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Khan et al. J Cancer Metastasis Treat 2019;5:71 Journal of Cancer
DOI: 10.20517/2394-4722.2019.017 Metastasis and Treatment

Review Open Access

Recent advances in the management of
hyponatremia in cancer patients

Maryam I. Khan , Steven G. Waguespack , Intekhab Ahmed 3
2
1
1 Division of Endocrinology, Diabetes and Metabolism, Jefferson Health, Voorhees, NJ 08043, USA.
2 Department of Endocrine Neoplasia and Hormonal disorders, University of Texas M.D. Anderson Cancer Center, Houston, TX
77030, USA.
3 Division of Endocrinology, Diabetes and Metabolism, Jefferson Health, Philadelphia, PA 19107, USA.

Correspondence to: Dr. Maryam I. Khan, Division of Endocrinology, Diabetes and Metabolism, Jefferson Health, 333 Laurel Oak,
Road Voorhees, NJ 08043, USA. E-mail: maryamijazkhan@gmail.com

How to cite this article: Khan MI, Waguespack SG, Ahmed I. Recent advances in the management of hyponatremia in cancer
patients. J Cancer Metastasis Treat 2019;5:71. http://dx.doi.org/10.20517/2394-4722.2019.017

Received: 1 Jul 2019 First Decision: 20 Aug 2019 Revised: 16 Oct 2019 Accepted: 16 Oct 2019 Published: 30 Oct 2019

Science Editor: Rossana Berardi Copy Editor: Jing-Wen Zhang Production Editor: Tian Zhang

Abstract
Hyponatremia is the most frequently encountered electrolyte disorder in cancer patients and is usually
multifactorial in its origin. In this review, we discuss the predisposing factors, pathophysiology, clinical
symptomatology, and currently available diagnostic and therapeutic options for the management of hyponatremia.
In addition to paraneoplastic syndromes, concurrent chemotherapy and comorbidities predispose oncology
patients to the risk of hyponatremia. Initial symptoms and signs can be subtle and the prompt evaluation and
initiation of treatment is of paramount importance to prevent neurocognitive and other complications. The
syndrome of inappropriate antidiuresis (SIAD) is the most common cause of hyponatremia, and the use of serum
and urine parameters that distinguish SIAD from other etiologies is discussed. Individualized treatment is preferred
depending on the underlying cause and severity of hyponatremia. The treatment of hyponatremia is reviewed and
the importance of avoiding rapid overcorrection of the sodium level to reduce the risk of osmotic demyelination
syndrome is emphasized. Vasopressin receptor antagonists (vaptans) offer a direct approach to the management
of euvolemic and hypervolemic hyponatremia, but the indications for their use and long-term safety need to be
clarified. The treatment of hyponatremia is likely to reduce complications and improve survival in cancer patients.

Keywords: Hyponatremia, electrolyte abnormalities, dysnatremias, cancer

© The Author(s) 2019. Open Access This article is licensed under a Creative Commons Attribution 4.0
International License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use,
sharing, adaptation, distribution and reproduction in any medium or format, for any purpose, even commercially, as long
as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license,
and indicate if changes were made.

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