Lung Cancer Patient Presents With Confusion, Lethargy & Excessive Thirst

Ms. PJ was recently diagnosed with small-cell lung cancer. She is fairly young at 52 years of age. She was a smoker for most of her life but quit about 10 years ago. She was subsequently admitted to the hospital for superior vena cava (SVC) syndrome. The cancer was discovered when a large tumor was compressing her right pulmonary artery in the upper lobe as well as her superior vena cava. This caused her much pain and discomfort.

She received her first chemotherapy treatment of Cisplatin and Etoposide during this admission in an effort to reduce the tumor size and lessen the SVC syndrome. Radiation is also planned as part of her treatment.

After receiving her first chemotherapy she developed confusion, became lethargic, and complained of excessive thirst.

Her vital signs are:

• Temperature: 97.7 degrees
• Pulse: 86 bpm
• Respirations: 16 bpm
• Blood pressure: 172/94
• O2 Sat: 92%

Her chemistries are:

• Glucose 89 mg/dL
• BUN 9 mg/dL
• Creatinine 0.41 L mg/dL
• Sodium 116 C mmol/L
• Potassium 3.7 mmol/L
• Chloride 75 L mmol/L
• Carbon Dioxide 28 mmol/L
• Calcium 8.7 mg/dL
• Total Protein 6.4 g/dL
• Albumin 3.0 L g/dL
• AST 40 H Units/L
• ALT 28 Units/L
• Alkaline Phos 87 Units/L
• Bilirubin, Total 1.0 mg/dL

		What is the likely concern for this patient?   Dehydration   Liver toxicity   Syndrome of inappropriate antidiuretic hormone (SIADH)   Pain medication overdose