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Liver Cancer Patient With Hypervolemic Hyponatremia

Diagnosis

Hypervolemic hyponatremia in a patient with hepatocellular carcinoma

Why Vaprisol was chosen for treatment

MRI of the chest and abdomen showed new metastases in the liver, pleura, pericardium, and spine. The patient's hyponatremia worsened during the hospital stay, accompanied by signs of mental confusion. Treatment with Vaprisol was initiated to raise serum sodium in hypervolemic hyponatremia.

Initial Presentation

The patient is a 69-year-old white female admitted to the hospital for evaluation of dyspnea and right-sided pleural effusion. At admission, the patient was mildly hyponatremic, with a serum sodium of 130 mEq/L and a serum creatinine of 0.9 mg/dL.*

Medical History

  • Hepatocellular carcinoma unrelated to cirrhosis
  • Diabetes
  • Hyperlipidemia
  • Heart failure
  • TIA

Medications

  • Aspirin
  • Clopidogrel
  • Atorvastatin
  • Insulin
  • Telmisartan
  • Carvedilol

Exam Findings

Vital Signs BP: 119/69 mm Hg, HR: 82 bpm, temperature: 99° F, RR: 18
Mental Status Oriented to person, place, and time
Lungs Diminished sounds on the right side
EKG NSR with left-axis deviation and borderline low voltage
X-ray Prominent hilar lymph nodes, small pleural effusion noted on the right side
Other 1+ pedal edema, evidence of jugular venous distension
Labs Albumin, INR, and bilirubin all within normal limits

Patient's progression from admission through follow-up at day 5

  VITAL SIGNS LAB VALUES  
  BP
(mm Hg)
HR
(bpm)
Weight
(lb)
Urine
Output
(cc)
Urine
Osmolality
(mOsm/kg-H20)
Urine
Na+
(mEq/L)
Serum
Na+
(mEq/L)
NOTES
Upon
Admission
119/69 82 165 625 55 130 Patient started on fluid restriction 1 L/day
Day 1 120/50 80 1100 122 A loading dose of Vaprisol 20-mg IV was administered over 30 minutes followed by a 20-mg continuous infusion administered over 24 hours
Day 2 110/70 76 163 2500 153 5 128 Vaprisol 20-mg IV continuous infusion administered over 24 hours
Day 3 136/68 74 162 1700 103 7 134 Vaprisol 20-mg IV continuous infusion administered over 24 hours
Day 4 110/68 74 1100 136 Vaprisol discontinued
Day 5 108/70 72 1200 138 Work-up of pleural effusion commences

*In clinical studies of Vaprisol, the adverse event profile in elderly patients was similar to that seen in the general population.1



REFERENCE: 1. Vaprisol Prescribing Information. Cumberland Pharmaceuticals Inc.