Symptomatic hyponatremia induced by low-dose cyclophosphamide in patient with systemic lupus erythematosus

Chen, Jiali; Jin, Yuebo; Li, Chun; Li, Zhanguo

doi:10.1097/md.0000000000022498

Cited by 12 publications

(6 citation statements)

References 28 publications

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“…Bruining et al summarized 12 cases of low-dose cyclophosphamide-induced hyponatremia, with most doses between 10 and 20 mg/kg but one as low as 50 mg and resultant serum sodium levels ranging from 106 to 116 [ 8 ]. More recently, Chen et al reported a case of symptomatic hyponatremia in a patient treated for SLE with low-dose cyclophosphamide of 8 mg/kg and reviewed multiple cases of low-dose cyclophosphamide-induced hyponatremia [ 4 ]. Interestingly, the authors note that only five cases were associated with rheumatic diseases, most often SLE.…”

Section: Discussionmentioning

confidence: 99%

“…Adverse effects include bone marrow suppression, amenorrhea, teratogenicity, bladder cancer, hemorrhagic cystitis, and hyponatremia [ 2 ]. Hyponatremia, more commonly induced by high-dose cyclophosphamide, can also occur with lower-dose regimens [ 4 ]. Additional uncommon adverse effects that require monitoring are hepatoxicity and cardiotoxicity [ 2 ].…”

Section: Introductionmentioning

confidence: 99%

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Low-Dose Cyclophosphamide Associated With Hyponatremia and Hepatotoxicity

DeChiara,

Birch,

Harper

2023

Cureus

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Cyclophosphamide (CY) is an alkylating agent often used as a chemotherapeutic agent, with increasing use as an immunosuppressant. Cyclophosphamide has many established adverse effects, including hyponatremia and limited reports of hepatotoxicity, particularly in high-dose treatment. A case of simultaneous hyponatremia and acute liver injury associated with the initiation of cyclophosphamide two weeks prior is discussed here. A 73-year-old male with acquired hemophilia A/factor VIII deficiency presented to the emergency department (ED) with four days of hip pain and was found to have jaundice and confusion. Laboratory evaluation demonstrated hyponatremia and an acute liver injury associated with his recent cyclophosphamide use. With the discontinuation of the offending agent and sodium correction, he made a full recovery. Cyclophosphamide-induced hyponatremia is likely secondary to the nephrogenic syndrome of inappropriate antidiuresis (NSIAD) and is most often associated with high-dose regimens. While the mechanism of hepatotoxicity requires further study, it is likely dose-dependent and related to excess levels of 4-hydroxycyclophosphamide (HCY). The management of cyclophosphamide-induced water toxicity and hepatotoxicity is centered around the discontinuation of medication, the correction of electrolyte abnormalities, and supportive treatment.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Low-Dose Cyclophosphamide Associated With Hyponatremia and Hepatotoxicity

DeChiara,

Birch,

Harper

2023

Cureus

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“…In addition, while hyponatremia in SLE has frequently been associated with CNS lupus in the forms of SIADH or cerebral salt wasting, 20,[40][41][42] it can also be iatrogenic, occasionally resulting from targeted lupus therapy. 43,44…”

Section: Sle and Hyponatremiamentioning

confidence: 99%

Machine learning: Predicting hospital length of stay in patients admitted for lupus flares

