Page 69 - Read Online
P. 69

Page 4 of 8                          Marquina et al. J Cancer Metastasis Treat 2020;6:6  I  http://dx.doi.org/10.20517/2394-4722.2019.39

                                              Table 4. Hyponatremia clinical approach
                          Hyponatremia approach
                          Timing of the onset of   Acute: onset less than 48 h earlier
                          hyponatremia     Chronic: onset more than 48 h earlier
                                           *Hyponatremia should be considered chronic when timing of onset is unknown
                          Neurological symptoms Mild         Impaired capacity for concentration
                                                             Cognitive deficit
                                                             Gait disturbances and falls
                                                             Memory loss
                                                             Anorexia
                                           Moderate          Cramps
                                                             Drowsiness
                                                             Headache
                                                             Nausea
                                                             Vomiting
                                                             Asthenia
                                                             Impaired gait and falls
                                                             Confusion
                                           Severe            Lethargy
                                                             Stupor
                                                             Seizures
                                                             Coma
                                                             Respiratory distress
                                                             Sudden death
                          Type of hyponatremia:   Hypovolemic
                          volemic classification  Euvolemic
                                           Hypervolemic
                                         *Onset unknown, - in this case it must be considered as chronic


               deficit is often overlooked, and all patients who are not receiving pharmacological steroid doses should
               have cortisolemia determined.


               TREATMENT OF HYPONATREMIA IN CANCER PATIENTS
               Hyponatremia should be treated to both correct clinical symptoms and permit adequate oncological
               and nutritional therapy. Furthermore, correction of hyponatremia could potentially influence the cancer
               patient’s quality of life.

               A patient who is a candidate for chemotherapy
               Severe hyponatremia (Na < 120 mmol/L)
               The management of cancer patients is exactly the same as is the case for a non-oncological patient.
               Hypertonic saline solution (3% sodium chloride) should be administered in i.v. infusion or in bolus
               therapy, regardless of the type or etiology of hyponatremia. The rate of correction will vary if hyponatremia
               is chronic or acute. In acute hyponatremia (< 48 h), there are no established limits for correction of
               hyponatremia. In chronic hyponatremia (> 48 h) or when the timing of the onset of hyponatremia is
               unknown, the goal of correction in the first 24 h should be a SNa rise of 4-6 mmol/L, reached during the
               first 6 h of treatment, to reduce cerebral edema [Figure 1].

               Additional treatments for hyponatremia must be avoided during the first 24 h of correction, except for
               associated furosemide in patients with heart failure or the addition of potassium chloride in patients with
                                          [22]
               initial hypokalemia [2,14]  [Table 5] .
               Hypercorrection of SNa should be avoided in patients with chronic hyponatremia (> 48 h from onset) or
               when the timing of the onset of hyponatremia is unknown. Patients presenting risk factors for the Osmotic
               Demyelination Syndrome (ODS) (hypokalemia, malnutrition, liver failure, and alcoholism) should not
               present 24-h SNa rises above 8 mmol/L during the first or second 24 h of therapy. Therefore, following
               Hypertonic saline therapy, SNa should be monitored every 6-8 h. If SNa re-descends, hypertonic saline can
   64   65   66   67   68   69   70   71   72   73   74