title: [Life-Threatening Hyponatremia by Chemotherapy in a Patient with Non-Hodgkin's Lymphoma].
abstract: Cyclophosphamide and vincristine are known to be the chemotherapeutic agents most frequently associated with hyponatremia. Here, we report the case of a 69-year-old man with non-Hodgkin's lymphoma who developed severe hyponatremia during chemotherapy. The Japanese man was diagnosed with diffuse large B-cell lymphoma, and underwent chemotherapy treatment with THP-COP (cyclophosphamide, pirarubicin, vincristine, and prednisolone). In the first course of chemotherapy, he developed hyponatremia (nadir 109 mEq/L) and his urinary N-acetyl-β-D-glucosaminidase (NAG) level had increased. After the second courses of chemotherapy with rituximab, pirarubicin, and prednisolone, without cyclophosphamide and vincristine, he had developed light hyponatremia (nadir 130 mEq/L). However, after the third and fourth courses of chemotherapy with rituximab, pirarubicin, prednisolone, and cyclophosphamide, he had developed a medium level of hyponatremia (nadir 124-125 mEq/L) and his NAG level had increased further. The possible mechanism of this phenomenon is due to renal tubular damage by cyclophosphamide. We conclude that extra caution is necessary if a patient develops severe hyponatremia following chemotherapeutic treatment with cyclophosphamide and vincristine.
authors.affiliation: Dept. of Pharmacy, Hokushin General Hospital.
authors.forename: Go
authors.initials: G
authors.lastname: Morikawa
authors.forename: Tsunemichi
authors.initials: T
authors.lastname: Kinjo
authors.forename: Yoko
authors.initials: Y
authors.lastname: Hanaoka
authors.forename: Tomokazu
authors.initials: T
authors.lastname: Kiyono
authors.forename: Katsuko
authors.initials: K
authors.lastname: Okazawa
authors.forename: Kazuo
authors.initials: K
authors.lastname: Dan
mesh_terms: D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D006801:Humans; D007010:Hyponatremia / Q000139:chemically induced*; D016403:Lymphoma, Large B-Cell, Diffuse / Q000188:drug therapy* / Q000473:pathology; D008297:Male; D009367:Neoplasm Staging; D016896:Treatment Outcome