P022 - WATER INTOXICATION AND STARVATION-INDUCED SEVERE HYPONATREMIA IN CANCER: A CASE REPORT

P022

WATER INTOXICATION AND STARVATION-INDUCED SEVERE HYPONATREMIA IN CANCER: A CASE REPORT

K. Lee^1,*, K. Hamilton¹

¹Nutrition and Dietetics, Austin Health, Heidelberg, Australia

Rationale: Nutrition is vital in cancer care with rising interest in complementary and alternative medicine. Extreme therapies such as prolonged fasting can cause adverse metabolic effects. The impacts of a 40-day water-only diet on nutritional, functional and cognitive status, electrolytes, disease progression, and interventions to restore nutrition are highlighted.

Methods: A 61-year-old male with T2N3 nasopharyngeal carcinoma presented with severe hyponatremia (99mmol/L) following a 40-day water-only diet to ‘starve’ cancer cells. During a 30-day admission, sodium levels were corrected at 4-6mmol/day to minimise osmotic demyelination syndrome (ODS) and indirect calorimetry was completed. Oral and enteral nutrition was reintroduced per refeeding protocol and increased until nutritional requirements were met. Weight, PG-SGA, handgrip strength (HGS), PET scans and Mini-Mental State Exam (MMSE) were assessed during admission, at one-month [start of chemoimmunotherapy (chemo-IO)] and three-months post discharge (after three cycles of chemo-IO).

Results: On admission the patient was severely malnourished and at high refeeding syndrome risk. Electrolytes stabilised by day 6, 100% of energy and protein requirements were met on day 7 and sodium levels normalised >131mmol/L by day 9. During admission, 6.1kg weight gain and 8.7kg increase in HGS were achieved. Cognitive impairment was noted (MMSE 17/30) but no ODS. PET scan revealed new lung metastases. One-month post discharge nutrition and functional improvements continued and chemo-IO commenced. At three-months post discharge, weight returned to pre-morbid, HGS was above normative value, MMSE improved (30/30), and PET showed complete metabolic response.

Conclusion: This report highlights the flawed theory of ‘starving’ cancer cells and shows the metabolic consequence of severe hyponatremia. Safe reintroduction of nutrition can reverse malnutrition and improve clinical outcomes.

Disclosure of Interest: None declared