Abstract
SODIUM retention and fluid accumulation manifested as edema are common in cancer patients.<sup>1</sup>This is usually secondary to pooling of fluids in a third space as occurs in ascites, pleural effusion, dependent edema secondary to obstruction of the inferior vena cava or lymphatics, peritonitis, or ileus. This abnormal accumulation of extracellular fluid is physiologically unavailable and results in a decreased effective circulating blood volume. Hyponatremia is common, but on a "dry weight" basis there is extra body sodium. A state of chronic protein depletion is common in cancer patients because of loss of protein into the malignant effusions and repeated drainage of these protein-rich fluids, loss of protein in diarrhea and external fistulae (especially pancreatic), decreased food intake and malnutrition, and hypercatabolism as a result of sepsis. Hypoalbuminemia with consequent decreased plasma oncotic pressure leads to a decreased plasma volume and facilitates the escape of fluid to these third
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