Cyclophosphamide and water retention: mechanism revisited.
We describe an 8 year-old girl with established diabetes insipidus who developed cyclophosphamide-associated antidiuresis. The patient had received cyclophosphamide as part of a high-dose chemotherapy regimen for recurrent suprasellar dysgerminoma prior to autologous bone marrow transplantation. Urinary output decreased and specific gravity increased shortly after a 1 hour i.v. infusion of 50 mg/kg cyclophosphamide and the effect lasted some 5 hours. No other drug could be implicated. This response, occurring in a patient with no ability to secrete vasopressin, suggests a direct tubular effect of one or more cyclophosphamide metabolites. Administering i.v. cyclophosphamide requires careful monitoring of fluid balance in order to avoid water intoxication. Further research is warranted both into the mechanism of this effect and the metabolite responsible for it.
Campbell
D M
DM
Division of Endocrinology, Hospital for Sick Children, Toronto, Ontario, Canada.
Atkinson
A
A
Gillis
D
D
Sochett
E B
EB
D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D016543:Central Nervous System Neoplasms / Q000150:complications / Q000188:drug therapy*; D002648:Child; D003520:Cyclophosphamide / Q000008:administration & dosage / Q000009:adverse effects*; D003894:Deamino Arginine Vasopressin / Q000008:administration & dosage; D003919:Diabetes Insipidus / Q000209:etiology*; D004407:Dysgerminoma / Q000150:complications / Q000188:drug therapy*; D005260:Female; D006801:Humans; D016055:Urinary Retention / Q000139:chemically induced*
D003520:Cyclophosphamide; D003894:Deamino Arginine Vasopressin