Chemotherapy — Nephrotoxic & Ototoxic Agents

Cisplatin is a platinum-based alkylating-like agent used for testicular, ovarian, bladder, and lung cancers. Its two signature toxicities are nephrotoxicity and ototoxicity, both dose-related and potentially irreversible. Cisplatin damages renal tubular cells directly, causing acute tubular necrosis. BUN and creatinine must be checked before each cycle — the drug is held if creatinine clearance falls below the provider-specified threshold (commonly CrCl < 60 mL/min). The primary nursing prevention strategy is aggressive IV hydration with normal saline (often 1–2 L) before and after infusion, plus forced diuresis with mannitol in some protocols, to flush platinum metabolites through the tubules quickly. Urine output must be maintained at ≥100 mL/hr during and after administration. Monitor serum magnesium and potassium — cisplatin causes renal tubular wasting of both electrolytes, and hypomagnesemia is a commonly tested complication. Ototoxicity presents as high-frequency hearing loss and tinnitus, often permanent. Baseline and serial audiometry are standard. The client should report any ringing, muffled hearing, or difficulty hearing high-pitched sounds immediately. Carboplatin, a related platinum agent, is less nephrotoxic and ototoxic but carries higher myelosuppression risk — this swap matters clinically when renal function declines.