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      Diagnosis and Management of Hyponatremia in Cancer Patients

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          Abstract

          The rationale for the diagnosis and management of hyponatremia in cancer patients is identified, the main causes are reviewed, and treatment options are discussed with a focus on the practical use of the arginine vasopressin antagonist tolvaptan.

          Abstract

          Hyponatremia, a common electrolyte abnormality in oncology practice, may be a negative prognostic factor in cancer patients based on a systematic analysis of published studies. The largest body of evidence comes from small-cell lung cancer (SCLC), for which hyponatremia was identified as an independent risk factor for poor outcome in six of 13 studies. Hyponatremia in the cancer patient is usually caused by the syndrome of inappropriate antidiuretic hormone (SIADH), which develops more frequently with SCLC than with other malignancies. SIADH may be driven by ectopic production of arginine vasopressin (AVP) by tumors or by effects of anticancer and palliative medications on AVP production or action. Other factors may cause hypovolemic hyponatremia, including diarrhea and vomiting caused by cancer therapy. Hyponatremia may be detected on routine laboratory testing before or during cancer treatment or may be suggested by the presence of mostly neurological symptoms. Treatment depends on several factors, including symptom severity, onset timing, and extracellular volume status. Appropriate diagnosis is important because treatment differs by etiology, and choosing the wrong approach can worsen the electrolyte abnormality. When hyponatremia is caused by SIADH, hypertonic saline is indicated for acute, symptomatic cases, whereas fluid restriction is recommended to achieve a slower rate of correction for chronic asymptomatic hyponatremia. Pharmacological therapy may be necessary when fluid restriction is insufficient. The orally active, selective AVP receptor 2 (V 2)-receptor antagonist tolvaptan provides a mechanism-based option for correcting hyponatremia caused by SIADH or other conditions with inappropriate AVP elevations. By blocking AVP effects in the renal collecting duct, tolvaptan promotes aquaresis, leading to a controlled increase in serum sodium levels.

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          Author and article information

          Journal
          Oncologist
          Oncologist
          oncologist
          theoncologist
          The Oncologist
          The Oncologist
          AlphaMed Press (Durham, NC, USA )
          1083-7159
          1549-490X
          June 2012
          22 May 2012
          : 17
          : 6
          : 756-765
          Affiliations
          [1] aDivision of Hematology and Oncology, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA;
          [2] bOtsuka America Pharmaceutical, Inc., Rockville, Maryland, USA;
          [3] cBioScience Communications, New York, New York, USA
          Author notes
          Correspondence: Jorge J. Castillo, M.D., The Warren Alpert Medical School of Brown University, Division of Hematology and Oncology, The Miriam Hospital, 164 Summit Avenue, Providence, Rhode Island 02906, USA. Telephone: 401-793-7151; Fax: 401-793-7132; e-mail: jcastillo@ 123456lifespan.org

          Disclosures: Marc Vincent: Otsuka (E); Eric Justice: BioScience (E). The other author indicated no financial relationships.

          Article
          PMC3380874 PMC3380874 3380874 3779711
          10.1634/theoncologist.2011-0400
          3380874
          22618570
          7b3469cb-c6ae-4bb8-9727-2e415b3e6d28
          ©AlphaMed Press
          History
          : 15 November 2011
          : 18 April 2012
          Categories
          Academia-Pharma Intersect
          Symptom Management and Supportive Care

          Arginine vasopressin,Cancer,Hyponatremia,Syndrome of inappropriate antidiuretic hormone,Tolvaptan

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