Hyponatremia Differential Diagnosis Algorithm in Cancer
UOsm ≥ 100 mOsm/kg = Urine is inappropriately concentrated for hypotonic plasma = Vasopressin-dependent
- UNa < 20 mEq/l = ↓EABV = Vasopressin secretion is physiologically appropriate
• Hypovolemia (chemotherapy-induced Gl losses, CAR-T- and IL-2- induced capillary leak syndrome, cisplatin-induced RSW)
• Heart failure (anthracyclines, targeted therapies, amyloidosis)
• Liver disease (metastases, chemotherapy, VOD following HSCT)
- UNa > 30 mEq/l = ↑ or N EABV = Vasopressin secretion is physiologically inappropriate
• SIAD (SCLC, head and neck tumors, brain or lung metastases, chemotherapy, nausea, pain)
• Cortisol deficiency (CTLA4 inhibitors- induced hypophysitis, or adrenalitis; PD-1 inhibitors- induced adrenalitis, hypophysitis, or isolated ACTH deficiency; adrenal metastases)
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