SHM Converge Scientific Abstract ePoster Gallery-Profound Hyponatremia and Dehydration: A Case of Cisplatin Induced Salt Losing Nephropathy

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This case describes a 63-year-old man with high-grade urothelial bladder carcinoma treated with radical cystoprostatectomy, neobladder diversion, and MVAC chemotherapy including cisplatin. Six months after completing chemotherapy, he developed recurrent episodes of profound hyponatremia, dehydration, prerenal azotemia, hyperchloremic metabolic acidosis, and hyperkalemia. His outpatient labs on the third admission showed sodium 124 mEq/L and creatinine 3.1 mg/dL, and he presented with weakness and dizziness.<br /><br />He had already been hospitalized twice for similar abnormalities, which improved temporarily with intravenous isotonic fluids, sodium bicarbonate, and a high-salt diet. However, despite compliance and adequate oral intake, he continued to have symptomatic volume depletion and hyponatremia. Because of the pattern of sodium loss with hypovolemia, cisplatin-induced renal salt wasting syndrome (RSWS) was suspected rather than SIADH.<br /><br />During the third admission, he was treated with fludrocortisone, oral salt tablets, sodium bicarbonate, and normal saline. Over five days, his renal function and electrolytes improved significantly, with sodium rising from 124 to 139 mEq/L and creatinine improving to 1.3 mg/dL by discharge. He was then maintained on these therapies along with advice for electrolyte-rich fluids, a high-protein/high-sodium diet, and weekly laboratory monitoring. Over nine months of follow-up, only mild lab fluctuations occurred and no further hospitalizations were needed.<br /><br />The report emphasizes that cisplatin can cause several renal complications, including RSWS, and that this condition is often mistaken for SIADH because the laboratory findings can overlap. Careful assessment of volume status is key to diagnosis. Treatment is primarily sodium and volume replacement, with fludrocortisone sometimes helpful.

Asset Subtitle

Tissa Bijoy George

Meta Tag

Author List Anjana Chandrasekhara Pillai, Kiran Kuriakose, Thomas R Powell, Tissa Bijoy George

Category Clinical Vignettes

Concept Cisplatin

Concept Renal Salt Wasting

Concept Hyponatremia

Concept Volume Depletion

Concept Sodium Repletion

Distinguished Non-Finalist

Presenter Organization Upmc

Presenting Author Tissa Bijoy George

Track Adult

Keywords

cisplatin

renal salt wasting syndrome

hyponatremia

urothelial bladder carcinoma

radical cystoprostatectomy

neobladder diversion

MVAC chemotherapy

fludrocortisone

prerenal azotemia

hyperchloremic metabolic acidosis

Cisplatin

Renal Salt Wasting

Hyponatremia

Volume Depletion

Sodium Repletion