A fall in the serum sodium to less than 130 mmol/l is associated with weakness, confusion, headache, drowsiness, and seizures. In cancer, the likely reason for hyponatraemia is the ectopic tumour production of antidiuretic hormone (ADH). Small cell lung cancer is the most commonly associated malignancy, but carcinoid tumours, lymphoma, leukaemia, and pancreatic cancers may also be responsible. Cytotoxic drugs used in the treatment of cancer, particularly ifosfamide, vincristine, and high-dose cyclophosphamide, may also stimulate ADH production. Other causes for hyponatraemia include pneumonia and raised intracranial pressure.

Investigation will reveal continued renal excretion of sodium with an inappropriately high urinary sodium concentration, with the urinary osmolality exceeding that of the plasma.

Treatments include a restricted fluid intake of around 500-700 mls per day, demeclocycline (which inhibits the action of ADH on the renal tubule), and, rarely, for severe life-threatening situations, the slow and closely monitored infusion of hypertonic (3%) saline.

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