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Hyponatraemia induced by low-dose intravenous pulse cyclophosphamide
Young-Chul Lee1, Joon-Sung Park, Chang Hwa Lee
1Correspondence and offprint requests to: Gheun-Ho Kim;
Summary
Low-dose intravenous cyclophosphamide can cause hyponatraemia, particularly when hypotonic fluids are used for hydration. Isotonic solutions are recommended to mitigate this risk during treatment.
Area of Science:
- Nephrology
- Oncology
- Rheumatology
Background:
- Cyclophosphamide, an alkylating agent, is used for various diseases.
- Traditionally, cyclophosphamide potentiates vasopressin's renal action.
- Few reports exist on cyclophosphamide-induced hyponatraemia despite its widespread use.
Purpose of the Study:
- To investigate the incidence of hyponatraemia after low-dose intravenous cyclophosphamide therapy.
- To identify factors associated with cyclophosphamide-induced hyponatraemia.
Main Methods:
- Retrospective analysis of 112 treatment episodes in 84 patients (lupus nephritis, non-Hodgkin's lymphoma).
- Intravenous pulse cyclophosphamide (500-750 mg/m2) with half-isotonic saline hydration.
- Hyponatraemia defined as serum sodium <135 mEq/L at 24 hours post-therapy.
Main Results:
- Serum sodium decreased significantly post-cyclophosphamide (P < 0.001).
- Hyponatraemia occurred in 13.4% of treatment episodes (14.3% of patients).
- Hyponatraemic patients were significantly older (P < 0.01); association with male sex on univariate analysis (P < 0.05).
Conclusions:
- Hyponatraemia post-low-dose intravenous cyclophosphamide is not rare.
- Hypotonic hydration protocols increase the risk of hyponatraemia.
- Avoid hypotonic fluids; use isotonic solutions for forced diuresis with cyclophosphamide.
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