A rapid and efficient way to manage hyponatremia in patients with SIADH and small cell lung cancer: treatment with tolvaptan

BMC Pulmonary Medicine

Christian Grohé¹  Heike Lüders¹  Ishak Teber¹  Okan Zaba¹  Claudia Petereit¹ 

[1] ELK Department of Respiratory Diseases, Lindenberger Weg 27, 13125, Berlin, Germany

关键词: Syndrome of inappropriate antidiuretic hormone hypersecretion (SIADH);    Hyponatremia;    Small cell lung cancer (SCLC);   

Others  :  1109696
DOI  :  10.1186/1471-2466-13-55

 received in 2013-01-30, accepted in 2013-07-15,  发布年份 2013

【 摘 要 】

Background

Hyponatremia based on syndrome of inappropriate antidiuretic hormone hypersecretion (SIADH) is observed in up to 15% of patients with small cell lung cancer (SCLC). The electrolyte imbalance is associated with a high morbidity and mortality and often delays appropriate treatment. Management of hyponatremia proved to be challenging until new vasopressin-2 receptor antagonists such as tolvaptan became available. This is the first report which presents a prospective case series with an efficient management of hyponatremia including tolvaptan in ten patients with SCLC and severe SIADH (plasma sodium < 125 mmol/l).

Methods

Ten patients with SCLC and severe SIADH were followed after the onset of clinical symptoms of SIADH. Patients were chosen on the basis of histological proven diagnosis of SCLC and the clinical picture of a neurocognitive deficit caused by SIADH-related hyponatremia. All patient data were monitored for clinical improvement based on ECOG status, commencement of chemotherapy and correction of sodium levels.

Results

The treatment followed a diagnostic and treatment algorithm and lead to a rapid and efficient correction of both clinical symptoms and plasma sodium level.

Conclusions

Based on this algorithm all patients started chemotherapy in time. Subsequently, the treatment with tolvaptan lead to an improvement of the ECOG-performance status. In addition, all patients benefit from the effective management of SIADH which omitted prolonged hospital stays and non-elective hospitalizations due to an unstable clinical condition due to severe hyponatremia. These observations add new insight to management of SIADH in thoracic oncology and are of interest for specialists in oncology, endocrinology and pulmonary medicine.

【 授权许可】

   
2013 Petereit et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

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