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Lung Cancer Patient With Euvolemic Hyponatremia

Diagnosis

Severe, chronic euvolemic hyponatremia secondary to SIADH related to small cell lung carcinoma.

Why Vaprisol was chosen for treatment

  • Vaprisol was selected based on its ability to raise serum sodium in patients with euvolemic hyponatremia
  • Treatment of hyponatremia facilitated the timely initiation of palliative chemotherapy and radiotherapy. Caution was exercised to avoid rapid correction of serum sodium greater than 12 mEq/L in 24 hours
  • Vaprisol treatment via peripheral IV was administered on the oncology floor, and the infusion site was rotated every 24 hours

Initial Presentation

A 69-year-old white male with SIADH related to small cell lung carcinoma was referred to the nephrology service for evaluation of hyponatremia. Serum sodium on hospital admission was 120 mEq/L.*

Medical History

  • Hypertension
  • Myocardial infarction
  • Hyperlipidemia
  • Left carotid endarterectomy
  • TURP
  • Bladder cancer

Medications

  • Enalapril
  • Pravastatin
  • Verapamil
  • Warfarin

Exam Findings

Vital Signs Height: 5' 10", weight: 207 lb, temperature: 98.5° F, BP: 157/92 mm Hg, HR: 78 bpm
Lungs Expiratory rhonchi and decreased breath sounds at both bases, R > L
Other Chronic venous stasis changes in lower extremities, no focal neurologic deficits, no edema; oxygen saturation 93% on 2 L oxygen per nasal cannula

Patient's progression from day 1 through day 4

  VITAL SIGNS LAB VALUES  
  BP
(mm Hg)
HR
(bpm)
BUN/Cr
(mg/dL)
Serum
(K+)
(mEq/L)
Serum
Osm
(osm/kg)
Urine
Osm
(osm/kg)
Serum
(Na+)
(mEq/L)
NOTES
Day 1 170/85 69 19/0.9 4.7 258 696 120 A loading dose of Vaprisol 20-mg IV administered over 30 minutes, followed by a 20-mg continuous IV infusion administered over 24 hours
Day 2 148/75 63 19/1.1 5.2 262 600 124 A 20-mg continuous IV infusion of Vaprisol administered over 24 hours. Improvement in volume overload
Day 3 139/71 70 20/1.0 4.0 265 540 131 A 20-mg continuous IV infusion of Vaprisol administered over 24 hours
Day 4 120/70 66 17/1.0 4.2 268 486 135 A 20-mg continuous IV infusion of Vaprisol administered over 24 hours

*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.