Open AccessSymptomatic hyponatremia induced by low-dose cyclophosphamide in patient with systemic lupus erythematosus
Author(s) -
Jiali Chen,
Yuebo Jin,
Chun Li,
Zhanguo Li
Publication year - 2020
Publication title -
medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.59
H-Index - 148
eISSN - 1536-5964
pISSN - 0025-7974
DOI - 10.1097/md.0000000000022498
Subject(s) - medicine , hyponatremia , cyclophosphamide , syndrome of inappropriate antidiuretic hormone secretion , headaches , adverse effect , gastroenterology , urine osmolality , complication , antidiuretic , anesthesia , chemotherapy , hormone , surgery , vasopressin
Rationale: Cyclophosphamide (CY) is an alkylating agent used widely to treat cancer and autoimmune diseases. Hyponatremia is a common adverse effect of high-dose and moderate-dose of intravenous CY, but is rare in patients treated with low-dose (<15 mg/kg). Patient concerns: A 52-year-old woman with new-onset systemic lupus erythematosus (SLE) was treated with low-dose cyclophosphamide (8 mg/kg, CY), but showed sudden headaches, disorientation and weakness. Laboratory examinations revealed severe isovolumic hyponatremia along with low-serum osmolality and high urine osmolality. Diagnosis: The acute hyponatremia was consistent with the syndrome of inappropriate antidiuretic hormone secretion (SIADH) and was an adverse event of low-dose CY, with no evidence of endocrine, cancer, pulmonary, or cerebral abnormalities relevant to the SIADH. Intervention: The hyponatremia was resolved after the supplementation of NaCl solution. Outcomes: The hyponatremia was resolved without any complications. Lessons: Hyponatremia induced by low-dose CY should be recognized as an underlying life-threatening complication in clinical practice.