Hyponatremia is one of the most common electrolyte abnormalities encountered in the cancer patient. The severity of hyponatremia is directly associated with mortality and length of hospital stay. It is often caused by ectopic production of arginine vasopressin (AVP) resulting in the syndrome of inappropriate antidiuretic hormone release; however, in the case of cancer, one needs to also consider the contribution of increasing age, the drugs used to treat co-morbid conditions, the underlying disease states, and hypovolemia as additional risk factors. The approach to hyponatremia in patients with cancer is no different from that utilized in noncancer patients. Successful work-up requires knowing whether hyponatremia is representative of a hypoosmolar state, determining whether the kidney's ability to dilute the urine is intact, and assessing the volume status of the patient. The chronicity of the hyponatremia is an important determinant as to the rate and method of treatment.
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