Practical issues for the management of hyponatremia in oncology
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CLINICAL MANAGEMENT OF ENDOCRINE DISEASES
Practical issues for the management of hyponatremia in oncology Rossana Berardi1 Andrea Antonuzzo2 Livio Blasi3 Roberta Buosi4 Vito Lorusso5 Maria Rita Migliorino6 Vincenzo Montesarchio7 Nicoletta Zilembo8 Roberto Sabbatini9 Alessandro Peri10 ●
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Received: 9 October 2017 / Accepted: 23 January 2018 © Springer Science+Business Media, LLC, part of Springer Nature 2018
Abstract Hyponatremia is common in cancer patients and has a negative impact on outcomes and survival. Both the diagnosis and treatment of hyponatremia are challenging. Easy-to-use, practical guidelines are needed. The aim of this article is to discuss practical issues related to the diagnostic workup and management of hyponatremia, with particular attention to complex patients, such as those affected by neoplastic diseases. Admittedly, these patients may present several comorbidities, which may cause sodium alterations. In addition, multidrug therapy may precipitate serum sodium fall. An algorithm for the diagnosis and treatment of hyponatremia was also developed, based on the discussion of the results of a questionnaire completed by the authors and of the published recommendations/guidelines on hyponatremia. The goal was to produce an algorithm that was as simple as possible but still comprehensive, without compromising information completeness. Many explanatory notes were added with the aim of guiding clinicians throughout the management of complex patients with hyponatremia, such as those with cancer. The resulting algorithm and supporting literature are presented. Keywords Antidiuretic hormone Arginine vasopressin Hyponatremia SIADH Tolvaptan Water excretion ●
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Introduction Hyponatremia is common in cancer patients. Hyponatremia occurs most often in patients with small cell lung cancer (SCLC), with a prevalence of 15–44%, depending on the definition of hyponatremia [1]. Association with other types
Electronic supplementary material The online version of this article (https://doi.org/10.1007/s12020-018-1547-y) contains supplementary material, which is available to authorized users. * Alessandro Peri alessandro.peri@unifi.it 1
Università Politecnica delle Marche, Azienda OspedalieroUniversitaria, Ospedali Riuniti Umberto I-GM Lancisi-G Salesi, via Conca 71, Ancona 60126, Italy
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Unit of Medical Oncology 1, Azienda Ospedaliero-Universitaria Pisana, Istituto Toscano Tumori Pisa, Via Roma 67, Pisa, PI 56126, Italy
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Medical Oncology Unit, A.R.N.A.S. Civico, Palermo, Italy
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Department of Medical Oncology, Ospedale Santo Spirito, Via Giovanni Giolitti 2, Casale Monferrato, AL 15033, Italy
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Department of Medical Oncology, National Cancer Research Centre “Giovanni Paolo II”, Via Samuel F. Hahnemann 10, Bari 70126, Italy
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of cancer, including head and neck carcinoma, hematological malignancies, brain, gastrointestinal, and breast cancers, and metastatic renal cell carcinoma (mRCC), has also been reported [2, 3]. The syndrome of inappropriate antidiuretic
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