title: Small Cell Lung Cancer Patient with Profound Hyponatremia and Acute Neurological Symptoms: An Effective Treatment with Fludrocortisone.
abstract: Hyponatremia is a frequent electrolyte abnormality in patients with small cell lung cancer (SCLC). Being usually asymptomatic, hyponatremia may cause symptoms like nausea, fatigue, disorientation, headache, muscle cramps, or even seizures, particularly if severe and rapid decrease of serum sodium levels occurs. Here we report a case of SCLC patient with severe hyponatremia and acute neurological symptoms that developed 2 days after the first course of second-line chemotherapy, most probably due to the release of antidiuretic hormone (ADH, also known as arginine vasopressin) during lysis of the tumour cells. Initial treatment consisted of continuous administration of hypertonic saline that resulted in improvement of patient's neurological status. However, to obtain a persistent increase in serum sodium level, pharmacological intervention with oral fludrocortisone 0.1 mg twice daily was needed. We can therefore conclude that mineralocorticoids may be used to correct hyponatremia in SCLC patients when appropriate.
authors.affiliation: Hematology and Oncology Clinic, Department of Radiotherapy and Oncological Therapy, Tartu University Hospital, 51014 Tartu, Estonia ; Department of Haematology and Oncology, University of Tartu, 51014 Tartu, Estonia.
authors.forename: Jana
authors.initials: J
authors.lastname: Jaal
authors.affiliation: Hematology and Oncology Clinic, Department of Radiotherapy and Oncological Therapy, Tartu University Hospital, 51014 Tartu, Estonia.
authors.forename: Tõnu
authors.initials: T
authors.lastname: Jõgi
authors.affiliation: Department of Pulmonary Medicine, University of Tartu, 51014 Tartu, Estonia ; Lung Clinic, Tartu University Hospital, 51014 Tartu, Estonia.
authors.forename: Alan
authors.initials: A
authors.lastname: Altraja