Hyponatremia related to medical anticancer treatment

Abstract

Hyponatremia is a common potential complication in cancer patients. It can be related to anticancer medical therapy. Vincristine, vinblastine, cisplatin and cyclophosphamide are the chemotherapeutic agents most frequently associated with hyponatremia. More recently, analogs such as carboplatin and ifosfamide have also been incriminated. Hyponatremia is also associated with new immunomodulators (interferon, interleukin-2 and levamisole) and monoclonal antibodies. The mechanism by which all these drugs act on the sodium steady state is only partially known. The syndrome of inappropriate antidiuretic hormone secretion is described secondary to vinca alkaloids and cisplatin and possibly with alkylating agents. Renal salt wasting is described with platinum compounds.

Interferon-alpha is a predisposing risk factor for carbamazepine-induced hyponatremia: A case of syndrome of inappropriate antidiuresis caused by interferon-alpha therapy

“…Also, interferon therapy alone has not been demonstrated to cause SIAD. Most patients appear to develop SIAD in combination with other drugs (Jones et al 1983;Bennet et al 1986;Lei et al 1995;Berghmans 1996;Bjorck and Samuelsson 1996). In fact, CBZ is known to sensitize the renal distal tubules (Meinders et al 1974;Wales 1975;Stephens et al 1978) or to cause inappropriate secretion of AVP (Soelberg Sørensen and Hammer 1984), thus, CBZ could have caused the abnormal antidiuresis in the present case.…”

“…There have been many reports of hyponatremia in patients treated with interferon (Jones et al 1983;Bennet et al 1986;Lei et al 1995;Berghmans 1996;Bjorck and Samuelsson 1996). However, the mechanism is unclear.…”

Esophageal Small-cell Carcinoma with Syndrome of Inappropriate Secretion of Antidiuretic Hormone

“…Indeed, several classic cytotoxic agents, especially platinum compounds, vinca alkaloids, and some alkylating agents, have been reported to induce hyponatremia (15). Some surgical procedures such as surgery on the ileal or jejunal ducts and choleresis after biliary drainage can also induce hyponatremia (16,17).…”

Tumor-Related Hyponatremia

“…3 The systemic manifestation of many types of tumors and the toxicities of anti-tumor therapy are involved in the pathogenesis of hyponatremia of malignancies. 3,4 They include pathways with intact or disturbed sodium balance and can be broadly classified into four major groups ( 15 Metastases may also induce a state of hypopituitarism and thus SIADH. Reported cases include intracellular remote metastasis from an adenoid cystic carcinoma of parotid gland origin 16 and metastatic renal cell carcinoma presenting with a bitemporal visual field defect, hyponatremia and panhypopituitarism.…”

“…1 Mild hyponatremia is defined as a serum sodium concentration <135, moderate <132, severe <130 mmol/L and life threatening <125 or abnormal sodium concentration with clinical signs. 2 It usually accompanies, but can also precede the diagnosis of the tumor with an incidence of about 3.7% to 5% 3 and may result from medical 4 or surgical intervention. 5 Hyponatremia develops most often when the ability of the kidney to excrete free water is impaired; hence it is primarily a disorder of water metabolism without impact on intravascular volume status.…”