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
517P - High BRCA1 expression is independently correlated with decreased overall survival in lung adenocarcinoma: Evidence from meta and bioinformatics analyses
Presenter: Fengzhu Guo
Session: Poster display session
Resources:
Abstract
528P - High-biologically effective dose radiotherapy may improve local control of small cell lung cancer patients with brain metastases: A propensity-matching analysis
Presenter: Qingyang Zhuang
Session: Poster display session
Resources:
Abstract
530P - Prognostic value of C-reactive protein, albumin and C-reactive protein to albumin ratio in small cell lung cancer: A meta-analysis
Presenter: Carla Emille Barbon
Session: Poster display session
Resources:
Abstract
531TiP - CANOPY-A: A phase III, placebo-controlled study of canakinumab as adjuvant therapy in patients (pts) with surgically resected NSCLC
Presenter: Byoung Chul Cho
Session: Poster display session
Resources:
Abstract
532TiP - CANOPY-1: A phase III, placebo-controlled study of pembrolizumab (PEM) plus platinum-based doublet chemotherapy (Ctx) with/without canakinumab in untreated patients (pts) with stage IIIB/IIIC-IV NSCLC
Presenter: Daniel Shao Weng Tan
Session: Poster display session
Resources:
Abstract
533TiP - CANOPY-2: A phase III, placebo-controlled study of canakinumab with or without docetaxel in patients (pts) with NSCLC previously treated with PD-(L)1 inhibitors and platinum-based chemotherapy (Ctx)
Presenter: Darren Lim
Session: Poster display session
Resources:
Abstract
534TiP - A randomized phase III study of carboplatin plus nab-paclitaxel with or without nintedanib for NSCLC with IPF (J-SONIC)
Presenter: Kohei Otsubo
Session: Poster display session
Resources:
Abstract
535TiP - Phase II study of atezolizumab for pretreated advanced / recurrent non-small cell lung cancer with idiopathic interstitial pneumonia (TORG1936 / AMBITIOUS study)
Presenter: Satoshi Ikeda
Session: Poster display session
Resources:
Abstract
536TiP - INSIGHT 2: Tepotinib plus osimertinib in patients with EGFR-mutant NSCLC having acquired resistance to EGFR TKIs due to MET-amplification: A phase II trial in progress study
Presenter: James C-H Yang
Session: Poster display session
Resources:
Abstract
YO8 - Carcinosarcoma of the Breast in a Filipino Female: A Case Report
Presenter: Ma. Angelle Lalaine Dantes
Session: Poster display session
Resources:
Abstract