YO33 - Hyponatremia – slaying the dragon or chasing a mirage- a Case report

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.

Clinical trial identification

Editorial acknowledgement