Just wondering if anyone has had a problem with extremely low sodium levels?
Around the time of his multiple myeloma diagnosis, my Dad's sodium and potassium levels were below normal range.
He had started cyclophosphamide, Velcade (bortezomib), and dexamethasone (CyBorD) treatment recently. This has been suspended due to a dramatic decrease in his sodium levels. He is currently hospitalised. His hyponatremia is slowly improving.
From what I have read, hyponatremia is not unusual in cancer patients but is not a good prognostic indicator.
We are concerned.
His initial presentation of multiple myeloma was a sudden onset unilateral numb chin. This is not a usual presentation of myeloma, but not unheard of.
This led to his multiple myeloma diagnosis in late July.
He has lambda light chain myeloma.
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Colette - Name: Colette
- Who do you know with myeloma?: Father
- When were you/they diagnosed?: 29/07/2016
- Age at diagnosis: 75
Re: Extremely low sodium levels & CyBorD
Sorry to hear about your father's problems with low sodium levels, Colette.
There are a number of case reports out there which, taken as a whole, suggest that cyclophosphamide – which is part of your father's CyBorD treatment regimen – can cause low sodium levels (hyponatremia). I did a quick Internet search on "cyclophosphamide low sodium", and several reports came up, including:
Baker, M., et al., "Cyclophosphamide-Induced Severe Acute Hyponatremic Encephalopathy in Patients with Breast Cancer: Report of Two Cases," Case Reports in Oncology, July 2014 (full text of article)
A couple cyclophosphamide drug monographs also say that the medication can cause low sodium levels.
But it's not just cyclophosphamide that is the potential source of your father's problems. It could be the Velcade in his treatment regimen. There are several reports of low sodium levels associated with Velcade treatment. See, for example, these articles:
Suyani, E., et al., "Bortezomib-Associated Severe Orthostatic Hypotension and Hyponatremia," Turkish Journal of Hematology, 2012 (full text of article - PDF)
Mineur, P, et al., "Syndrome of inappropriate antidiuretic hormone secretion associated with bortezomib," Belgian Journal of Hematology, Sep 2014 (full text of article - PDF)
Of course, there are other possible causes of low sodium levels. In myeloma patients, an important one to look for would be kidney failure, but I'm sure your father's doctors are monitoring his kidneys very carefully. Other possibilities would include heart issues, cirrhosis, overuse of diuretics – which frequently are used to treat high blood pressure – and consuming too many fluids.
If your father's low sodium levels persist even after stopping his CyBorD treatment, that would suggest the cause is something other than the CyBorD.
Please let us know how things go with your father.
There are a number of case reports out there which, taken as a whole, suggest that cyclophosphamide – which is part of your father's CyBorD treatment regimen – can cause low sodium levels (hyponatremia). I did a quick Internet search on "cyclophosphamide low sodium", and several reports came up, including:
Baker, M., et al., "Cyclophosphamide-Induced Severe Acute Hyponatremic Encephalopathy in Patients with Breast Cancer: Report of Two Cases," Case Reports in Oncology, July 2014 (full text of article)
A couple cyclophosphamide drug monographs also say that the medication can cause low sodium levels.
But it's not just cyclophosphamide that is the potential source of your father's problems. It could be the Velcade in his treatment regimen. There are several reports of low sodium levels associated with Velcade treatment. See, for example, these articles:
Suyani, E., et al., "Bortezomib-Associated Severe Orthostatic Hypotension and Hyponatremia," Turkish Journal of Hematology, 2012 (full text of article - PDF)
Mineur, P, et al., "Syndrome of inappropriate antidiuretic hormone secretion associated with bortezomib," Belgian Journal of Hematology, Sep 2014 (full text of article - PDF)
Of course, there are other possible causes of low sodium levels. In myeloma patients, an important one to look for would be kidney failure, but I'm sure your father's doctors are monitoring his kidneys very carefully. Other possibilities would include heart issues, cirrhosis, overuse of diuretics – which frequently are used to treat high blood pressure – and consuming too many fluids.
If your father's low sodium levels persist even after stopping his CyBorD treatment, that would suggest the cause is something other than the CyBorD.
Please let us know how things go with your father.
Re: Extremely low sodium levels & CyBorD
Colette,
If your dad's sodium levels were below normal at the time of diagnosis, it could be due to pseudohyponatremia, where the paraprotein levels in the blood throw off the sodium test results. I actually suffer from that phenomena. It is easy for a hematologist to verify if that may be the case by running a serum osmolality test, along with some of the other standard myeloma tests.
However, pseudohyponatremia wouldn't explain a big drop in the sodium level while on CyBorD, unless his paraprotein levels had increased while on the treatment.
If your dad's sodium levels were below normal at the time of diagnosis, it could be due to pseudohyponatremia, where the paraprotein levels in the blood throw off the sodium test results. I actually suffer from that phenomena. It is easy for a hematologist to verify if that may be the case by running a serum osmolality test, along with some of the other standard myeloma tests.
However, pseudohyponatremia wouldn't explain a big drop in the sodium level while on CyBorD, unless his paraprotein levels had increased while on the treatment.
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Multibilly - Name: Multibilly
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Smoldering, Nov, 2012
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