Paraneoplastic syndromes such as hyponatremia due to inappropriate secretion of antidiuretic hormone such as seen in small cell lung cancers, prostate, pancreas, and other cancers, or hypercalcemia such as seen in squamous cell carcinomas of the lung, breast, or kidney, will alter nutritional and fluid and electrolyte management. Although mild hyponatremia can be associated with mild symptoms such as nausea and headaches, severe, acute hyponatremia can lead to more severe symptoms, even seizures or coma. Hypercalcemia is most often associated with bone metastasis, but it may be related to a paraneoplastic syndrome and can lead to neuro-muscular symptoms such as weakness and fatigue and gastrointestinal symptoms such as nausea, ileus, and abdominal pain. Severe hypercalcemia can disturb cardiac conductivity. Given the tendency to malnutrition and low serum albumin in cancer patients, serum calcium levels are often best determined by measuring ionized calcium.
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