Page 70 - Read Online
P. 70

Marquina et al. J Cancer Metastasis Treat 2020;6:6  I  http://dx.doi.org/10.20517/2394-4722.2019.39                         Page 5 of 8

               Table 5. The 24- and 48-h goals for correction of chronic hyponatremia (adapted from [22] )
                          Minimum 24 h SNa                Maximum 24 h SNa                 Maximum 48 h SNa
                ODS risk                  24 h Goal (mmol/L)              48 h Goal (mmol/L)
                            rise (mmol/L)                   rise (mmol/L)                    rise (mmol/L)
                Low           4-8             6-8             10-12            6-8             18
                High          4-6             6               8                4-6             8/day
               ODS: osmotic demyelination syndrome; SNa: serum sodium



































               Figure 1. When the patient is a candidate for chemotherapy (modified from Escobar et al. [29] )


               be administered anew. If SNa levels have reached the desired goal hours before 24 h have elapsed since the
               start of treatment, desmopressin (DDAVP) can be associated at doses of 1-2 μg every 6-8 h until the 24 h
               have elapsed, to prevent SNa levels from continuing to increase. Diuresis should be monitored and DDAVP
               administered in the case of polyuria.

               A marked exception to the use of hypertonic saline is the suspicion of an adrenal crisis. In this case,
               established protocols for treatment should be applied, with i.v. hypertonic saline only used if the patient’s
               SNa fails to rise adequately [2,19] .

               Mild/moderate hypovolemic hyponatremia
               Management will depend on the cause of hyponatremia. Diarrhea and vomiting are frequent side effects
               of chemotherapy. Antiemetics and adequate hydration and salt intake can be enough to correct non-severe
               hypovolemic hyponatremia, although i.v. isotonic saline can be required.


               If it is mild hyponatremia, the patient can proceed with chemotherapy and control serum sodium levels in
               outpatient clinic.

               Mild/moderate hypervolemic or euvolemic hyponatremia
               In patients with a diagnosis of SIADH, fluid restriction can be attempted if patients are not candidates
               for surgery, hyperhydration, or nutritional supplements or support. Furthermore, patients at nutritional
               risk could limit protein intake when reducing fluids, as the latter are usually needed to eat solids. Fluid
   65   66   67   68   69   70   71   72   73   74   75