Post-Chemo Lab Review after First SN-38 (Irinotecan) Dose
Snapshot
Regimen: Irinotecan → SN-38
Cycle: 1 • Post-dose labs
Status: Monitoring
Hemoglobin
11.7 g/dL
Low (13–17)CO₂ (Bicarb)
22 mmol/L
Low (23–34)Sodium
135 mmol/L
Low-normal (137–150)Platelets
476 ×10³/µL
High (150–450)WBC
8.18 ×10³/µL
Within rangeCreatinine
1.00 mg/dL
Normal kidney functionLiver Enzymes
AST 49 • ALT 23 U/L
Within normalInterpretation (Brief)
Mild anemia (low HGB/HCT), high RDW suggesting mixed RBC sizes, and reactive thrombocytosis likely from inflammation or marrow response. Electrolytes show mild hyponatremia and low CO₂ consistent with a mild metabolic acidosis, which can be aggravated by diarrhea from irinotecan. Kidney and liver markers are stable.
Selected Results
| Test | Result | Flag | Ref Range |
|---|---|---|---|
| WBC | 8.18 ×10³/µL | Normal | 4.5–11.5 |
| Hemoglobin | 11.7 g/dL | Low | 13–17 |
| Hematocrit | 36.8% | Low | 40–50 |
| MCHC | 24.2 g/dL | Low | 32–36 |
| RDW-CV | 31.9% | High | 11–14 |
| RDW-SD | 35.1 fL | Low/atypical | 37–54 |
| Platelets | 476 ×10³/µL | High | 150–450 |
| Sodium | 135 mmol/L | Low-normal | 137–150 |
| CO₂ (HCO₃⁻) | 22 mmol/L | Low | 23–34 |
| BUN | 10 mmol/L | Low | 23–34 |
| Creatinine | 1.00 mg/dL | Normal | 0.7–1.3 |
| Total Bilirubin | 0.20 mg/dL | Normal | 0.2–1.3 |
| AST / ALT | 49 / 23 U/L | Normal | 38–126 / 9–69 |
| Albumin / Globulin | 42 / 33 g/L | Normal | 60–82 / 20–50 |
Reference intervals are taken from the submitted hospital report.
Action Focus (Next 7 Days)
- Hydration with ORS (water + sodium + glucose + pinch of bicarbonate) to correct low CO₂ and sodium.
- Monitor for delayed diarrhea and fever between days 7–10; seek care promptly if present.
- Iron-rich foods (e.g., liver, sardines) plus vitamin C as tolerated to support anemia.
72-Hour Gut Support Plan to Reduce SN-38G Reactivation
Quick Overview
This plan aims to reduce gut β-glucuronidase–mediated reactivation of SN-38G after irinotecan by combining Saccharomyces boulardii with gentle prebiotics (inulin & acacia), while maintaining therapeutic ketosis and strong hydration.
- S. boulardii: 250 mg twice daily (or 5–10B CFU/day) for 72 hours.
- Inulin: 1–2 g/day, start low; adjust to gas/bloating.
- Acacia fiber: 3 g/day; gentle, can help with loose stools.
- Hydration: target 2–3 L/day with electrolytes; sip steadily.
- Meals: fat-forward, low-carb to preserve ketosis.
Note: Take S. boulardii ideally on an empty stomach and separate from systemic antifungals. If severely immunocompromised/neutropenic or with central lines, use only under medical guidance.
Day 0 (Infusion Day)
| Time | Action | Notes |
|---|---|---|
| 2:30 PM | Meal Light fat-based refeed | 1–2 tsp coconut oil + leafy greens or small avocado; avoid carbs to keep ketosis. |
| 3:30 PM | Probiotic S. boulardii 250 mg | Prefer empty stomach; start early to pre-empt SN-38G reactivation. |
| 6:30 PM | Prebiotic Acacia fiber 3 g | Mix in water/herbal tea; gentle, helps bind toxins & support barrier. |
| 8:00 PM | Hydration Electrolyte fluids | 250–500 mL; repeat as needed overnight. |
Day 1 (≈24 hours post-infusion)
| Time | Action | Notes |
|---|---|---|
| 7:30 AM | Probiotic S. boulardii 250 mg | Empty stomach if possible. |
| 8:00 AM | Hydration 250–300 mL | Mineral/electrolyte water; sip, don’t chug. |
| 12:00 PM | Prebiotic Inulin 1–2 g | Start low; mix into water or low-carb smoothie. |
| 1:30 PM | Meal Fat-forward plate | Sardines + olive oil + greens; keep carbs minimal. |
| 3:30 PM | Hydration 250–300 mL | Coconut water only if diarrhea starts; otherwise mineral water. |
| 6:30 PM | Prebiotic Acacia fiber 3 g | Continues barrier support; gentle on gas. |
| 8:00 PM | Probiotic S. boulardii 250 mg | Second daily dose to maintain gut levels. |
Day 2 (≈48 hours post-infusion)
| Time | Action | Notes |
|---|---|---|
| 7:30 AM | Probiotic S. boulardii 250 mg | Empty stomach if possible. |
| 8:00 AM | Hydration 250 mL | Electrolytes to protect kidneys & bowels. |
| 12:00 PM | Prebiotic Inulin 1–2 g + optional resistant starch | If tolerated, add small cooled-potato or green banana flour portion. |
| 1:30 PM | Meal Fat-forward plate | Egg yolks + avocado + greens (keto-friendly). |
| 3:30 PM | Hydration 250 mL | Increase if stools loosen. |
| 6:30 PM | Prebiotic Acacia fiber 3 g | Supports barrier; gentle bulking. |
| 8:00 PM | Probiotic S. boulardii 250 mg | Maintain colonization through 72 hours. |
Day 3 (≈72 hours post-infusion)
| Time | Action | Notes |
|---|---|---|
| 7:30 AM | Probiotic S. boulardii 250 mg | Final dose in this window (continue if beneficial). |
| 8:00 AM | Hydration 250 mL | Keep electrolytes steady. |
| 12:00 PM | Prebiotic Inulin 1–2 g | Adjust to tolerance (back off if gassy). |
| 1:30 PM | Meal Fat-forward plate | Salmon + olive oil + low-carb veg. |
| 3:30 PM | Hydration 250 mL | Coconut water only if diarrhea. |
| 6:30 PM | Prebiotic Acacia fiber 3 g | Continue daily if helpful. |
| 8:00 PM | Probiotic S. boulardii 250 mg | You may taper to once daily thereafter. |
Pro Tips
- Increase inulin slowly; reduce if bloating/gas.
- Acacia is gentle—okay to keep during loose stools.
- Keep carbs low to maintain ketosis and reduce gut fermentation load.
- If diarrhea starts, prioritize fluids, sodium, potassium, magnesium.
- Short easy walks aid motility without taxing recovery.
Safety & Medical
Use S. boulardii with oncology guidance if you are severely immunocompromised or have a central line. Separate from antifungals. This plan is supportive and not a replacement for medical care.
Watchouts: escalating abdominal pain, persistent watery diarrhea, fever, or inability to hydrate → contact your care team.
Prepared for post-irinotecan support. Customize doses/meal examples to your pantry & tolerance.
