Abstract: PO1849
Characteristics and Outcomes of Cancer Patients with Severe Hyponatremia
Session Information
- Cancer and Kidney Diseases: Nephrotoxins, RCC, and More
November 04, 2021 | Location: On-Demand, Virtual Only
Abstract Time: 10:00 AM - 12:00 PM
Category: Onco-Nephrology
- 1500 Onco-Nephrology
Author
- Isaranuwatchai, Suramath, Chulabhorn Hospital, Bangkok, Thailand
Background
Hyponatremia is the most common electrolyte disorder in cancer patients and associated with poor prognosis in several types of cancer. Severe hyponatremia (serum sodium < 120 mmol/L) is linked to increased hospital length. We conducted this retrospective study to evaluate for clinical and laboratory characteristics of cancer patients with severe hyponatremia.
Methods
Medical records from previous 2 years at Chulabhorn hospital were reviewed. Cancer patients who had serum sodium less than 120 mmol/L were included. Clinical data, including symptoms, causes of hyponatremia, treatments, response to treatments and survival rate, were recorded.
Results
A total of 154 patients with cancer and severe hyponatremia were identified. 147 patients (95.5%) had solid malignancy. Only 7 patients (4.5%) had hematologic malignancy, all of which were lymphoma. The most common solid malignancy was hepatocellular carcinoma (14.9%), followed by lung cancer (14.3%) and pancreatic cancer (10.4%). Interestingly, 36.3% of patients were asymptomatic despite severe hyponatremia. Of 98 patients that were symptomatic, the most common symptom was fatigue (30.5%), followed by nausea/vomiting (26.0%) and alteration of consciousness (19.5%). Seizures were present in only 3 patients (1.9%). The most common cause of hyponatremia was volume depletion (83.8%), which was mostly due to poor intake. Syndrome of inappropriate antidiuresis (SIAD) was the cause of severe hyponatremia in only 7 patients (4.5%). Most of our patients (76.0%) were treated with isotonic saline infusion and 83.8% of which responded with significant improvement in serum sodium level. Hypertonic saline infusion was given in only 27 patients (17.5%). Survival rate at 30 days was 46.1% and survival rate at 90 days was 26.6%.
Conclusion
Our data demonstrated that the most common cause of severe hyponatremia in cancer patients was volume depletion from poor intake, in contrast to SIAD which was suggested by other previous studies. In addition, most patients in our cohort responded to isotonic saline infusion. Fluid restriction and diuretic/aquaretic drug administration, presuming that patients have SIAD, may worsen the serum sodium level in these hypovolemic cancer patients. This study emphasized the importance of clinical evaluation and investigation for cancer patients with severe hyponatremia to achieve the correct diagnosis and provide proper management.