The full content of Annals is available to subscribers

Subscribe/Learn More  >
Articles |

Water Intoxication in Man After Cyclophosphamide Therapy: Time Course and Relation to Drug Activation

[+] Article, Author, and Disclosure Information

Grant support: U.S. Public Health Service Research Grants CA-6973, CA-06973, and AM-15584.

Presented in part at the Eastern Section Meeting, American Federation for Clinical Research, Boston, Massachusetts, 13 January 1973.

▸Address requests for reprints to Paul J. Davis, M.D., Baltimore City Hospitals, Baltimore, MD 21224.

Baltimore, Maryland

Ann Intern Med. 1973;78(6):861-869. doi:10.7326/0003-4819-78-6-861
Text Size: A A A

Cyclophosphamide therapy in doses greater than 50 mg/kg body weight has resulted in frank impairment of water excretion in 17 of 19 normally hydrated patients with cancer. Clinically, these patients developed hyponatremia, weight gain, and inappropriately concentrated urine during cyclophosphamide infusion, but without cyclophosphamide they excreted water loads normally. The decrease in serum osmolarity (range, 5 to 41 milliosmols/litre) and rise in urine osmolarity (range, 309 to 798 milliosmols/litre) occurred 4 to 12 hours after cyclophosphamide infusion, lasted up to 20 hours, and was related temporally with the urinary excretion of active alkylating metabolite(s) of the drug. Treatment of four cancer patients with cytosine arabinoside failed to provoke water intoxication. The mechanism of cyclophosphamide-induced impairment of water excretion is unclear. Tumor release of antidiuretic hormone after cyclophosphamide administration seems unlikely since the study group included patients with leukemia and aplastic anemia without tumor. The likelihood and self-limited time course of impaired water excretion during high-dose cyclophosphamide treatment should be recognized because such patients are invariably waterloaded to prevent uric acid lithiasis and drug-related cystitis.





Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).


Submit a Comment/Letter
Submit a Comment/Letter

Summary for Patients

Clinical Slide Sets

Terms of Use

The In the Clinic® slide sets are owned and copyrighted by the American College of Physicians (ACP). All text, graphics, trademarks, and other intellectual property incorporated into the slide sets remain the sole and exclusive property of the ACP. The slide sets may be used only by the person who downloads or purchases them and only for the purpose of presenting them during not-for-profit educational activities. Users may incorporate the entire slide set or selected individual slides into their own teaching presentations but may not alter the content of the slides in any way or remove the ACP copyright notice. Users may make print copies for use as hand-outs for the audience the user is personally addressing but may not otherwise reproduce or distribute the slides by any means or media, including but not limited to sending them as e-mail attachments, posting them on Internet or Intranet sites, publishing them in meeting proceedings, or making them available for sale or distribution in any unauthorized form, without the express written permission of the ACP. Unauthorized use of the In the Clinic slide sets will constitute copyright infringement.


Buy Now for $42.00

to gain full access to the content and tools.

Want to Subscribe?

Learn more about subscription options

Related Articles
Topic Collections
PubMed Articles
Forgot your password?
Enter your username and email address. We'll send you a reminder to the email address on record.