Cyclophosphamide-Induced Hyponatremia in a Patient With Diabetes Insipidus

Rachel A. Steinman, Sara E. Schwab, Kashif M. Munir

Abstract


Cyclophosphamide has been previously observed to induce hyponatremia. The mechanism remains unclear. Cyclophosphamide may produce a syndrome of inappropriate anti-diuretic hormone-like phenomenon through impairment of the kidney’s ability to dilute urine. Whether cyclophosphamide or its metabolites have a direct effect on the kidney, a vasopressin-like effect on the kidney, or cause vasopressin release is unknown. A 29-year-old man with intracranial germinoma diagnosed at age 11 treated primarily with chemo-radiation developed a recurrence 17 years later and was noted to have panhypopituitarism with resultant central diabetes insipidus. He was admitted for chemotherapy with cisplatin, cyclophosphamide and mesna. His admission serum sodium was normal, but he became hyponatremic while undergoing chemotherapy with cyclophosphamide and mesna in conjunction with the initiation of intravenous hydration with 5% dextrose/0.45% normal saline despite withholding two doses of desmopressin (DDAVP). The sodium eventually normalized after administration of 20 mg intravenous furosemide. A similar episode occurred several weeks later, while again receiving cisplatin, cyclophosphamide and mesna chemotherapy. He again became hyponatremic despite receiving isotonic saline fluids and withholding DDAVP during cyclophosphamide treatment. Serum sodium did not improve with three doses of 10 mg intravenous furosemide but improved instead with sodium chloride tablets. The mechanism of cyclophosphamide-induced hyponatremia remains unknown. Given that this patient’s central diabetes insipidus prevents him from secreting increased amounts of anti-diuretic hormone, hyponatremia is likely induced by a direct nephrogenic effect of cyclophosphamide or its metabolites.




J Endocrinol Metab. 2015;5(6):337-339
doi: http://dx.doi.org/10.14740/jem319w

Keywords


Cyclophosphamide; Hyponatremia; Diabetes insipidus

Full Text: HTML PDF
 

Browse  Journals  

     

Journal of clinical Medicine Research

Journal of Endocrinology and Metabolism

Journal of Clinical Gynecology and Obstetrics

World Journal of Oncology

Gastroenterology Research

Journal of Hematology

Journal of Medical Cases

Journal of Current Surgery

Clinical Infection and Immunity

Cardiology Research

World Journal of Nephrology and Urology

Cellular and Molecular Medicine Research

Journal of Neurology Research

International Journal of Clinical Pediatrics

 

 

 

 

 

Journal of Endocrinology and Metabolism, bimonthly, ISSN 1923-2861 (print), 1923-287X (online), published by Elmer Press Inc.            
The content of this site is intended for health care professionals.
This is an open-access journal distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License, which permits unrestricted
non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Creative Commons Attribution license (Attribution-NonCommercial 4.0 International CC-BY-NC 4.0)


This journal follows the International Committee of Medical Journal Editors (ICMJE) recommendations for manuscripts submitted to biomedical journals,
the Committee on Publication Ethics (COPE) guidelines, and the Principles of Transparency and Best Practice in Scholarly Publishing.

website: www.jofem.org   editorial contact: editor@jofem.org
Address: 9225 Leslie Street, Suite 201, Richmond Hill, Ontario, L4B 3H6, Canada

© Elmer Press Inc. All Rights Reserved.