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Acute hyponatremia from immune checkpoint inhibitor therapy for non–small cell lung cancer
  1. Sai Prasad Desikan,
  2. Ron Varghese,
  3. Roy Kamoga,
  4. Raman Desikan
  1. Internal Medicine, White River Health System Inc, Batesville, Arkansas, USA
  1. Correspondence to Dr Raman Desikan, Internal Medicine, White River Health System Inc, Batesville, AR 72501, USA; rdesikan{at}

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Case Presentation

A 52-year-old Caucasian woman on pembrolizumab maintenance after induction with chemotherapy (carboplatin, pemetrexed) and pembrolizumab for stage 4 non–small cell lung cancer was admitted with increasing weakness. She had presented to emergency with similar complaints 2 weeks earlier, and she was hydrated with normal saline and sent home on antibiotics for urinary tract infection. She reported worsening weakness, anorexia and weight loss of 12 pounds over 3 months. Her other medical problems include chronic pain and depression. Home medications listed at admission were methocarbamol and lorazepam.

Vital signs at admission revealed a blood pressure of 105/63 mm Hg and a pulse of 73/min, and pulse oximetry showed 98% saturation on room air. Physical evaluation was normal other than cachexia.


Labs revealed low sodium …

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  • Collaborators Eddie Liu, Anktha Antony.

  • Contributors SPD with assistance from RV wrote in first draft. Initial edits were made by RK. Oncological input, final version and submission by RD.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Obtained.

  • Provenance and peer review Not commissioned; internally peer reviewed.

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