Yeoh Kheng-Wei, Camilleri Philip, Patel Kinnari
Oxford Radcliffe Hospital, Oncology, Churchill Site, Old Road, Oxford OX3 7LJ, UK.
BMJ Case Rep. 2010;2010. doi: 10.1136/bcr.05.2009.1920. Epub 2010 Jan 13.
We present a case report of chemotherapy induced renal salt wasting syndrome (RSWS) that was initially diagnosed and managed as syndrome of inappropriate secretion of antidiuretic hormone (SIADH), based on osmolality values as well as hydration status. The patient was receiving chemotherapy for metastatic testicular cancer. Progressive deterioration of electrolyte balance prompted the diagnosis of RSWS. This was confirmed by a high urinary sodium concentration, a simple but important investigation which is rarely requested in the initial investigation of hyponatraemia. Urine sodium concentration is high in RSWS but normal in SIADH. With chemotherapy playing such an important role in cancer management, the correct diagnosis of hyponatraemia in an oncology patient is vital in order to allow appropriate management. Although the distinctions between SIADH and RSWS can be very subtle, the management of these two distinct clinical situations is very different-namely, fluid restriction versus salt replacement.
我们报告一例化疗诱发的肾性失盐综合征（RSWS）病例，该病例最初基于渗透压值及水合状态被诊断为抗利尿激素分泌不当综合征（SIADH）并进行相应处理。该患者正在接受转移性睾丸癌的化疗。电解质平衡的逐渐恶化促使RSWS的诊断。高尿钠浓度证实了这一诊断，这是一项简单但重要的检查，在低钠血症的初始检查中很少被要求进行。RSWS时尿钠浓度高，而SIADH时尿钠浓度正常。鉴于化疗在癌症治疗中发挥着如此重要的作用，肿瘤患者低钠血症的正确诊断对于进行适当处理至关重要。尽管SIADH和RSWS之间的区别可能非常细微，但这两种不同临床情况的处理却大不相同——即限液与补盐。
