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Inappropiate ADH secretion associated with massive vincristine overdosage
Australian and New Zealand Journal of Medicine
|June 1, 1975
Summary
A patient with acute lymphocytic leukemia experienced vincristine overdosage, leading to pancytopenia, neurotoxicity, and seizures. This rare adverse event was linked to inappropriate antidiuretic hormone secretion, managed with fluid restriction.
Area of Science:
- Oncology
- Pharmacology
- Neurology
Background:
- Acute lymphocytic leukemia (ALL) management often involves chemotherapy.
- Vincristine is a standard chemotherapeutic agent used in ALL treatment protocols.
- Prophylactic administration aims to maintain remission but carries risks.
Observation:
- A patient with ALL received a tenfold overdose of vincristine (15 mg instead of 1.5 mg).
- The overdose led to pancytopenia, neurotoxicity, and a grand mal seizure.
- A delayed onset of hyponatremia was observed post-overdose.
Findings:
- The patient's symptoms, including seizure and hyponatremia, were attributed to vincristine toxicity.
- Hyponatremia was presumed to result from the inappropriate secretion of antidiuretic hormone (ADH).
- This endocrine-metabolic complication responded well to fluid restriction and anti-epileptic treatment.
Implications:
- Highlights the critical importance of accurate vincristine dosing in leukemia therapy.
- Underscores vincristine's potential for severe toxicity, including neurotoxicity and endocrine dysfunction.
- Suggests careful monitoring for hyponatremia and neurological symptoms following accidental vincristine overdose.