Exam 2 Oncologic Emergencies Flashcards
associated malignancies with TLS
- Highest risk: Burkitt’s lymphoma, Lymphoblastic lymphoma, Acute leukemias
- Moderate risk: Low-grade lymphomas, Multiple myeloma, Breast cancer, Small cell lung cancer, Germ cell tumors
- Low risk: Medulloblastoma, Adenocarincomas
presenting lab values associated with TLS
- hyperkalemia
- hyperphosphatemia
- hypocalcemia
- hyperuricemia
clinical presentation of TLS
- hyperkalemia: Muscle cramps, weakness, N/V/D EKG changes, cardiac arrhythmias/arrest
- hyperphosphatemia: Muscle cramps, tetany, seizures, arrhythmias, renal failure
- hypocalcemia: Muscle cramps, tetany, mental status changes (confusion, hallucinations, seizures)
- hyperuricemia: Acute renal failure
prevention of TLS
- aggressive hydration before chemotherapy
- 2000-3000 ml/m2/day x 24-48 hrs prior to therapy
- remove external sources of K and Ph
allopurinol
- max dose: 600-800 mg/day
- prevent hyperuricemia, does not treat it
- levels may not fall for 48-72 hours
- renally adjust
- ADE: rash, urticaria
Rasburicase (Elitek®)
- treatment and prevention of hyperuricemia
- takes 4 hours to normal levels
- take blood samples to see efficacy; blood samples must be on ice
- caution use in pts w/ glucose-6-phosphatase deficiency
- ADE: rash, mild N/V
treatment for hyperkalemia
- Calcium gluconate – stabilize cardiac cells
- Cation exchange resins (sodium polystyrene sulfate;Kayexalate®) – exchange Na+/K+
- NaHCO3, Dextrose 50% + insulin – shift K+ intracellularly
treatment for hyperphosphatemia
- Phosphate binders:
- calcium acetate
- PhosLo
- sevelamer
- Renagel
associated malignancies with hypercalcemia
- Lung cancer (35%)
- Breast cancer (25%)
- Multiple myeloma (7%)
In a normal body, high calcium stimulates the body to release calcitonin to do what?
to decreases kidney Ca reabsorption which results in lower Ca levels
Normal Ca level
8.5-10.5 mg/dL
equation for corrected Ca
Corrected Calcium (mg/dL) = measured calcium + (0.8 x [4-albumin])
When should you use the corrected Ca equation?
for patients with albumin < 4 mg/dL
clinical presentation of hypercalcemia
- Polyuria
- Constipation
- Nausea
- Vomiting
- Stupor
- Seizures
- Coma
- Shortened QT interval
Classification of Hypercalcemia according to corrected calcium
- Mild: <12
- Moderate: 12-13.9
- Severe: >=14
principles of treatment of hypercalcemia
- Rehydration
- Stop bone resorption
- Treat the underlying cause
- Remove external sources of calcium (food, meds)
strategies used against hypercalcemia
- Hydration
- Diuretics
- Bisphosphonates
- Calcitonin
symptomatic mild hypercalcemia
- 1-2 liters over 2hr
- Loop
- possible IV bisphosphonates
bisphosphonates
- takes 4-10 days to work
- last for 4-6 weeks
- ADE: Nephrotoxic, Osteonecrosis of the Jaw, hypocalcemia, arhtralgia, infusion site reactions, fever
moerdate hypercalcemia
- 1-2 liters over 2hr
- Loop
- IV bisphosphonates
- possible calcitonin
calcitonin
- Rapid decline in serum calcium within 4-6 hrs
- possible tachyphylaxis
- ADE: N/V, facial flushing, injection site pain
severe hypercalcemia
- 1-2 liters over 2hr
- Loop
- IV bisphosphonates
- calcitonin
associated malignancies with spinal cord compression
- breast
- lung
- prostate
- lymphoma
- myeloma
clinical presentation of spinal cord compression
- pain
- weakness
- ataxia
- sensory loss
treatment for spinal cord compression
- steroids
- analgeics
