Cyclophosphamide-Induced Hyponatremia in a Patient With Diabetes Insipidus
Bibliographic record
Abstract
Cyclophosphamide has been previously observed to induce hyponatremia. The mechanism remains unclear. Cyclophosphamide may produce a syndrome of inappropriate anti-diuretic hormone-like phenomenon through impairment of the kidney’s ability to dilute urine. Whether cyclophosphamide or its metabolites have a direct effect on the kidney, a vasopressin-like effect on the kidney, or cause vasopressin release is unknown. A 29-year-old man with intracranial germinoma diagnosed at age 11 treated primarily with chemo-radiation developed a recurrence 17 years later and was noted to have panhypopituitarism with resultant central diabetes insipidus. He was admitted for chemotherapy with cisplatin, cyclophosphamide and mesna. His admission serum sodium was normal, but he became hyponatremic while undergoing chemotherapy with cyclophosphamide and mesna in conjunction with the initiation of intravenous hydration with 5% dextrose/0.45% normal saline despite withholding two doses of desmopressin (DDAVP). The sodium eventually normalized after administration of 20 mg intravenous furosemide. A similar episode occurred several weeks later, while again receiving cisplatin, cyclophosphamide and mesna chemotherapy. He again became hyponatremic despite receiving isotonic saline fluids and withholding DDAVP during cyclophosphamide treatment. Serum sodium did not improve with three doses of 10 mg intravenous furosemide but improved instead with sodium chloride tablets. The mechanism of cyclophosphamide-induced hyponatremia remains unknown. Given that this patient’s central diabetes insipidus prevents him from secreting increased amounts of anti-diuretic hormone, hyponatremia is likely induced by a direct nephrogenic effect of cyclophosphamide or its metabolites. J Endocrinol Metab. 2015;5(6):337-339 doi: http://dx.doi.org/10.14740/jem319w
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".