Small Cell Lung Cancer Patient with Profound Hyponatremia and Acute Neurological Symptoms: An Effective Treatment with Fludrocortisone

Figure 1

Changes in serum sodium levels during the treatment of hyponatremia in a patient with extensive stage SCLC. The figure illustrates changes in serum sodium levels in relation to the received treatment (hypertonic saline or fludrocortisone). The blue arrows indicate the onset of neurological symptoms. The first and relatively severe neurological symptoms (disorientation, mental confusedness) appeared 2 days after the completion of the first cycle of second-line chemotherapy with topotecan. Secondary, a slighter and less durable disorientation appeared during the treatment with hypertonic saline. Hypertonic saline treatment was given on days 1–9 after the onset of severe hyponatremia and fludrocortisone starting from day 12. In between (on days 10 and 11), patient received no treatment since the acquisition of the fludrocortisone from hospital pharmacy took 2 days. Quick increase of the serum sodium level into the steady normal range was achieved only with fludrocortisone 0.1 mg b.i.d.