Abstract YO33
Case summary
Background
Hyponatremia is known to be a modifiable prognostic factor in advanced cancer. It is also known to be a medical emergency. Correction of hyponatremia in the absence of urinary analysis and radiological investigations is a challenge. This case report discusses the feasibility and challenges involved in correction of hyponatremia in the Palliative medicine ward.
Case details
62 year old male patient with a smoking index of 2000, a known case of Adenocarcinoma of the lung with adrenal, liver and brain metastasis presented with backache, weakness and obstructive urinary symptoms. A biopsy done from the site of a pelvic fracture that he had obtained in the recent past was suggestive of a poorly differentiated tumor. A biopsy from the right lung mass was reported as adenocarcinoma. He was bieng evaluated for potentially reversible causes of deterioration in general medical condition during which routine biochemical and haematological investigations were sent. The successive serum sodium levels were found to be 100, less than 100, 82.8, 111 and 114.8 meq /l during the course of the next 12 hours. Fluid restriction was initiated after a presumptive diagnosis of Syndrome of Inappropriate ADH secretion had been considered. The 24 hour urine output was 2250 ml.
Discussion
The following questions with regards to the management of hyponatremia in advanced cancer merit further discussion – Is the palliative medicine ward a feasible setting for the management of an oncological emergency, can the diagnosis of SIADH be made presumptively in the absence of urine analysis, does the syndrome of cerebral salt wasting exist as a separate entity and are vaptans useful in the management of hyponatremia.
Laboratory parameters | 0 hours | +6 hours | +12 hours |
Serum Haemoglobin | 9.7 | 10.6 | |
Total Leucocyte count | 18800 | 21680 | |
Total Platelet count | 64000 | 85000 | |
ESR | 70 | ||
pH | 7.46 | 7.42 | 7.46 |
pCO2 | 26 | 30 | 25 |
pO2 | 41 | 49 | 68 |
Sodium | 100 | <100 | 82.8 |
Potassium | 4.9 | 4.4 | 5.7 |
Calcium | 0.40 | 0.59 | 0.92 |
Glucose | 101 | 203 | 195 |
Lactate | 1.4 | 1.6 | |
Bicarbonate | 18.5 | 26.4 | |
Total Co2 | 19.3 | 20.4 | |
Base equivalents | 5.3 | 4.1 | |
SpO2 | 80 | 82 |
Clinical trial identification
Editorial acknowledgement
Resources from the same session
184P - Expression pattern of CDK12 protein in gastric cancer and its positive correlation with CD8+ cell density and CCL12 expression
Presenter: Jun Ji
Session: Poster display session
Resources:
Abstract
185P - Evaluation of the effect of cholesorption on the concentration of TNF-α in the serum of the blood in tumours of the biliopancreatoduodenal zone
Presenter: Marufjon Salokhiddinov
Session: Poster display session
Resources:
Abstract
186P - Efficacy and safety of sorafenib following hepatic resection in patients with hepatocellular carcinoma: A meta-analysis
Presenter: Yang Yuan
Session: Poster display session
Resources:
Abstract
187P - Correlation between spleenic dose and grade of hematological toxicity in chemoradiation of stomach
Presenter: Umesh Velu
Session: Poster display session
Resources:
Abstract
188P - Survival and prognostic factors in cholangiocarcinoma: A single-center experience
Presenter: Sonngwit Payapwattanawong
Session: Poster display session
Resources:
Abstract
189P - Stereotactic body radiotherapy in primary hepatocellular carcinoma and oligometastatis to liver: A single Institution experience
Presenter: Sayan Paul
Session: Poster display session
Resources:
Abstract
190P - Details of response with first-line gemcitabine and nab-paclitaxel therapy in patients with advanced pancreatic cancer
Presenter: Yusuke Nagata
Session: Poster display session
Resources:
Abstract
191P - Assessment of efficacy and safety of sorafenib versus no treatment in Egyptian hepatocellular carcinoma patients
Presenter: Noha El Baghdady
Session: Poster display session
Resources:
Abstract
192P - Clinical importance of the determination of interleukin-6 in bile and blood in tumours of biliopancreatoduodenal zone
Presenter: Marufjon Salokhiddinov
Session: Poster display session
Resources:
Abstract
193P - Metastatic carcinoma gall bladder: A clinicoepidemiological profile of Indian patients
Presenter: Anvesh Rathore
Session: Poster display session
Resources:
Abstract