Cisplatin-Induced Renal Salt Wasting Syndrome in a Patient with Small Cell Lung Cancer

鉑金類為主之化學治療計畫已成為肺癌標準治療。其中Cisplatin（順鉑）為目前全球最常使用之鉑金類藥物。腎性耗鹽症候群為極罕見Cisplatin 引起之不良反應，會造成血清鈉離子濃度快速下降，引起神經學症狀。個案為58 歲患有肺小細胞癌婦女接受cisplatin 及etoposide 治療。個案接受化學治療後有無力，食欲不振，頭暈及低血鈉的情形（121 降至107 mmol/L）。低血鈉及相關症狀在鈉離子溶液補充後快速恢復。個案之後接受化學治療時仍有類似情形。且除了低血鈉外也發現血漿滲透壓下降；而尿鈉濃度、尿滲透壓、及尿鈉排出率均有上升。臨床懷疑為cisplatin 所引起。之後於第四、五次化學治療僅使用etoposide後無低血鈉的情形產生。基於臨床證據我們認為是cisplatin 造成罕見的腎性耗鹽症候群。在此分享此個案並進行文獻資料回顧。

關鍵字

順鉑；低血鈉；腎性耗鹽症候群

並列摘要

Platinum-based chemotherapy has been the standard regimen for lung cancer treatment, and cisplatin is the most common platinum compound worldwide. However, its most adverse effect has been nephrotoxicity. Cisplatin-induced renal salt wasting syndrome is a rare type of nephrotoxicity and may result in a rapid decline in serum sodium in only a few days, with or without neurological symptoms and signs. We present the case of a 58-year-old female who was admitted for standard chemotherapy with a cisplatin plus etoposide regimen for her newly diagnosed small cell lung cancer. Prominent weakness, poor appetite and dizziness developed, and an unexpected low serum sodium level (from an initial serum level of 121 mmol/L to 107 mmol/L) was noted on day 3. Her serum sodium level returned to a normal range after saline fluid was administered, and her symptoms recovered shortly afterwards. However, similar episodes developed following the 2nd and 3rd chemotherapy treatments with concurrent cisplatin and etoposide. At that time, we noticed not only a rapid decline of serum sodium but also decreased serum osmolality, increased urine sodium, urine osmolality, and an elevated fractional excretion of sodium (FENa). The clinical course and laboratory data indicated that cisplatin may induce renal salt wasting syndrome. We then replaced the concurrent etoposide and cisplatin regimen with etoposide alone in the 4^(th) and 5^(th) chemotherapy sessions, and no further serum sodium level decrease was noted. We share this report of a rare case and our literature review.

並列關鍵字

cisplatin ； hyponatremia ； renal salt wasting syndrome

國際替代計量

Cisplatin-Induced Renal Salt Wasting Syndrome in a Patient with Small Cell Lung Cancer

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