demeclocycline and Neoplasms

Disorders of sodium [Na+] and water metabolism are commonly encountered in the hospital setting due to the wide range of disease states that can disrupt the balanced control of water and solute intake and output. In particular, the prompt identification and appropriate management of abnormally low serum [Na+] is critical if we are to reduce the increased morbidity and mortality that accompany hyponatremia in hospitalized patients. Use of an algorithm that is based primarily on the symptomatology of hyponatremic patients, rather than the serum [Na+] or the chronicity of the hyponatremia, will help to choose the correct initial therapy in hospitalized hyponatremic patients. However, careful monitoring of serum [Na+] responses is required in all cases to adjust therapy appropriately in response to changing clinical conditions. Although this approach will enable efficacious and safe treatment of hyponatremic patients with syndrome of inappropriate antidiuretic hormone secretion (SIADH) at the present time, evolving knowledge of the consequences of chronic hyponatremia will likely alter treatment indications and guidelines in the future.

Topics: Algorithms; Antidiuretic Hormone Receptor Antagonists; Arginine Vasopressin; Consciousness Disorders; Demeclocycline; Disease Management; Diuresis; Extracellular Fluid; HIV Infections; Humans; Hyponatremia; Iatrogenic Disease; Inappropriate ADH Syndrome; Inpatients; Mineralocorticoids; Natriuresis; Neoplasms; Osmolar Concentration; Pneumonia; Saline Solution, Hypertonic

Topics: Demeclocycline; Humans; Hypothyroidism; Inappropriate ADH Syndrome; Lithium; Neoplasms; Osmolar Concentration; Vasopressins

Seventeen patients with cancer or aplastic anemia received demeclocycline as treatment for hyponatremia. Prior to demeclocycline therapy no patients showed clinical signs of fluid overload or saline depletion. In all patients inappropriately concentrated urine (mean urine osmolality = 548 mOSM/kg H2O) or increased urine content of sodium (mean urine sodium = 91 mEq/L) were documented prior to demeclocycline therapy. No patient had developed hyponatremia in association with antineoplastic drug therapy. The average serum sodium (NaS) at the time of initiation of therapy was 121 mEq/L. NaS increased in all patients despite the simultaneous administration of generous volumes of fluid. NaS exceeded 130 mEq/L and average of 3.5 days following institution of demeclocycline. Patients lost an average of 2.3 kg during demeclocycline. The toxicity noted following demeclocycline was azotemia and increased serum creatinine. Eight patients developed serum urea nitrogen (SUN) in excess of 25 mg/dl; average maximum creatinine in these eight patients was 1.9 mg/dl. Average peak creatinine in eight patients who did not develop azotemia was 0.87 mg/dl. Azotemia seemed to be correlated with simultaneous administration of other nephrotoxic agents and with administration of higher doses (1200 mg/day) of demeclocycline.

Topics: Creatinine; Demeclocycline; Humans; Hyponatremia; Neoplasms; Osmolar Concentration; Uremia; Water Intoxication

Topics: Anti-Bacterial Agents; Demeclocycline; Early Diagnosis; Fluorescence; Gastric Lavage; Humans; Neoplasms; Protein Synthesis Inhibitors; Stomach Neoplasms; Tetracycline

Topics: Demeclocycline; Fluorescence; Humans; Neoplasms; Paraganglioma; Skin Neoplasms

Topics: Anti-Bacterial Agents; Antibiotics, Antitubercular; Chlortetracycline; Demeclocycline; Fluorescence; Fluorometry; Humans; Neoplasms; Stomach Neoplasms

Topics: Anti-Bacterial Agents; Demeclocycline; Humans; Neoplasms

Topics: Anti-Bacterial Agents; Demeclocycline; Fluorescence; Humans; Neoplasms; Protein Synthesis Inhibitors; Stomach Neoplasms; Tetracycline

Topics: Carcinoma; Demeclocycline; Fluorescence; Fluorescent Dyes; Neoplasms; Protein Synthesis Inhibitors; Tetracycline