculation

• Calculate the patient's body surface area (BSA) using height and weight, then multiply by 80 mg/m² to determine the total cisplatin dose in milligrams 2
• Verify the calculated dose does not exceed 100 mg/m² per cycle, as doses above this threshold require prescriber confirmation 1

Pre-Hydration Protocol (8-12 Hours Before Cisplatin)

• Infuse 1-2 liters of normal saline (0.9% NaCl) over 8-12 hours prior to cisplatin administration 1
• Target urine output of ≥100 mL/hour during pre-hydration phase 3
• Oral hydration alone is insufficient and must not be substituted for intravenous hydration at this dose level 3

Cisplatin Dilution and Infusion

• Do not dilute cisplatin in 5% dextrose alone—this is contraindicated 1
• Dilute the calculated cisplatin dose in 2 liters of 5% dextrose in 1/2 normal saline (D5W/0.45% NaCl) or 1/3 normal saline (D5W/0.33% NaCl) 1
• Add 37.5 g of mannitol (approximately 0.25-0.5 g/kg) to the cisplatin infusion solution 3, 1
• Infuse the cisplatin-mannitol solution over 6-8 hours 1
• Never use needles, IV sets, or filters containing aluminum parts, as aluminum reacts with cisplatin causing precipitate formation and loss of potency 1
• Administer mannitol through an in-line filter to prevent crystallization 3

Forced Diuresis with Mannitol

• The 37.5 g mannitol included in the cisplatin infusion provides forced diuresis to protect renal tubules 1
• Mannitol combined with hydration significantly reduces cisplatin-induced nephrotoxicity, particularly at doses >80 mg/m² 4
• Consider urinary catheter placement to accurately monitor urine output and ensure target diuresis is achieved 3
• Monitor serum osmolality periodically during diuresis, as mannitol can cause hyperosmolality 3
• Mannitol and furosemide demonstrate similar nephroprotective efficacy, though mannitol is preferred in most protocols 5

Post-Hydration and Monitoring (24 Hours After Cisplatin)

• Maintain adequate hydration and urine output for 24 hours following cisplatin infusion 1
• Continue IV fluids to maintain urine output ≥100 mL/hour 3
• Many patients require 5-7 days of outpatient IV fluid support after cisplatin to prevent dehydration 3, 6
• Monitor serum creatinine and blood urea nitrogen (BUN) at baseline and before each subsequent cycle 1

Electrolyte Supplementation

• Aggressive magnesium replacement is critical, as hypomagnesemia exacerbates potassium wasting and must be corrected first 3
• Consider adding 30 mmol/L magnesium sulfate to hydration fluids 7
• Add 60 mmol/L potassium chloride to hydration fluids to prevent hypokalemia 7
• Monitor electrolytes (potassium, magnesium, sodium) every 6 hours for the first 24 hours in high-risk patients, then daily until stable 3

Contraindications to Standard Hydration

• Congestive heart failure and significant urinary obstruction are relative contraindications to aggressive saline hydration 3
• Patients with these conditions require modified hydration protocols with careful volume monitoring

Criteria for Next Cycle Administration

• Do not administer the next cisplatin cycle until serum creatinine is <1.5 mg/dL and BUN is <25 mg/dL 1
• Platelet count must be ≥100,000/mm³ and white blood cell count ≥4,000/mm³ 1
• Audiometric analysis must confirm auditory acuity is within normal limits before proceeding 1

Critical Safety Considerations

• Avoid concomitant nephrotoxic medications (NSAIDs, aminoglycosides) during cisplatin administration 3
• If diluted cisplatin solution is not used within 6 hours, protect from light 1
• Store unopened cisplatin vials at 20-25°C (68-77°F); do not refrigerate 1
• Wear impervious gloves when handling cisplatin vials and IV sets to prevent dermal exposure 1
• If skin contact occurs, immediately wash thoroughly with soap and water 1

Alternative Diuretic Approach

• Furosemide 40 mg IV may be substituted for mannitol if mannitol is contraindicated, though this is less commonly used 5
• When using furosemide, administer prior to cisplatin infusion rather than mixed with the cisplatin solution 5

Outpatient Abbreviated Protocol (Alternative)

• For select patients with good performance status and normal baseline renal function, an abbreviated outpatient protocol using 4000 mL normal saline over 6 hours (rather than the standard 24-28 hour protocol) has demonstrated comparable safety 7
• This abbreviated approach is appropriate only when standard inpatient hydration is not feasible and requires careful patient selection 7