Grovu,

Huo,

Nguyen

et al. 2023

Lupus

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Background Although rare, severe systemic lupus erythematosus (SLE) flares requiring hospitalization account for most of the direct costs of SLE care. New machine learning (ML) methods may optimize lupus care by predicting which patients will have a prolonged hospital length of stay (LOS). Our study uses a machine learning approach to predict the LOS in patients admitted for lupus flares and assesses which features prolong LOS. Methods Our study sampled 5831 patients admitted for lupus flares from the National Inpatient Sample Database 2016–2018 and collected 90 demographics and comorbidity features. Four machine learning (ML) models were built (XGBoost, Linear Support Vector Machines, K Nearest Neighbors, and Logistic Regression) to predict LOS, and their performance was evaluated using multiple metrics, including accuracy, receiver operator area under the curve (ROC-AUC), precision-recall area under the curve (PR- AUC), and F1-score. Using the highest-performing model (XGBoost), we assessed the feature importance of our input features using Shapley value explanations (SHAP) to rank their impact on LOS. Results Our XGB model performed the best with a ROC-AUC of 0.87, PR-AUC of 0.61, an F1 score of 0.56, and an accuracy of 95%. The features with the most significant impact on the model were “the need for a central line,” “acute dialysis,” and “acute renal failure.” Other top features include those related to renal and infectious comorbidities. Conclusion Our results were consistent with the established literature and showed promise in ML over traditional methods of predictive analyses, even with rare rheumatic events such as lupus flare hospitalizations.

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“…Taquicardia Náuseas Prolongación del QTc n (%) 19 (27) 18 ( 26) 5 (7) una paciente con cáncer de mama 14 , no obstante Chen en 2020 15 , encontró una frecuencia de 24,26% de hiponatremia, la mayoría fue leve y ningún paciente con hiponatremia severa.…”

Section: Efectos Adversosunclassified

Adverse effects related to intravenous infusion of cyclophosphamide in patients in a referral hospital

Lugo¹,

Duré²,

Rotela

et al. 2022

Rev. parag. reumatol

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Fecha de envío 24/02/22 Fecha de aprobación 15/05/22 Palabras claves Ciclofosfamida, efectos adversos, efectos colaterales, enfermedades autoinmunes ResumenIntroducción: La ciclofosfamida es un fármaco de la familia de agentes alquilantes utilizada como antineoplásico e inmunodepresor. Es un fármaco muy tóxico y tiene muchos efectos adversos por lo que, dentro de las enfermedades autoinmunes, se reserva a aquellos con afectación severa para inducir la remisión de la enfermedad. Objetivos: Determinar los efectos adversos relacionados a la infusión endovenosa de ciclofosfamida en pacientes del Hospital Nacional, Itauguá, periodo 2020-2021. métodos: Se realizó estudio prospectivo, observacional, descriptivo. Los datos se obtuvieron de una encuesta realizada a los pacientes al momento del reclutamiento y se extrapolaron a una planilla Excel y analizados mediante el programa estadístico EPI INFO 7. Resultados: La muestra estuvo compuesta de 70 pacientes, con edad media de 38±15 años, 44 (63%) fueron mujeres, 51 (73%) recibió como tratamiento inmunosupresor en enfermedades autoinmunes y 19 (27%) como tratamiento antineoplásico. Las comorbilidades detectadas fueron hipertensión arterial en 37 pacientes (47%), diabetes mellitus en 1 paciente (1%) y asma bronquial en 2 pacientes (3%). Presentaron efectos adversos 51 pacientes (73%), se identificaron 82 eventos adversos, los cuales fueron hiponatremia en 25 (36%), taquicardia en 19 (27%), náuseas en 18 (26%), leucopenia en 15 (20%), y prolongación del QTc en 5 (7%). Conclusión: Predominó el sexo femenino con edad media de 38 años. El efecto adverso más frecuente fue hiponatremia, siendo severa en 3 pacientes. Los demás efectos adversos fueron la taquicardia, leucopenia, prolongación del QTc y náuseas.

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Symptomatic hyponatremia induced by low-dose cyclophosphamide in patient with systemic lupus erythematosus

Cited by 12 publications

References 28 publications

Low-Dose Cyclophosphamide Associated With Hyponatremia and Hepatotoxicity

Low-Dose Cyclophosphamide Associated With Hyponatremia and Hepatotoxicity

Machine learning: Predicting hospital length of stay in patients admitted for lupus flares

Adverse effects related to intravenous infusion of cyclophosphamide in patients in a referral hospital

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