Electrolyte Blood Press.  2007 Jun;5(1):50-54. 10.5049/EBP.2007.5.1.50.

Water Intoxication Following Low-Dose Intravenous Cyclophosphamide

• Koo TY
• Bae SC
• Park JS
• Lee CH
• Park MH
• Kang CM
• Kim GH

• KMID: 2134806
• DOI: http://doi.org/10.5049/EBP.2007.5.1.50

Abstract

Cyclophosphamide is frequently used for the treatment of severe lupus nephritis, but is very rarely associated with dilutional hyponatremia. Recently we experienced a case of water intoxication following low-dose intravenous cyclophosphamide. Five hours after one dose of intravenous pulse cyclophosphamide 750 mg, the patient developed nausea, vomiting, and general weakness. Serum sodium concentration revealed 114 mEq/L and her hyponatremia was initially treated with hypertonic saline infusion. Then her serum sodium concentration rapidly recovered to normal with water restriction alone. During the course of intravenous pulse cyclophosphamide therapy, one must be aware of the possibility of significant water retention.

MeSH Terms

Cyclophosphamide*
Humans
Hyponatremia
Lupus Nephritis
Nausea
Sodium
Vomiting
Water Intoxication*
Cyclophosphamide
Sodium
Water Intoxication*

Figure

• 

  Fig. 1 Lighg microscopy finding of the renal biopsy, compatible with lupus nephritis class III(A). Note moderately segmental endocapillary cell proliferation and infiltration of neutrophils and lymphocytes with some karyorrhetic bodies. The glomerular capillary walls are segmentally thickened and narrowed by large subendothelial fuchsinophilic deposits to form 'wire loop' lesion and hyaline thrombi in some lumina. There are moderate tubular atrophy, focal interstitial fibrosis and scattered lymphocytes.

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  Fig. 2 Immumofluorescence microscopy finding. Segementally positive stainings for IgG and C3 are conspicuous, and staining for IgA in the mesangium and along the glomerular capillary wall is weak, compatible with lupus nephritis class III.

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  Fig. 3 Electron microscopy findings. Left : Endocapillary proliferation with double contour of glomerular basement membrane is shown along with mesangial electron dense deposits, Right: There are small subendothelial (arrow), and scattered subepithelial deposits. Below: Note large electron dense deposits in Intertubular capillary basement membranes.

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  Fig. 4 Time course of serum sodium concentration following intravenous cyclophosphamide. A) Intravenous pulse cyclophosphamide, B) The first episode of hyponatremia, C) The second episode of hyponatremia.

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