Syndrome of inappropriate secretion of antidiuretic hormone as a leading cause of hyponatremia in children who underwent chemotherapy or stem cell transplantation.
BACKGROUND
Hyponatremia is a common metabolic disorder in cancer patients. However, little information is available for patients receiving chemotherapy or stem cell transplantation (SCT). We analyzed the frequency, characteristics, and various causes of hyponatremia including routine use of hypotonic fluids in children following chemotherapy or SCT.


METHODS
We reviewed the clinical and laboratory data of 63 children who received chemotherapy or SCT at the Department of Pediatrics, Hanyang University Medical Center from July 2005 to July 2008.


RESULTS
All 63 patients at admission received routine parenteral fluids of 0.25% or 0.45% NaCl and 82 episodes of hyponatremia were observed in 40 (63.5%) patients. Of these 82 episodes, 50 episodes of hyponatremia developed in 29 children following chemotherapy and 32 episodes in 16 children following SCT. Seventy-six out of 82 episodes (92.7%) of hyponatremia developed in 37 patients receiving hypotonic fluids with NaCl concentrations between 30 and 150 mEq/L. The frequency of SIADH in the SCT setting was more frequent (14/21, 66.6%) than in the chemotherapy setting (18/58, 31.0%) (P = 0.02), even though the leading cause of hyponatremia was SIADH in both settings.


CONCLUSIONS
SIADH is a leading cause of hyponatremia in children following chemotherapy or SCT, and more frequent in SCT settings than in chemotherapy settings. Furthermore, the routine use of hypotonic fluids which could aggravate the development of hyponatremia for these patients should be avoided and then switched to isotonic fluids.
Lim
Yeon-Jung
YJ
Department of Pediatrics, Hanyang University Medical Center, Seoul, South Korea.
Park
Eun-Kyoung
EK
Koh
Hyun-Chul
HC
Lee
Young-Ho
YH
D000293:Adolescent; D000328:Adult; D000970:Antineoplastic Agents / Q000009:adverse effects*; D002648:Child; D002675:Child, Preschool; D005260:Female; D005440:Fluid Therapy / Q000379:methods; D006801:Humans; D007010:Hyponatremia / Q000209:etiology* / Q000517:prevention & control; D007177:Inappropriate ADH Syndrome / Q000209:etiology* / Q000517:prevention & control; D007223:Infant; D007552:Isotonic Solutions / Q000627:therapeutic use; D008297:Male; D012307:Risk Factors; D012462:Saline Solution, Hypertonic / Q000009:adverse effects; D033581:Stem Cell Transplantation / Q000009:adverse effects*
D000970:Antineoplastic Agents; D007552:Isotonic Solutions; D012462:Saline Solution, Hypertonic