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SCLC: Case Notes - Low Na Issues


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One of the most common symptoms of small cell lung cancer is low Na levels (hyponatremia). SCLC can cause the pituitary gland to secrete an anti-diuretic hormone (ADH) which increases fluid retention. This is called syndrome of ADH (SIADH). This is also a side effect of chemotherapy which is a "double-whammy" with SCLC.

SIADH was the case with my wife. She was very confused and stumbling around on Friday morning, January 24, 2020. Her Na level was critically low at 113 when she got to the hospital. It dropped to 111 before the got it to begin going back up. We knew something was up when all the testing began. A pulmonologist gave us the bad news on Sunday (probable SCLC). Treatment for critically low Na is very very slowly injecting a saline solution. Severe complications such as brain damage can occur if Na levels are brought back too quickly. My wife was in the hospital 11 days while her Na was brought under control and receiving her 1st cycle of chemo. She was given the drug Samsca (Tolvaptan) the last few days of her hospital stay. It was prescribed 3 times per week for 4 weeks after discharge. Ideally, the Samsca would bring the SIADH under control such that treatment could be limited to IVs as needed. Her Na was generally brought under control until after her 3rd cycle of chemo. Low Na was an "on again, off again" issues for a couple of months after the 3rd cycle of chemo. Beginning in June low Na seriously cropped up again. Samsca was again talked about but ultimately, salt pills seem to do the trick. My wife is taking a whopping 6 1000mg salt pills each day.

1/24/20 - hospital Na @ 113 (critical) dropping to 111 (critical)

1/29/20 - SCLC dx Na up to 127 (low)

1/31/20 - 1st cycle of chemo begins Na up to 131 (abnormal)

2/4/20 - discharged from hospital Na up to 133 (abnormal), Samsca prescribed

2/25/20 - 2nd cycle of chemo Na @ 138 (normal)

3/3 - 3/23/20 - Na average 129 (abnormal) , decision to watch it

3/17/20 - 3rd cycle of chemo Na @ 135 (abnormal)

3/19 - 3/23/20 - hospitalized (high BP, arrythmia) Na average 129 (abnormal)

3/25 - 4/7/20 - Na average 126 (low) , decision to watch it

4/14/20 - 4th cycle of chemo (complete) Na @ 132 (abnormal)

4/14 - 4/30/20 - Na average 134 (abnormal), decision to watch it

4/27 - 5/1/20 - hospitalized (pneumonia) Na average @ 134 (abnormal)

5/15 - 5/21/20 - hospitalized (high BP, arrythmia) Na average 129 (abnormal)

5/26/20 - Na @ 126 (low), decision to watch it

6/5/20 - Na @ 117 (critical) , salt pills prescribed (2 per day)

6/8 - 6/23/20 - Na average 124 (low) increase salt pills (3 per day)

7/4 - 7/9/20 - hospitalized (dangerous low Na) Na @ 109 dropping to 106 (dangerous) , Samsca prescribed but nurse failed to call in. 6 salt pills per day prescribed until Samsca arrives.

7/16 - 7/18/20 - hospitalized (pneumonia) Na @ 133 (abnormal), since Samsca screw up decided to stay on salt pills (6 per day)

7/23 - 8/4/20 - Na average 134 (abnormal) , salt pills appear to work, will continue to watch


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Thank you for your very complete explanations of SCLC treatment and side effects made on this forum. Your devotion to your wife is obvious as is your concern for those who suffer a future SCLC diagnosis.

Thankfully, few of us suffer from this devastating form of lung cancer. Indeed our presence on the SCLC thread was barely there before you and a stalwart few others joined us recently. I do hope your wife's treatments arrest her lung cancer and her side effects wane.

Stay the course.


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thx Tom ... My hope is that others that follow may get something out of these actual notes from my wife's treatment.

I certainly want to caution others that they may have different symptoms and should only view these as potential things that could happen.


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I am glad to hear she is stable for the most part.  I don't recall my husband have low Na and his Magnesium was always within range.

I stop in every now and again to check on you guys.

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