A case of renal salt-wasting syndrome induced by cisplatin and 5-FU during treatment of esophageal squamous cell carcinoma

Dai Shimizu; Mitsuro Kanda; Masahiko Koike; Shinichi Umeda; Fuminori Sonohara; Hideki Takami; Yoshikuni Inokawa; Norifumi Hattori; Masamichi Hayashi; Chie Tanaka; Daisuke Kobayashi; Suguru Yamada; Goro Nakayama; Michitaka Fujiwara; Yasuhiro Kodera

doi:10.4993/acrt.27.64

Dai Shimizu, Mitsuro Kanda , Masahiko Koike, Shinichi Umeda, Fuminori Sonohara, Hideki Takami, Yoshikuni Inokawa, Norifumi Hattori, Masamichi Hayashi, Chie Tanaka, Daisuke Kobayashi, Suguru Yamada, Goro Nakayama, Michitaka Fujiwara, Yasuhiro Kodera

Author information

Dai Shimizu
Department of Gastroenterological Surgery (Surgery II), Nagoya University Graduate School of Medicine [Japan]
Mitsuro Kanda Corresponding author
Department of Gastroenterological Surgery (Surgery II), Nagoya University Graduate School of Medicine [Japan]
Masahiko Koike
Department of Gastroenterological Surgery (Surgery II), Nagoya University Graduate School of Medicine [Japan]
Shinichi Umeda
Department of Gastroenterological Surgery (Surgery II), Nagoya University Graduate School of Medicine [Japan]
Fuminori Sonohara
Department of Gastroenterological Surgery (Surgery II), Nagoya University Graduate School of Medicine [Japan]
Hideki Takami
Department of Gastroenterological Surgery (Surgery II), Nagoya University Graduate School of Medicine [Japan]
Yoshikuni Inokawa
Department of Gastroenterological Surgery (Surgery II), Nagoya University Graduate School of Medicine [Japan]
Norifumi Hattori
Department of Gastroenterological Surgery (Surgery II), Nagoya University Graduate School of Medicine [Japan]
Masamichi Hayashi
Department of Gastroenterological Surgery (Surgery II), Nagoya University Graduate School of Medicine [Japan]
Chie Tanaka
Department of Gastroenterological Surgery (Surgery II), Nagoya University Graduate School of Medicine [Japan]
Daisuke Kobayashi
Department of Gastroenterological Surgery (Surgery II), Nagoya University Graduate School of Medicine [Japan]
Suguru Yamada
Department of Gastroenterological Surgery (Surgery II), Nagoya University Graduate School of Medicine [Japan]
Goro Nakayama
Department of Gastroenterological Surgery (Surgery II), Nagoya University Graduate School of Medicine [Japan]
Michitaka Fujiwara
Department of Gastroenterological Surgery (Surgery II), Nagoya University Graduate School of Medicine [Japan]
Yasuhiro Kodera
Department of Gastroenterological Surgery (Surgery II), Nagoya University Graduate School of Medicine [Japan]

Keywords: renal salt-wasting syndrome, hyponatremia, cisplatin, esophageal squamous cell carcinoma

JOURNAL FREE ACCESS

2019 Volume 27 Issue 2 Pages 64-66

DOI https://doi.org/10.4993/acrt.27.64

Details

Abstract

The combination regimen of cisplatin (CDDP) and fluorouracil (5-FU) (FP) is a standard regimen for definitive chemoradiotherapy, neoadjuvant chemotherapy, and for treatment of unresectable or recurrent esophageal squamous cell carcinoma (ESCC). Here, we report a patient with FP-induced renal salt-wasting syndrome (RSWS) who presented with severe hyponatremia with disturbance of consciousness and was admitted to the intensive care unit (ICU). A 66-year-old man with recurrent ESCC was admitted and started on chemotherapy with FP. From day 3 of the first course of FP, he presented with anorexia and vomiting (grade 3). At day 6, he experienced disturbance of consciousness and blood test showed severe hyponatremia (sodium (Na): 119 mmol/L) accompanied with excessive urinary excretion of Na (181 mmol/L). He was diagnosed with RSWS because of CDDP and was transferred to the ICU. Through intensive monitoring and 3% NaCl infusion, serum Na level and symptoms recovered with no sequelae and he was discharged from the ICU after a 4-day stay.

RSWS is sometimes difficult to diagnose because of its low recognition and is misdiagnosed as the syndrome of inappropriate secretion of antidiuretic hormone. During chemotherapy with platinum-based agents, RSWS should be kept in mind as a disorder that causes hyponatremia.

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