Hyponatremia and Fever in a Patient on Ipilimumab and Nivolumab (Immune Checkpoint Inhibitors): A Case Report.

Immune checkpoint inhibitors (ICIs) are novel anticancer therapy approved in multiple tumors and their use is rapidly increasing. They are associated with various systemic side effects that are immune-mediated and clinically coined as "immune-related adverse effects" (irAE). Hyponatremia is a possible side effect in patients receiving ICIs. Fever is another side effect that is mostly non-infectious. There are different mechanisms leading to hyponatremia in patients on ICIs, which could be (1) hypovolemic hyponatremia due to hemodynamic disturbance secondary to volume depletion (eg, from irAE like colitis and enteritis) or hypervolemia due to congestive heart failure, cirrhosis, or nephrosis; (2) syndrome of inappropriate antidiuretic hormone (SIADH) secretion (especially from underlying lung cancer or neurological irAE like encephalitis and meningitis) with elevated urine sodium and urine osmolarity; and (3) irAE-related endocrinopathies such as hypophysitis, adrenal insufficiency, and hypothyroidism leading to euvolemic hyponatremia. We describe an interesting case of hyponatremia and fever in a patient receiving Ipilimumab and Nivolumab. The possible etiology of hyponatremia, in this case, was hypovolemia and volume depletion secondary to fever.

Pharmacists and medication reconciliation: a review of recent literature.

Background: Adverse drug event (ADE) errors are common and costly in health care systems across the world. Medication reconciliation is a means to decrease these medication-related injuries and increase quality of care. Research has shown that medication reconciliation accuracy and efficiency improved when pharmacists are directly involved in the process. Objective: We review studies examining how pharmacists impact the medication reconciliation process and we discuss pharmacists' future roles during the medication reconciliation process and then barriers pharmacy staff may face during this critical process. Methods: A comprehensive literature search from MEDLINE and manual searching of bibliographies was performed for the time period January 2012 through November 2018. Conclusion: Although the issue of rising costs and injury due to medication errors in our health care system are not solvable via medication reconciliation alone, it is the first and perhaps most critical piece of the medication management puzzle. As such, numerous organizations have called for pharmacists to expand their roles in the medication reconciliation process due to their expertise in medication management.