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Acute hyponatraemia with generalised seizure: case report A 56-year-old woman developed acute hyponatraemia with a generalised seizure while receiving cyclophosphamide and enalapril for invasive ductal carcinoma of the right breast and hypertension, respectively [routes not stated]. The woman was scheduled to receive four cycles of adjuvant chemotherapy with cyclophosphamide 600 mg/m2 and doxorubicin (AC), and four cycles of paclitaxel thereafter with a 3-week interval. Her medical history was notable for hypertension and cerebral haemorrhage, for which she was treated with propranolol, nifedipine, aspirin, and enalapril 10mg [frequency and duration of treatment to reaction onset not stated]. During the first cycle of chemotherapy with cyclophosphamide 900mg and doxorubicin, she received antiemetic therapy and hydration with isotonic sodium chloride. Fifty hours after chemotherapy, she presented to an emergency department with generalised weakness, nausea, vomiting, and oedema. Just after arriving, she developed a generalised seizure with convulsions, following a period of incoherent speech and impaired consciousness; her Glasgow Coma Score was 3. Laboratory analysis was notable for a serum sodium level, serum osmolality, and urine osmolality of 116 mmol/L, 254 mOsmol/kg, and 189 mOsmol/kg, respectively. Hypertonic sodium chloride and furosemide were administered. Within 12 hours, the woman’s serum sodium level progressively increased to 126 mmol/L and her neurological condition recovered. Her serum sodium level was corrected to 136 mmol/L over the following 2 days, and she was discharged without symptoms after 10 days. She received the following adjuvant chemotherapy cycle with a 20% dose reduction. Despite developing water retention with a 2kg-weight gain, she was successfully treated with hypertonic sodium chloride and furosemide without any neurological symptoms. At last observation, further adjuvant AC chemotherapy was to be administered, as initially scheduled. Author comment: "We suspected intravenous low-dose cyclophosphamide-based chemotherapy as the cause of severe hyponatremia. . . The enalapril maleate that she took as an antihypertensive drug could also have caused hyponatremia." Hwang S-B, et al. Life-threatening acute hyponatremia with generalized seizure induced by low-dose cyclophosphamide in a patient with breast cancer. Journal of Breast Cancer 14: 345-348, No. 4, Dec 2011. Available from: URL: http:// 803068857 dx.doi.org/10.4048/jbc.2011.14.4.345 - South Korea

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Reactions 7 Apr 2012 No. 1396